Re: [Gnumed-devel] Re: Cannot change the dates of the encounters

[James Busser]

On 5-Sep-08, at 2:00 PM, Karsten Hilbert wrote:

> If you add a note today the entry will have a modified_when
> of today and an fk_encounter of "the current encounter".
> Such there is no doubt about the fact that the information
> was "just added".
>
> It could be argued that if one doesn't want to add on to the
> two-year old closed episode one could open a new episode.
> After all, there *was* new activitiy after a marked period
> of non-activity.

I am entirely happy with the (Chronological) EMR Journal displaying  
its content organized according to the datetimes of the *encounters*,  
meaning this display is sequenced from the datetime of the encounter  
*entries* and not of the clinically historical dates being referred- 
to as having happened.

I suppose we can think of

	EMR Journal == the *literally* chronological journal, within which  
any soapLets (optionally attributed to a variety of different  
episodes) would be clustered together.

and

	EMR tree == the representation of health issues, each defined by  
(and displaying) zero [1], one, or more *clinically*-ordered episodes  
unique to this issue, where -- inside each episode -- there will have  
been attached at least one entry, and there may have been attached a  
variety of entries (progress notes, lab results, imported documents).

Now...

1) we had identified that the representation of the health issues  
(i.e. the sort order) could be governed by whatever combination of  
pre-pended ( * , - ) and alpha characters was desired to be the  
operand of a simple sort on clin.health_issue.description ---> coming  
in 0.3x or 0.4x?

2) clin.episode apparently (in the EMR tree) shows the same encounter  
multiple times but maybe within each episode we only want to see the  
clin_narrative rows that pertain to the episode, sorted by clin_when  
instead of modified_when. These two (clin_when and modified_when)  
will be the same except when the clinician changed it. Such changes  
are crucial to guide an understanding of the patient and so should be  
a high priority to "leverage" into the record.

Footnotes:
[1] Health issues can have zero episodes, think "past Hx"  items.  
Even so, the health issue could only have been created through some  
form of encounter, whether that would have been a batch import as  
part of clinical bootstrapping, or addition of the issue at a visit.