Re: [Gnumed-devel] Clinician call of judgement

[James Busser]

On 4-Apr-08, at 3:53 AM, Karsten Hilbert wrote:
> However, it now seems to me that a) the previous information
> isn't really lost (of course) due to auditing (and could
> thus potentially still participate in informing on-screen)

yes... the benevolent/knowledgeable (or even plain everyday)  
colleague is more often helping than hurting the patient's usual  
doctor by signing and flagging the test results expected to be of  
interest to the returning colleague, who when themselves signing  
could simply accept the current values when this would be fitting.

One engineering piece may remain, namely that if the ordering-but-not- 
usual doctor had failed to reassign the results to the usual doctor,  
and the usual doctor (upon their return or at any later time) would  
update any results as to their abnormality or significance, these  
updated values would then become visible to the ordering doctor as  
needing to be again signed. This would make it important for the  
reassignment function (in place of the originally-proposed "Take  
over") to be part of the signing widget.

This would mean we should move (earlier in the roadmap) the ability  
to designate which among existing clinician-users is a patient's  
usual or principal or default clinician.

> b) we could *notify* the previously-signing clinician
> when a change was done to the flags

Yes. The way I would see it working is that if user A is not the  
usual doctor, but has ordered tests in the absence of usual doctor B,  
and these tests return and have not yet been signed by anyone, then  
from the points of view of anyone and everyone (even the secretaries)  
the tests would be flagged with "?" or whatever we have chosen to  
denote "unsigned"

- if user A signs, then (until the capacity to reassign is  
implemented) no users would see "?"

- if (instead of A) it would be B or C who first sign, then it will  
only be A (by virtue of still being fk_intended reviewer) who would  
still see "?" which is what I think we would want. I consider it only  
a small drawback that A could not easily see that some had already  
been signed by someone else... it is evident when any among the set  
of results has been flagged as clinically significant, and the info  
is in the tooltip.