Re: [Gnumed-devel] Aggregating health issues on screen. - Contextual Info

[J Busser]

Perhaps a clarification is needed for what is intended within any one 
encounter (e.g. "visit")

Do we envision ONE i.e. a *single* SOAP editing area whose content:

a) if it relates to only a single problem-episode, requires no 
division into encountlets *but*
b) if, in the judgement of the doctor, the content is meaningfully / 
usefully separable into encountlets --- each such "bit" able to be 
"attached" to the pertinent problem --- this is *not mandatory* 
however *is recommended (the only sensible way)* for any doctor who 
desires to later assemble the pieces specific to such a "thread" to 
be able to do so

Alternatively some might think or favor that multiple SOAPlets be 
created concurrently, in some combination of full or collapsed views, 
with the doctor jumping back and forth among these SOAPlets as the 
patient jumps around, but I worry this forces premature choices of 
where the information "belongs". Moreover there could be 2 new 
problems happening but if the problems had not yet been created there 
is a risk of circularity to the process. Lastly if I am busy I might 
rather end the visit having captured my SOAP content but preferring a 
while later (maybe after a few phone calls and a few patients) to 
come back and further process what I was thinking. So I would rather 
have the option of collecting and caching content in a single area to 
be able to attach pieces to problems as time and reason permit.

So some more questions:
- suppose we have within a SOAP  editing area several bullet points 
and/or a few paragraphs
- suppose portions are highlighted, or demarcated (whatever is the 
method) thus denoting "encountlets" to be attached to each of 
multiple specified problems (episodes)
-- what happens to any text that was *not* thus highlighted or 
demarcated,  i.e. was the SOAP content being held only in memory, and 
after the encountlet(s) are parsed off and processed, any other text 
gets "dumped"?  Or are we talking about *preserving* everything that 
was in the SOAP editing area, and simply supporting the additional 
functionality of *copying* bits into various problems
-- can the same bit of text be multipurposed into two separate problems?

At 11:34 PM +0100 11/29/04, Karsten Hilbert wrote:
> If one so wishes one can display by encounter and
> not worry about which part was connected to which problem but
> rather just display all the linked problems as a list.
>
> ... It is not snipped out of context. Also this is entirely a
> matter of display. What we are doing is *in*creasing the
> contextual information by allowing to specify which parts of
> the consultation relate to which problem. This neither says
> how that data is later displayed. Also, it may not easily be
> possible to cleanly discern which problem a specific data item
> belongs to (in which case the user will just decide on
> *something*) or the user may not even care (in which case she
> will just "dump" all data onto a catch-all generic "problem").
>
>  > Yet when faced witha  difficult case, where the symptoms have started to
> >  present on a few occasions over a period of time, and the patient history is
> >  often a little vague, or changing with every presentation,  When you look
> >  backwards through a set of patient notes - your eye takes in the context of
> >  the key words, and what information is associated with them. If you cut out
> >  this context, and link display to only part of an encounter, then you may
> >  miss the clues that will cause the 'penny to drop' and help you make the
> >  diagnosis.
> Sure! If needed just look at the notes in a whole-consultation
> mode. Where's the problem ? It's a frontend presentation
> issue.