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Re: [Gnumed-devel] clinician input wanted: how to implement "coding"

From: Rogerio Luz Coelho
Subject: Re: [Gnumed-devel] clinician input wanted: how to implement "coding"
Date: Tue, 1 Dec 2009 21:05:44 -0200

Well I can see your point now ...

I guess I think of coding (and this reffers to ICD only) as a sorting pattern, it is easier to see what people with different views put on a ICD field of a patient.

Sometimes you see that the patient has come for emergency treatment with very different diagnosis, but when look at as a hole the people who saw him seem to put similar ICD's (J209 - J069 - J459 - J441) and after just a glance you see that this patient has some (albeit maybe not yet diagnosed) Pulmonary ilness.

Nevertheless I HATE EMR's that MAKE you put a ICD, so you half the time are seeing patients and making ICD of (Z000 - medical exam , Z001 - normal child consult , Z029 - administrative consult ... etc) so I suppose the ICD should NOT be mandatory, but should be left to the IT personel to set this option if the law or the billing makes this mandatory .

ICD's could go in the Summary field or something similar, while you type the Diagnosis the client **could** search a DB for some entry related to that as a drop-down menu. And if it doesn't find anything it saves as a simple string , if we do select something it could present itself as:
ICD = R520 Signs and Symptoms / Pain / Acute Pain
(sorry haven't got the translation here with me so it might not be just this way)

Maybe a new field called ... ICD ?? (and of course we could make this depend on the backend DB installed, as ICD 10, ICD 9 etc...)


2009/12/1 Karsten Hilbert <address@hidden>
On Thu, Nov 19, 2009 at 11:11:42PM -0800, Jim Busser wrote:

> We only presently use ICD9 for billing. In the billing program that
> I wrote,

Say what ?  :-)

> >How would you *like* to use coding ?
> >Do you see any application of coding ?
> >If so, how would you like GNUmed to support that ?
> I assume the above are closely related :-)
> What quickly comes to mind...
> - per patient, a coding system that had a nice population of
> language translations could be invaluable, judging from the (at
> best) limited translations we achieve when a visiting patient brings
> a foreign, text-based document with them. Typically we have no local
> access to someone who is both clinically familiar with what might be
> the patient's true issue AND confidently able to determine what was
> meant by the foreign clinician
> - per patient, the above even applies to native speakers within the
> same language, whose meaning of text-based notes can still be hard
> to interpret
> - per patient, a coding system could offer a semi-automated index of
> within-praxis diagnostic certainty (or at least of precision),
> depending on the precision that the coding clinician chose to apply,
> for example with ICD9 three or four or five character
> - assisting an organ-based or system-based auto-tree within a
> patient's health issues list
> - reducing small keyboard errors (mistyping words) albeit at the
> risk of substituting an item that wildly alters the clinical
> meaning, based on mistyping a code character. The UI in this context
> would take on critical importance!
> - across-patient searches and groupings of somewhat-similar conditions
> - defining potentially-useful language-independent queries that
> could be shared among GNUmed users internationally
> - linking to internal or external clinical guideline engines that
> will surely depend on coding systems
> - transcoding between coding systems, if that proved safely possible

Those are good reasons to want coding for our own benefit.

Now, *how* do we want it to happen in the UI ?

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