Re: [Gnumed-devel] Medication lists - Corrections vs Changes

[Busser, Jim]

On 2013-07-11, at 10:38 AM, Jim Busser <address@hidden> wrote in part:

> truly, if GNUmed is to be an EMR, it has to keep available in the *clinical* 
> tables (and not in the audit tables) the clinically-useful records of what 
> has happened to the patient. Therefore we really must evolve
> 
>       Current substance intake
> 
> into
> 
>       Substance intake history
> 
> wherein, at any one time, some substances may be active and others inactive.
> 
> I am not here talking about a "Prescription writer".

I think this thread did not yet get commented on. The full posting is archived 
at http://lists.gnu.org/archive/html/gnumed-devel/2013-07/msg00099.html but the 
point and question remains

… why can't we remove the constraint which prevents for a single patient to 
have, in clin.substance_intake, more than one row with the same clin.substance, 
thereby allowing both:

1) to support the reality where the patient is taking two or more forms of a 
substance at the same time and

2) to support to be able to keep, in the medications table, previous dosages of 
a substance which are currently 'inactive' ?



Yes, I know that if more than one row of a substance has the status of being 
'active' at the same time, then this offers some risk.

However the following are all clinical realities, where a patient takes

- a particular strength in a blister pack, and that same strength 'on the side' 
from a bottle
        (I confess not the best example, but read on …)

- and / or the same strength, in two forms

        1) a strength of an ace inhibitor that is combined with a diuretic

            (combined, when the diuretic is already a max dose, with)

        2) a dosage increment using the same strength of ace inhibitor 
mono-substance tablet
        
- and / or two different strengths (say, warfarin 5 mg and 2 mg tablets)


BTW  am I somehow escaping what was preferred to be a constraint, because I am 
able to put a patient on

        hydrochlorothiazide 25 mg daily (as unbranded substance)
+
        hydrochlorothiazide 25 mg daily (as part of a combination branded drug)

?


--> The latter means that even while we work out acceptable constraints, we do 
-- even *now* already -- need an additional medication display sort order, 
which should IMO by default be

        Substance   Strength   Schedule   Started   Duration/Until   Brand   
Health issue (or episode)  OK?

-- Jim