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Re: [Gnumed-devel] Medication viewing

From: Jim Busser
Subject: Re: [Gnumed-devel] Medication viewing
Date: Fri, 23 Oct 2009 09:57:43 -0700

On 2009-10-23, at 4:07 AM, Karsten Hilbert wrote:

The universe of what is relevant for a patient could include

a. what they had *ever* taken

There's a full audit trail which carries this information.

Once a row has been created in the medication listing, it can display the {drug, dosage, schedule} as it was last known to be taken by the patient. However the simple existence of an item

        acetylsalicylic acid 81mg daily

created three years ago and which needs no prescription does not mean the patient continues to take it. Maybe nine months ago their surgeon directed it to be stopped a week before surgery and no-one ever made clear that it was supposed to be restarted. This is an inverse of the allergy situation where just because "No allergies" was true when asked 5 years ago it is worth verifying from time to time (if not every visit) and maybe capturing this verification. Can I attract us to a medication column

last_confirmed (date, maybe NULL is ok in a case where the information was pre-entered from documentation and it turns out the patient says "no, that's wrong")


The end result is a set of rows that always contains the last-altered version. At discontinuation, the row could be updated to reflect when a patient last used it, as well as the reason for discontinuation which could be any combination of not needed, not tolerated or not effective. But unless a row can be deleted: - the rows will always represent a mix of current and no-longer used medications (i.e. not just current medications) - the rows will not offer a complete history (as some alterations would be in the audit file).

So.. the "current medications" might more correctly be seen as a partial index of drugs that the patient did, at some point, take and *may* currently be taking. For drugs that are no longer being taken, we could see the most-recent regimen as last-used. But a key dependency as to whether it is a complete index is whether, upon changing the strength of a drug (or changing brands), the doctor discontinued an existing row and added another or just made the alteration inside the row. That affects whether it is an inventory of *medications* that the patient has used, or medication *regimens* that the patient has used. I imagine that for this table we are preferring medications, but a regimen that mixes different strengths maybe has to be handled in two rows. Failure to do so might greatly complicate later efforts to administer the supply (prescribing).

At the point where in future we will want to view the total history of any drug, will it be no trouble to query-combine information from the current medication table with information taken from an audit table (I am supposing the audit table constraints would protect against inappropriate alteration)?

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