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Re: [Gnumed-devel] emrjounalplugin.py comments further html work
From: |
Richard Terry |
Subject: |
Re: [Gnumed-devel] emrjounalplugin.py comments further html work |
Date: |
Mon, 19 Sep 2005 08:07:46 +1000 |
User-agent: |
KMail/1.8.2 |
I take in all you say. You must be fairly unique amongst doctors Karsten, or
or perhaps it is the german system, or the sort of clinic you work in.
Reason: I've perused many many thousands of clinical records from patients
from many hundreds of doctors in my time, and it exceptionally rare to find
structured notes.
In my 'on-the-ground' tutoring of GP's in the use of clinical record programs,
and in projects where we wrote the software specifically to enforce entering
a reason for encounter (for research projects), we had a huge problem trying
to educate doctors how to use that, and also if they knew how, getting them
to fill it in.
In my own consultations I reckon there may be about 50% of consulations I
could tag with something sensible.
Must be different in Germany?
Regards
Richard
On Sun, 18 Sep 2005 11:00 pm, Karsten Hilbert wrote:
> On Wed, Sep 14, 2005 at 08:19:45AM +1000, Richard wrote:
> > Regarding your comments on complexity I agree we have to
> > look beyond the single encounter visit.
>
> Beyond the single *problem* visit, right ?
>
> > As you mentioned, having to input SOAP notes as we do
> > currently, we end up with
> >
> > S ...
> > O ...
> > A ...
> > P ...
> >
> > S ...
> > O ...
> > A ...
> > P ...
>
> That is what I would expect. It also fits my workflow quite
> well. I capture what I am told, what I find, what I think
> about it, what I do about it. I am going back and forth, of
> course, but in general that's how I work.
>
> Notice how this does not predefine how the data is
> *displayed* later on ! The EMR is a tool to make things
> *easier* for us. We can use one format to make input follow
> our workflow but use *another* format to guide our reception
> of information later on. The requirement for this ability is
> that the input is in some sort of structure. That's
> precisely the point. On paper I am forced to write down the
> notes in a way that will facilitate easy reception. No
> reformatting is possible unless I have the notes
> transcribed! Such *is* the power of using a machine and
> using structured data. That's exactly why we want to give
> the machine some idea of what's what !
>
> So, in the end, the statement "we end up with ..." is wrong
> (thanks $DEITY). What we end up with is a bunch of unordered
> lines of text thrown into an opaque bag called "table". It
> is *our* responsibility to grab the proper lines from this
> bag and display them any way we see fit. For that to be
> possible we need to add metadata to the text when throwing
> it into the bag: who, when, what type of text, which
> encounter, which problem, etc.
>
> > The essence of the encounter which we as a doctor
> > immediately grasp is that of poor diabetic control
>
> Hence we use "poor control" for the AOE of the encounter and
> "foot problems" and "high sugars" for the progress note
> assessment lines.
>
> > Diabetes
> > =====
> > - poor control:
> > Having trouble adhering to diet. Checking ~ 2x daily, staggered
> > times, 9-13 mmol/L
> > last A1C 0.09% ( is it under O we would comment on test results,
> > under A?)
> > Agrees to incr meds while continuing effort at wt loss
> > Incr metformin 500->850mg bid
> >
> > - diabetes mellitus (foot care)
> > Noted slight drainage on socks past 3 days. No
> > pain/red/fever/trauma but new shoes 7d ago.
> > (Details of exam)
> > Assement Whatever
> > Plan Whatever'
>
> And yes, one could reformat the above notes into that sort
> of display - that's precisely what I asked for when I wanted
> HTML snippets for how you guys want the notes to be
> formatted. The above is simply:
>
> $health_issue
> =============
> - soAp
> Soap
> sOap
> soaP
>
> - soAp
> Soap
> sOap
> soaP
>
> (Apart from the fact that we cannot currently have two open
> episodes at once.)
>
> > The more and more I play with this type of data entry in my
> > consultations, , the more I'm coming around to Malcom Irelands view (and
> > I suspect Horsts and David Guest's as well) that we need a large single
> > textbox to collect all the information we type in,
>
> Sure, no problem. If you guys want a single text box you can
> have it. Simply save all the text under, say, Soap (or
> whatever category) and be done with it. Within that
> narrative line the information can be structured any way. A
> viewer can be made intelligent enough to not destroy the
> pre-existing formatting and to ignore empty categories. That
> way within the structure unstructured data is saved. The
> additional structured data (scripts, vaccs, etc) can happily
> coexist.
>
> Karsten
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, (continued)
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Horst Herb, 2005/09/14
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Ian Haywood, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/21
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/18
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work,
Richard Terry <=
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Horst Herb, 2005/09/18
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Richard Terry, 2005/09/18
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Horst Herb, 2005/09/18
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, J Busser, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Horst Herb, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/19
- Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/19
Re: [Gnumed-devel] emrjounalplugin.py comments further html work, Karsten Hilbert, 2005/09/15