Re: [Gnumed-devel] EMR tree display of allergy

[James Busser]

> On 23-Sep-08, at 10:26 AM, James Busser wrote:
>
> > I am having a bit of a hard time to see the flow with proposed states

As I think about it, the worry about being sued should only be if it  
can be successfully argued that you did not seem to (adequately) ask.

Provided we can say that we asked then, sure, it is possible that we  
got less than a fully satisfactory answer. However it would seem we  
should always in this case make a text entry like "apparently some  
but cannot recall" or "rash in hospital - details awaited" or "would  
not say". We could even (and may as well) add into the fray one  
additional corner case: imagine a patient who, despite lacking known  
allergies, knows this is no protection against an adverse event,  
therefore refuses to commit "no allergies" because, after all, how  
could he know until after he had been prescribed the drug? Therefore,  
in his mind, this could be protecting himself from having signed away  
any of his rights if something later happened.

Regardless, a state which is "asked, not none" would seem to cover  
all the other states, the other states including

- definite and possible allergies
- recording a comment to the effect that details cannot be  
specifically remembered
- recording a comment to the effect that the patient refused to  
commit details (or a lack of allergy)

Since all of the aforementioned justify a requirement for text entry  
if they are to be captured, their entry would decide that the allergy  
state must have been asked and cannot be none. The allergy manager  
would only need the capacity to accept text (or substance database  
list) entries, and if there was nothing to enter, the user could  
simply click a single button "Asked, None". If for any reason there  
was discomfort around the "None", the user could input something into  
the allergy manager. The state of allergy could then be computed.

I am having a hard time seeing the operational implications of  
supporting any values other than "asked, none" or "asked, something- 
as-can-be-seen-from-detail" on the user. If it is intended that there  
be some means to prompt the user to address it next time (maybe you  
are awaiting details to come from collateral, or maybe you are hoping  
to have more of the patient's trust at the next visit) then I could  
see some value to "!?" as a prompt. Is that the intended use?