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Re: [Gnumed-devel] Re: Kirk's penicillin allergy

From: Rogerio Luz Coelho
Subject: Re: [Gnumed-devel] Re: Kirk's penicillin allergy
Date: Sun, 11 Jul 2010 20:13:00 -0300

2010/7/11 Jim Busser <address@hidden>
On 2010-07-11, at 2:50 PM, Rogerio Luz Coelho wrote:

> I agree Jim, but this should not be the priority, priority should be to make FD a frasewheel to populate GNUmed´s medication list ... after this I assume it is all downhill

You are maybe thinking

       EMR user sets focus into medication field
       get ready to supply a GNUmed phrasewheel
               establish connection to FD
               pull down all of the FD "drug selector" values

but this is IMO not so easy because even if such functions (now missing) were added to FD, I am not sure it would work... in GNUmed you would still need to decide

       is what I am typing "brand (commercial)" or molecule?
       does this phrasewheel combine
               brand +- strength +- form +- route ?
       or, if these are done individually, does that then mean
               --> multiple "calls" back and forth?

How does it presently work for the German db?

As far as competing priorities, I agree that "intelligent" allergy handling is a future-item in terms of *implementation* but IMO may be good to think about it already. My big-picture question when discussing medical "intelligence" is how much to build into the EMR and how much to outsource to clinical decision support (CDS)?

When a patient reports an allergic reaction, the EMR may do as little as report the exact substance that was taken. How widely applicable to other substances becomes a matter of clinical judgement and expertise.

It would be nice for an EMR to support ~ "one optional level of extra clinical intelligence" while still letting outside resources help when a user may be unaware or incorrectly recall or judge a situation. So in the example of the penicillin allergy it may be good that

- an EMR, at the patient level, allows a judgement to extend an allergy more broadly (without a subsystem of expert knowledge inside GNUmed because this would be heavy lifting)
- the interoperating system (FreeDIams), when fed "dumb" allergy information, could still prompt the user... maybe FD can eventually support computational + table based prompts for drug-allergy and drug-disease interactions, or maybe this would be maintained in some separate open source expert system that both GNUmed and FreeDiams can access

Agreed ... the allergy of drug CLASSES is a very good aplication of computer/emr power, but how to get it in there without at least some kind of frasewheel interaction ?

Seems complex to expect for clinicians to find the correct drug ID ... at least in my part of the world these ID´s are far from widely known.


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