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Re: [Gnumed-devel] Past History Comments (was 1.2.3.....)
From: |
Karsten Hilbert |
Subject: |
Re: [Gnumed-devel] Past History Comments (was 1.2.3.....) |
Date: |
Wed, 24 Nov 2004 12:33:33 +0100 |
User-agent: |
Mutt/1.3.22.1i |
> My comments below are based on a series of 39622 patient consultations over 7
> years, with some 12,000 past history items for various patients entered, and
> I'd hate to think how many archived/changed.
Tell you what, I can't say how much I appreciate having you
around on this.
> The thing about past history is one needs some sort of detail beyond the
> diagnosis.
Agree.
> A past history being recorded is Not a SOAP note.
You mean cannot simply be recorded just like a SOAP progress note ?
> Here is what I record in my medical records program. Each of these are
> discrete fields in data_PH table
Let's see if we can fit this into our data model.
> ===========================================
> PastHistory_ID table key
clin_health_issue.pk
> Consult_ID key to consults
if there are encounters recorded pertaining to a health issue
they are indirectly linked to that issue via the episode they
occurred in
> Age_Onset number could be months or years
> Age_onset_Units key to lu_units table
this we would have to record the following way and I agree
this is ugly:
enter an issue, attach an episode, attach a clin_narrative
soap row, record the age/unit as text in it, attach a type "PH
age" to it
We should perhaps derive a new table from clin_root_item
called past_history that has dedicated age/unit fields.
Entries in that table would then be attached to health issues
which would somewhat clean things up on the backend. Comments
there ?
> Description eg Hypertension
clin_health_issue.description
> Notes eg BP's 190/110, 200/150
Any number of clin_narrative rows can be attached to the
clin_health_issue. The frontend could scan for particular
types of clin_narrative rows and display them as Notes.
> Side_of_Body key to lu_laterality (0,1,2) ie left,right,both
Given the clin_narrative was declared a diagnosis we would
then have a locality field in the corresponding clin_diag row.
> Ozcode disease code
Any number of codes can be attached to any of the
clin_narrative rows.
> Date date condition noted or recorded
clin_narrative(clin_root_item).clin_when
> Active if true this is an active problem
clin_health_issue.is_active
> Operation yes/no true/false whatever you want
> Cause_of_death yes/no
> Confidential yes/no
see age_onset
> Significant yes/no
clin_health_issue.clinically_relevant
> Deleted yes/no
Handled by the auditing mechanism.
> ==========================================
Seems we do need some work but aren't in that bad a shape.
> * a SOAP editor as the list envisages it is not capable of recording this
> informatiion with this granularity,
Agree.
> *a Popup sub-editor will, such as in in SOAP2.py using the skeletal recall
> example as a substandard and incomplete, but suggestive visual model, or as
> in the early gnuMed designs I did. when the PH editing area actually existed.
That's precisely what I would have intended. Have the SOAP
widget pop up the PH editing area when, say, "PHx" is entered
into the soap widget.
> -Laterality is important (if not for the obvious medico-legal reasons!), then
> for recalling effects of treatments, progress (when often the patient and
> yourself forget which side of the body the condition was on).
No kidding !
> What does not work in these examples
> =======================
> 1) The biggest single thing I've found over the 7 years I've been entering
> data into this is that there is NOT ENOUGH DETAIL in the Notes line and this
> is a constant source of annoyance to me when entering details of the PH item.
>
> I allowed 50 characters for this - arbitrary somewhat - dictated somewhat by
> the screen design. This is adequate for 90% or consultations, but as with any
> history it is the few percent where you need more detail that really matter.
Our backend would allow for any length of text (well, within a
few MB). The GUI might want to strip that down on display.
Getting rid of that limit (but perhaps warning on entry when a
threshold is exceeded) will do away with the annoyance of not
being able to fit in that 101st character into a 100 chars
field.
I would appreciate more discussion on how to solve that PH
thing within our framework !
Karsten
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- Re: [Gnumed-devel] Re: clin_health_issue - some thoughts, (continued)
- [Gnumed-devel] The 1,2,3's of SOAP for multiple problems, Richard Terry, 2004/11/21
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems, Karsten Hilbert, 2004/11/22
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, Richard Terry, 2004/11/22
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, Carlos Moro, 2004/11/22
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, Karsten Hilbert, 2004/11/23
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, J Busser, 2004/11/23
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, catmat, 2004/11/23
- [Gnumed-devel] Past History Comments (was 1.2.3.....), Richard Terry, 2004/11/23
- Re: [Gnumed-devel] Past History Comments (was 1.2.3.....),
Karsten Hilbert <=
- Re: [Gnumed-devel] Past History Comments (was 1.2.3.....), catmat, 2004/11/24
- Re: [Gnumed-devel] Past History Comments (was 1.2.3.....), Karsten Hilbert, 2004/11/24
- Re: [Gnumed-devel] Past History Comments (was 1.2.3.....), J Busser, 2004/11/24
- Re: [Gnumed-devel] Past History Comments (was 1.2.3.....), Karsten Hilbert, 2004/11/24
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, Karsten Hilbert, 2004/11/24
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, J Busser, 2004/11/24
- Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2, Karsten Hilbert, 2004/11/24