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

From: Eric MAEKER
Subject: Re: [Gnumed-devel] Re: Kirk's penicillin allergy
Date: Mon, 12 Jul 2010 23:51:51 +0200

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

That is really interesting. FreeDiams already computes drug and molecules allergies. It is planned that FreeDiams will also computes incompatibilities between "patient physiology" and drugs. For this second "computation" FreeDiams needs datas... That I didn't find over the web... So we have to create them. That the objective of the "protocoles" when prescribing.


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