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Re: [Gnumed-devel] Synopsis (AOE?) attaches to the prior encounter?

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] Synopsis (AOE?) attaches to the prior encounter?
Date: Thu, 6 Dec 2012 12:44:44 +0100
User-agent: Mutt/1.5.21 (2010-09-15)

On Sun, Dec 02, 2012 at 07:31:03PM +0000, Jim Busser wrote:

> > Would that mean you would want the _entire_ episode journal
> > entry to float towards .modified_when ?
> I think so.

This would mean that the episode entry would NOT show up
when it was created - in other words, information on the
state of thought on the patient's health is yet again not
rendered the way it was known-at-the-time.

All this shows is that a chronologically sequencing view is
simply not able to display the whole truth of the EMR.

One solution would be to include in a chronologically
sequencing view _all modifications_ of any data within the
record at the time they were made -- which, again, leads us
to a forensically complete display, not really fit for
clinical consumption (due to possibly massive redundancy).

I do agree with your sentiment of providing correct and
aduquate information to the user.

While I don't feel inclined to spend much time on improving
the wrong tool (chronological journal) one compromise might
be to list episodes (and issues, and encounter, and ... !?!)
twice: once at their encounter of creation showing their
then-state of affairs from the audit log and once at the
time of their latest modification.

This will, however, still bear the chance to make the
clinician wonder why something was done or not done:

2.1.2010        episode: suspicion of SARS (cluster of signs)                   
        3.1.2010        episode: seasonal flu (syndromic diagnosis)             
                (not shown)
6.1.2010        episode: SARS (proven diagnosis)                                
                (last mod)
6.1.2010        admit to ICU

The user will only see the first and last episode mods and
wonder why we've waited 4 days.

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