Re: [Gnumed-devel] clin_health_issue - some thoughts

[Karsten Hilbert]

> be able to re-examine what was found/done at discrete encounters
>   -> Richard may advise this is not _usual_, yet it may be an important
> functionality on an intermittent basis, when having later to rethink /
> reconsider / defend the care or actions, IMO - am I alone here?
This is certainly necessary and this is why we do attribute
data to encounters in the backend regardless of how the data
is presented later on. I don't think Richard argues against
that. He only seemed to say that *in consultation* the tree
widget is not optimal to present what we want to see. He also
seemed to say that we won't be referring back to previous
notes *in consultation* that much. No question that we do
refer back to them at other times. And then we do want to see
them related to the encounter they were generated in.

> group any apparent recurrence of clinical items
>   -> makes it easier to locate individual items
>   -> permits scrutiny of frequency & time profiles
>   -> facilitates nesting
Can you elaborate on this ?

> nest related items &/or assign importance (clinical_relevance)
>   -> reflects a decision concerning relationship or importance
>   -> permits meaningful collapse of data &
>   -> limits drowning in a sea of information
>   -> assists more relationships to be observed / inferred
Relating may actually be useful. It certainly is something we
don't support yet beyond issue/episode/encounter. I think,
however, it could be quite complicated to support
satisfactorily.

> code data, where useful
>   -> assists communication; analysis; and decision support
any clinical item can be coded as many times as needed
concurrently

> avoid logical and clinical inconsistencies
>   -> less dependence on human compensation for weak design
We sure want that. That's also the point of this discussion.
We need many eyes to look at what comes up, though. People
like Liz et al who aren't directly involved in coding but know
perfectly well what they are talking about.

> Taking the above together, in assessing patients, we
> 
> - identify one or more Purpose(s) (RFEs / Patient requests) for the visit
> - collect History / Subjective data that may concern more than one problem
> - examine patients and may find abnormalities (or notable normal 
> findings) in more than one area
> - take into account test results and come to an assessment
> - make decisions and take action
Sounds like it to me !

Karsten
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