Re: [Gnumed-devel] clin.operation

[Karsten Hilbert]

> An operation could be a
> 
>       health issue past history item
> 
> or it could be mentioned in a progress note soap row (perhaps a "P"  
> as treatment) inside an episode that gets attributed to the health  
> issue attempting to be remedied.

Yes, this is the concept of the scope of "operation" in the original 
Richard-design
sense: A somewhat enriched flag.

However, the description

 >> A first thought that occurs to me that you may be solving one  
 >> specific instance of a general
 >> "report on a therapeutic procedure" use case (which is fine). IOW,  
 >> perhaps your code and/or
 >> tables may need some generalization as to supporting "something"  
 >> being done to "someone"
 >> by "a few actors" with the help of "a few things".

as well as what I think Jerzy is working towards is a more general concept
of capturing operations as such - which would be clin_root_item children in 
their
own right (quite similar to allergy or family hx) and become attached to the
episode for the health issue they pertain to...

Ah, maybe this is then how to best understand the difference:

Jerzy's operation always requires an episode because he's treating an episode
of (possibly) a health issue by means of an opertion.

OTOH, Richard's has_operation flag is just a marker on a health issue and thus
NOT requiring an episode because it simply records a fact on the issue:

   issue: appendizitis with was_operated = True

Mind you, I am not entirely convinced of the sufficiency of Richard's approach
but at least it'd make things computable as opposed to

   issue: "post-appendectomy state"

The implementation of Jerzy's operation concept does allow for several
operations per episode.

My question is then if his concept of "operation" should eventually be
generalized to "procedure" with the attributes mentioned above.

> One example might be urinary incontinence, which can receive multiple  
> procedures. Another could be inflammatory bowel disease or other  
> condition which gets many diagnostic or therapeutic endoscopies.
Exactly.

> ... leading me to think that the procedures should most often not be  
> issues of themselves,
Yes, I would rather attach them to issues on behalf of which they were carried 
out.

> maybe only complications or status post, such as
> 
>       s/p amputation R below-knee --- in a patient with vascular disease  
> who failed multiple revascularization procedures or
> 
>       post-splenectomy state --- after trauma (motor vehicle accident)  
> which required multiple procedures for the abdominal bleeding, limb  
> fracture, skull fracture / concussion

Correct. The fact of having had a procedure done may inform the clinician
to choose a particularly informative issue description.

> I am imagining that any documents which were imported would get  
> attached to a row in a progress note... or is that wrong, meaning can  
> documents get attached just to health issue foundational items?

Neither. They get attached to a) encounters and b) episodes.

Karsten
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