[Top][All Lists]
[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
Re: [Gnumed-devel] need assessment from fellow clinicians
From: |
James Busser |
Subject: |
Re: [Gnumed-devel] need assessment from fellow clinicians |
Date: |
Tue, 29 Jun 2004 22:51:28 -0700 |
User-agent: |
Internet Messaging Program (IMP) 3.1-cvs |
Methinks an even bigger challenge than billing!
A few thoughts that may help/guide convergence and some questions to determine
if we
are of the same understanding:
- active problems (aPs) are a subset of all of a patient's problems, so aPs can
(best?) be regarded as those problems that have the attribute "active". Yet
problems, while active, can have further attributes:
...active-uncontrolled (by definition most "active" & likely source of RFEs)
...active-controlled (parameters [like symptoms, measures] satisfactory)
...inactive-dormant (able to recur)
...inactive-cured (unable to recur e.g. appendicitis post appendectomy)
- if we assert that the following, though codable to diagnoses, are also
appropriate
to consider "problems', then each of a patient's Diabetes, Hypertension, Asthma
and
Back pain can, if coded as controlled or uncontrolled, be automatically
understood
to be "active" whereas once the back pain improves, or the diabetes proved to
be
gestational or steroid-related, these could be coded "dormant" thus understood
to be
"inactive". These are more functionally informative than active/inactive,
provide
more useful thresholds by which to expand and contract data displays while
sparing
the need to manually update a separate active/inactive attribute.
- the aPs would arise from the latest AOE per episode, I am wondering therefore
if
aP table records are just a subset of specially-attributed AOE records, and
whether
during any one episode the AOE approximates an active-uncontrolled problem and
whether it is upon conclusion of an episode that an AOE becomes an aP that is
considered either active-controlled or inactive (-dormant or -cured as the case
applies) --- see also below, concerning "forced closure" of an episode when a
problem is not yet controlled ---
Reason for Encounter (RFEs)
- initiation may be
...by doctors (as in followups or recalls or periodic health exams)
...by patients (as in new, or worsening, or recurrent complaints) or
...by others (a concerned relative, a community nurse, an employer)
- presumably a Gnumed doctor initiating an encounter would desire to designate
the
inciting aP or, if none yet exists, input a value into the AOE that is able to
be
either kept, or modified, at the time of the encounter
- supposing a Gnumed doctor initiates an encounter to reassess the hypertension
of a
patient last seen 6 or 12 months before, is a new episode being created/opened,
with
the potential to range from a one-encounter episode (if the BP is under
control) or
a multi-encounter episode (if the hypertension proves to be active-uncontrolled)
- if within any one "open" episode more than one problem is being dealt with,
does
the episode remain "open" until the last of the problems achieves the status
active-
controlled (or can an episode be "forced" closed if the patient and doctor
agree
that partial control is all that can be achieved until the patient can later
engage
again in a future episode)
If multiple RFEs across multiple encounters within an episode prove to pertain
to a
single disorder, together with its investigations, treatments and any side
effects,
I could understand that a single AOE could meaningfully give:
> the gist thereof in one catchy phrase.
Suppose a patient begins thiazide for hypertension, gets a rash and gout, takes
NSAIDs, and gets a GI bleed, all before hypertension control is achieved.
In such a case, where within an open episode of care the encounters span more
than
one problem, we don't open multiple overlapping episodes, do we? But if we
don't,
and there is therefoe only one AOE, it will have to provide a phrase to
paraphrase
multiple problems e.g.
"BP high, thiazide for hypertension, got a rash and gouty flare, stopped
thiazide,
started ACE, GI bleed on NSAIDs, scoped for large gastric ulcer, Rx PPI,
stable, BP
controlled"
If the above is what is intended, then the AOE would not equate to an aP, would
it?