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

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] clinician input wanted: how to implement "coding"
Date: Thu, 3 Dec 2009 23:00:06 +0100
User-agent: Mutt/1.5.20 (2009-06-14)

On Wed, Dec 02, 2009 at 12:40:43AM -0800, Jim Busser wrote:

> >> We only presently use ICD9 for billing. In the billing program that
> >> I wrote,
> you mean re the ICD9? I know... way old...
> re the billing program I wrote? That was in 1990 using a dBASE competitor 
> (FoxBASE, since bought out by M$ as FoxPro).

But then you do have some technical understanding of coding!
That explains a few things.

> As to the main question on coding in the GUI, a few initial thoughts:
> - EMR tree and Notes (left pane "problem list") remain the key places to 
> access diagnoses
> - are we potentially coding other things such as medications?

We are already: test types can be/are coded as LOINC,
substances can be/are coded as ATC.

> - the detail of coding risks to greatly clutter up the GUI
> especially in any summary views,

Well, no, only if they are displayed - and I believe there
needs to be VERY good reason to display codes at all (except
when explicitely asking for them or in secondary "detail"
views"). One reason I deem good enough to actually display a
code for informational purposes (but I fully expect to be
proven wrong) is with ATC codes in the substances and drug

Typically, the codes in themselves don't carry much meaning
helpful to humans. They often help in correlating other
information. They better be accessible, however, when such
correlation occurs to understand the reasoning of the

> - I imagine the detail of the coding would be inputted via
> detail editor on the health issue or unattributed episode (I
> suppose it could even be an attributed episode within a
> health issue).

I do think there should be a dedicated widget for coding but
making that directly accessible from issue/episode/RFE+AOE
(ICPC) details editor makes a lot of sense.

> - we contemplated more than one kind of code per item, for
> example a single item might have associated with it both an
> ICD10 and a SNOMED or READ code

That's a must in any case.

I am still looking for more use cases defining genuine
*medical* desires.

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