Re: [Gnumed-devel] Re: Can�t change the dates of the encounters

[James Busser]

On 5-Sep-08, at 12:40 AM, Karsten Hilbert wrote:

> Data in GNUmed links to two grouping principles:
>
>  episode: this is the semantic grouping
>  encounter: this is the chronological grouping


Encounter groups chronologically by date & time of the encounter,  
does it not, which means according to the date and time of the  
changes being written into the EMR. This permits a chronologically  
later encounter to record information about things that happened even  
before the previous encounter, and so while the *record* is  
chronological, the storyline of the patient illness becomes  
disrupted. This is what I meant when I indicated that encounters may  
need some second dimension of time (clinical "attributed" time) to  
permit a clinically-meaningful sort.

I recognize that there are multiple clinically-meaningful time  
perspectives:

- the timeline of the patient's illness, which is sometimes only  
figured out and pieced together after-the-fact
- the timeline of any findings, which are sometimes only entered  
after-the-fact
- the timeline of the recording of information, and of signing, and  
of any edits to these, in the EMR

Episodes, in addition to their top-level semantic grouping, also have  
(within their top-level) a chronologic order among episode which I  
expect is mangeable.

The challenge may be to display entries within episodes in clinical  
chronological order as opposed to when-entered-and-audited  
chronological order.

Does this well-capture the conundrum?