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Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES
From: |
Karsten Hilbert |
Subject: |
Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES) |
Date: |
Sun, 24 Aug 2008 12:20:02 +0200 |
User-agent: |
Mutt/1.5.18 (2008-05-17) |
On Sat, Aug 23, 2008 at 08:31:33PM -0700, Jim Busser wrote:
> 1. --- If the special "placeholder" health issue that is Unattributed
> will permit >1 episode to keep the status "open" (Karsten?) --- then
> each attribute of interest (smoker, problem drinker of alcohol,
> unhealthy diet, family history of each of breast cancer, colon cancer,
> premature cardiac disease) could be nicely listed within this branch of
> the EMR tree. In order to keep the components clustered together, users
> could prepend a space or a hyphen or other character, and could use an
> additional naming convention to include "habit:" or "fam hx:" within the
> episode name:
>
> EMR of patient ...
> Unattributed episodes
> fam hx: breast ca
> fam hx: colon ca
> fam hx: premature coronary disease
> habit: problem drinking
> habit: smoking
> encounter 1
> encounter 2
> habit: unhealthy diet
Very sane advice.
> A further advantage is among Unattributed episodes is that upon their
> closure (say, a patient has quit smoking for sufficiently long to be
> convincing) it would automatically disappear from the problem list.
Correct. But beware, the tree is not the problem list. There
is a TODO item to make the tree optionally behave like a
problem list but currently it displays all issues and
episodes. It informs of the entirety of the EMR.
> Until such a time, it would remain visible it the problem list except at
> times that the tree was fully closed. An additional advantage to
> managing such _potential_ issues is that they could be associated /
> attributed at a later time.
This is how it is intended to work :-)
> For example if a patient should later prove
> to have developed breast cancer it could be chosen to attribute the
> family history under the health issue of breast cancer. I know... the
> issue of breast cancer did not cause the family history...
The association isn't strictly documenting causation, just
"relation" between things of lower and higher order.
> If a patient had quit smoking and the clinician closed the Unattributed
> episode "smoking", does the schema prevent the episode being re-opened if
> it should later prove that the patient is again smoking?
It can surely be re-opened. There can even be a second
episode of the same name. For attributed episodes only one
can be open while for unattributed even two of the same name
can be open -- I guess this should be fixed.
> 2. (alternative approach) make each one its own health issue.
>
> issue "smoking"
> issue "alcohol intake"
> issue "exercise"
> issue "diet"
>
> or
> issue "habit: smoking"
> issue "habit: alcohol intake"
> issue "habit: exercise"
> issue "habit: diet"
>
> issue "fam hx: breast cancer"
>
> I suppose the decision could be whether or not the smoking / alcohol /
> diet have contributed to clinical problems in which case the importance
> of attacking the risks becomes more, and maybe at that point they warrant
> to be issues of their own right.
Personally, I would create health issues "habits" and "fam
hx" and create appropriate episodes thereunder:
issue "habits"
episode "smoking"
episode "exercise"
issue "fam hx"
episode "breast cancer"
Episodes already attributed to one of the issues "habits" or
"fam hx" can later be re-attributed to other issues as
needed.
Karsten
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- [Gnumed-devel] NEW TOPIC - FEATURES, Rogerio Luz, 2008/08/11
- Re: [Gnumed-devel] NEW TOPIC - FEATURES, Jerzy Luszawski, 2008/08/11
- Re: [Gnumed-devel] NEW TOPIC - FEATURES, Karsten Hilbert, 2008/08/12
- Re: [Gnumed-devel] NEW TOPIC - FEATURES, Rogerio Luz, 2008/08/12
- Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES), Karsten Hilbert, 2008/08/17
- Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES), Rogerio Luz, 2008/08/17
- Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES), James Busser, 2008/08/23
- Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES), Karsten Hilbert, 2008/08/24
- Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES),
Karsten Hilbert <=
- Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES), James Busser, 2008/08/24
- Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES), Karsten Hilbert, 2008/08/24