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[Gnumed-devel] Anticoagulation project and larger planning issues
From: |
J Busser |
Subject: |
[Gnumed-devel] Anticoagulation project and larger planning issues |
Date: |
Fri, 4 Feb 2005 11:58:17 -0800 |
I now have a computer (Windows XP) set up for the nurses. It makes
them independent of the secretary's computer which had been their
means of getting lab results, which are however still being printed
on paper (the entire workflow is still paper based).
My larger interest is in seeing if I can move a couple of pieces
together. My "district" has 2200 doctors of whom 65% are estimated to
have little or no EMR functionality. Most of these do have a computer
on which a secretary does scheduling and billing, and some have
internet access for on-line resources.
The local district strategic planning committee believes that a set
of very basic modules
- patient identification (even if just "fed" from an appointment
manager / biller)
- lab results handling
- medication management
would be a very good starting point for many people, it would be a
tremendous help while staying compatible with an otherwise largely
paper practice.
OSCAR, while having some management issues, is still in place locally
so has a head start. I believe Gnumed's technical & clinical design
are better but, to warrant consideration, Gnumed must *at least* fit
it into the basic frame above. I was hoping my anticoagulation
project could be a demonstration platform.
@ Horst, the above is partly FYI but to what extent does OSCAR's work
with drugref put OSCAR significantly ("even further") ahead of Gnumed
or could gnumed redeploy what OSCAR is doing with little added work
perhaps especially using a browser?
@ Karsten & others, would it take a full-time programmer more than a
month to develop gnumed to the extent I need? Should a programmer
from a developed country cost much more than $50 Can/Aus (30 euros)
per hour? (Not twice that, I hope!!!)
EMR needs for an anticoagulation clinic:
========================
input new patient from the keyboard,
detect / warn if duplicate patient about to be created
find patient
edit current demographic information
input health issue(s)
indication for anticoagulation
target intensity (INR 2.5-3.5)
input medications (warfarin & maybe a low molecular weight heparin
(LMWH) e.g. tinzaparin)
input soaP
set date for next lab_request
identify lab_request status (needed/printed/submitted vs
standing order)
establish connection to lab to fetch lab data
fetch data (LOINC)
populate gnumed test_type table with any "new" combinations of
organisation/code/coding_system
notify users that new lab data is available
import data into staging table
match to patients (since Canada uses no lab_request id) :-(
if lab_request originated from the clinic
offer that encounter/episode as the one to link
elif originated from some other provider
create dummy encounter/episode "unrequested test results"
update the following for actual requests +- unrequested test results
update lab_request_id (internal to the lab)
update lab_rxd_when (specimen date/time received)
update results_reported_when (was the report generated)
update request_status (final, preliminary, partial)
update is_pending
transfer data into test_results
assign fk_reviewer
permit manual entry of lab results that did not arrive by way of the
electronic interface
next, the following must be identifiable and must support a good work flow:
- for test results outside of range
instruction obtained from doctor
input medication change (including "no change")
- capture the change as "as nurse user xx" for "authorizing Doctor yy"
soaP entry references medication change and next lab_request
patient notified & notification status is captured
(might we want notification_status in test_results?)
test results outside of range are marked as having been dealt with
for all these, set reviewed_by_clinician boolean "TRUE"
- for test results within range
soaP entry specifies per-protocol next lab_request
patient notified & notification status is captured
test results within range are marked as having been dealt with
for all these, set reviewed_by_clinician boolean "TRUE"
- for overdue requests having lab_rxd_when is NULL
patient is contacted / reminded / SoaP captured
existing lab_request is CANCELLED
new lab_request is entered (or should existing be modified?)
overdue requests are marked as having been dealt with
optionally / Stage 2
- support appointments for those requiring bridging injections of LMWH
- data export / reporting tools
- [Gnumed-devel] Anticoagulation project and larger planning issues,
J Busser <=
Re: [Gnumed-devel] Anticoagulation project and larger planning issues, Thilo Schuler, 2005/02/04