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

[Karsten Hilbert]

I understand the clinical side of things.

I am talking about technical implications which need to be thought through
(and handled) before "just removing a constraint".

Karsten

> Gesendet: Dienstag, 23. Juli 2013 um 17:38 Uhr
> Von: "Busser, Jim" <address@hidden>
> An: "address@hidden list" <address@hidden>
> Betreff: Re: [Gnumed-devel] Medication lists - Corrections vs Changes
>
> On 2013-07-23, at 12:14 AM, Karsten Hilbert <address@hidden> wrote:
>
> > On Mon, Jul 22, 2013 at 09:44:46PM +0000, Jim Busser wrote:
> >
> >> … 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,
> >
> > Because it requires thinking through, and handling, the
> > consequences.
>
> First of all, we should agree that among the substances that are inactive, 
> there should be no reason why we cannot allow duplicates of the same 
> substance, to reflect
>
> 1) different dates started and discontinued
> 2) optionally, differences in the schedule or instructions
>
> I would argue a difference between
>
> - editing something to "make it right" (with the prior version going into the 
> audit table)
>
> and
>
> - capturing, in the record information that -- for any period of time -- 
> represents a new, or different state
>
> and where the second purpose is what provides value to any *clinical* history 
> in the record. Not the audit tables.
>
> If this is disagreed with, then GNUmed should not bother with progress 
> note*s* and should instead support a maximum of only one progress not*e* per 
> patient, editing of which should always cause the *only* copy of the original 
> to be relocated to the audit tables.
>
> Presently, I can input three times that a patient has diabetes, with variant 
> spellings so they won't even be able to be sorted together.
>
> What exactly is the concern?
>
> With medications, duplicates among the inactive are not even visible, unless 
> one chooses to see them.
>
> If the argument is to be that some clinician might "mistakenly prescribe" 
> from among the inactive substances, then they can as easily mistakenly 
> prescribe from among unique-but-inactive substances.
>
> In fact the latter is an even bigger risk for non-duplicated substances, 
> because at least any duplication in any prescription between an inactive and 
> active substance would draw attention to the duplication.
>
> -- Jim
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