Re: [Gnumed-devel] Medication lists - Corrections vs Changes

[Busser, Jim]

On 2013-07-11, at 10:08 AM, Jim Busser <address@hidden> wrote:

> Is there room to adjust the triggers...
> ...
> 2) to keep in the substance table (inactive) the previous dosage of a 
> medication

The above reminds me that there are two distinct use cases for altering the 
information about a substance:

The first is a "correction". The second is a "change".

A "correction" :

- record into GNUmed a dosage of 5 mg nightly
- realize within the visit that, for the patient in question, this is a bit of 
a strong initial dose, and caution them to start with only half (2.5 mg) nightly
- the "correction" permits to alter the row (the original of which goes into 
the audit table) to keep the same value for 'started' but to reflect a 
different dosage or instruction

… a correction therefore involves to alter a row in a way that makes it 
correctly reflect a single clinical episode of current substance intake.

vs A "change":

- the patient *actually* takes 5 mg nightly and either phones the praxis, or 
reports at an early visit in 3 to 7 days, that the medication is giving them 
side effects
- here, we should want to keep available, for clinical reference, the history 
that for those 3 to 7 days, beginning with the original date 'started', the 
patient actually consumed 5 mg daily
- currently, the user has 2 choices:

1. (a) "Delete" the substance (though, in reality, it is not the substance, 
maybe not even the strength, that is being changed. It might be just the 
dosage, or even just the instruction) which will cause the substance to 
disappear into the audit table. (b) Then, re-lookup the same substance, and 
perhaps the same strength, and construct this row all over again, except with 
the revised dosage or instruction,

OR

2. (a) "Edit" and alter the information inside the substance. Here, the user 
could choose to input a date into Discontinued, and a comment into Reason, and 
this will allow this substance to remain listed (inactive) in the list. 
However, if I do this, I cannot proceed with (b) re-lookup the same substance, 
in order to create a row describing the new state of 2.5 mg nightly, because 
the triggers will not allow two rows of the same substance in the same table.

I know that Karsten knows what I am about to say, and I think it is simply the 
challenge of finding the time to do the coding that has caused him thus far to 
delay refactoring the initially-manageable concept of "Current substance 
intake".

But, truly, if GNUmed is to be an EMR, it has to keep available in the 
*clinical* tables (and not in the audit tables) the clinically-useful records 
of what has happened to the patient. Therefore we really must evolve

        Current substance intake

into

        Substance intake history

wherein, at any one time, some substances may be active and others inactive.

I am not here talking about a "Prescription writer".

I am just talking about our discontinuing our current removal, from 
clin.substance_intake, of clinical history.

-- Jim