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RFE and AOE was Re: [Gnumed-devel] Translation help

From: Jim Busser
Subject: RFE and AOE was Re: [Gnumed-devel] Translation help
Date: Thu, 28 Jan 2010 13:00:52 -0800

On 2010-01-28, at 11:28 AM, Rogerio Luz Coelho wrote:

> I wonder if anyone would mind to give me a real life example of RFE and AOE

No doubt the hardest two concepts on which to achieve the same understanding.

Think of RFE and AOE as potential "meta" fields, each of which extends across 
the multiple problems that might be dealt with inside any one visit. While they 
could be used however local practice might best decide, what I believe to be 
the concept was and remains:

RFE ("Reason for Encounter) starts as either or both of

- the patient's *stated* agenda and/or
- what that the clinician wants to evaluate or do

but the content of this RFE field can then be edited, even while the visit 
continues, to allow the doctor to make themselves a reminder of what needs 
attention (or action) before closing the encounter / visit.

So for example...

> # patient comes in, tells the secretary he has an appointment with Dr. Spok 
> for his back pain (RFE = back pain appointment) 
> - Dr Spok starts a new episode: Back Pain / wich starts a new encounter

RFE may start "back pain" and if prior to the end of the visit the patient asks 
"oh I also wanted a refill of my Blood Pressure medications" you can revise

        RFE = back pain; BP meds

and then if you then realize there were unreviewed labs and on review find a 
low hemoglobin you may do

        RFE = back pain; BP meds; (anaemia)

where my use of ( ) is no hard-and-fast rule but rather notional on my part, to 
capture that it was in this example unplanned to be taken care of.

The nice thing about the implementation of the RFE is that it remains available 
above the set of notelets so that no matter which of multiple problem notelet 
editors that you may have open, it remains easy to see whether you have fully 
attended to your "visit" (encounter) "agenda" 


Accordingly, if the above is a shared view, we can understand RFE to serve as a 
text enumeration of the one-to-multiple reasons, planned or unplanned, for this 
encounter to "happen"

> # Dr. Spok goes and does a Vulcanian-Karate-Chop (TM) on his spine and sends 
> him home pain free and with orientation to come back next week (AOE = return 
> in 7d for reavaluation of back pain)

I would have to check but in a one-problem visit, where your Assessment (soAp 
row) might be

        Back pain ?mechanical

then I think you can choose to leave the AOE blank in cases where to write a 
"synthesis" is extra work with no value. If this is correct (that the AOE can 
left blank), then the tree display will (in absence of an AOE) display the 
content of an "A" row.

If memory serves, the AOE "auto-offers" a concatenation of notelet soAp 
string(s) which can be user-edited an over-ridden. The user can put in an 
improved, concise summary assessment, whether it would be some shorthand 
listing of multiple working diagnoses or whether it would be an over-arching 
integrative whole-patient assessment "meta thought" like:  "multisystem illess 
vs stress?" or "deteriorating, could need nursing home"

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