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Re: [Gnumed-devel] Overlapping encounters?

From: Busser, Jim
Subject: Re: [Gnumed-devel] Overlapping encounters?
Date: Sun, 20 Nov 2011 09:26:22 +0000

On 2011-11-19, at 3:40 PM, Karsten Hilbert wrote:

> Technically it is possible.
> The question being why one would want that.

Because it can be too easy to misunderstand what actually happened with a 
patient's care, when something appeared (on surface) to be a part of a visit, 
but was not.

We understand the concept of encountlets being the components of encounter but 
that is only meaningful when we are talking components of an interaction with a 
*patient*. For example, within a physical visit (whether in praxis or at a home 
visit or even by phone) more than one distinct clinical issue can be managed 
and thus the origin and meaning of encountlet.

If GNUmed's encounters are to be technical segmentations of (invariantly) 
consecutive interactions with the backend, we confuse things by labelling each 
encounter with a "type" when the type is not an accurate depiction of what is 

Say that, while away from a computer (in the car) from 0820 to 0830, I handle a 
clinical phone call that needed to be documented. Once I reach the praxis and 
log on and create a new encounter of type

        phone w/patient

I will input start times and end times of 0820 and 0830 (despite that in "real 
time" it is happening between 0902 and 0905h). This is clinically natural and 
will cause GNUmed clinicians to believe entries are about what was learned / 
communicated during interactions with the patient (or interactions with other 
caregivers) and not about interactions with the backend.

Just because a lab result was auto-imported at 0904 (or even later within the 
configured auto-expire setting) does not mean it formed any part of the 
interaction with the patient and a clearer example of puzzlement is when there 
had been an in-praxis visit between 1300 and 1400 and an abnormal lab from 1310 
is auto-entered as being part of the in praxis encounter when not only did the 
clinician not deal with it, the clinician may not even realize it was available?

Similarly if a nurse is providing pregnancy or post-natal or diabetes education 
from 1400-1430

        in praxis

while I am busy contacting the patient's psychiatrist to sort out a care plan 
for a concurrent psychiatric problem, do I really want to be unable to create 
an encounter

        phone w/provider 1415-1425

just because the nurse is seeing the patient such that my encounter should go 
hidden inside the nurse's

        in praxis 1400 - 1430

even though I did not see the patient? These are the reasons why when user A 
has created an encounter, when user B loads this patient User B should be able 

1) see (courtesy of the upcoming encounter info in the top ribbon) that an 
encounter is open
2) have the possibility of creating a new encounter of a different type
3) but the fact of User B creating a new encounter should not impede user A to 
continue the first encounter and close it when clinically meaningful
4) likewise a lab result should be able to be written as an
        'imported data' encounter
        even while a patient is in the praxis

-- Jim
-- Jim

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