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

[Busser, Jim]

On 2012-11-30, at 2:39 PM, Karsten Hilbert <address@hidden> wrote:

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

I think so.

I think both "views" (sequences of information) are important.

if you are trying to look over (review) the record and understand each clinical 
problem episode within a frame of biological sense, then

(1) no matter how late we would create or modify a record, when we are talking 
about a patient's condition as it existed any time earlier than "now", when 
anyone in the praxis would

        - "add" soap rows, or
        - "add" a document, or
        - make corrections to a previous entry, whether it is to
                add or correct the spelling of words, or
                fix clinical inaccuracy i.e. right vs left

then it is valuable and necessary to be able to brain-parse in a way to 
maximally understand the *condition* and that is what the within-EMR-tree notes 
(organized by clin_when) achieves.

(2) there is however equally a value and a need to understand the *care* where 
*not* only the medico-legal justifiability, but even the *clinical sense* of 
what was done or not done, needs to be understood on the basis of what was able 
to be known *at the time* that the assessment or plans were rendered.

Visualizing the record in a frame that has in the meantime recorded changes 
*after-the-fact* can make clinicians look like idiots and (even outside a 
medico-legal context) would cause a reviewing clinician, who is filling in for 
the usual clinician,  difficulty to understand why the things that were done 
(or not done) happened. The reviewing clinician will easily think "this does 
not make sense" and despite that I acknowledge the datestamp is shown in parens 
() at the end of the strings, it is not a very good way for the brain to 
reassemble the information.

This is not good for care. That is why even if we pretended medico-legal was 
extraneous, I still think GNUmed would be a better *clinical EMR* by making 
available both views:

(i) clin_when … which is done in the EMR tree and, I think, the Notes pane, but 
also

(ii) modified_when … which the EMR journal partly achieves, but may need a 
slight refactor to fully achieve

-- JIm