Re: [Gnumed-devel] question reg prog note when entering past medical history item

[J Busser]

At 9:41 PM +0200 4/21/05, Karsten Hilbert wrote:
> Example:
>
> Consider a patient with Crohn's Disease which I've been seeing
> for two months to get the recent flare under control. While
> entering notes during today's encounter the patient suddenly
> feels like informing me of his last-year bout of heavy NSAID
> use due to now-chronic polyarthritis. I decide that the CPA is
> a health issue/past history item I want to store in GNUmed.
> Hence I type "phx" and up pops the edit area for past medical
> history. I enter "chronic Polyarthritis", "age 47", "11/2004
> heavy use of Ibuprofen due to acute bout", respectively, for
> condition, age_noted, progress_note. This will result in a new
> health issue "chronic Polyarthritis" with a proxy episode "past
> medical history" and an attached S(oap) row "11/2004 heavy use
> of Ibuprofen due to acute bout". However, in the clin_narrative
> row created for the Crohn's Disease problem that I am currently
> working under we would *also* want to add a short blurb (eg
> embed a string) like "relates history of 'chronic
> polyarthritis' known since 'age 47'".
>
> Now, the question is: would we want to also embed the
> (potentially quite long) progress note or leave that for
> storage under the new health issue only ? I tend to think the
> latter is better.

In the case of a patient reporting a "past history' issue, you might 
enter quite a bit of detail into that "new" (retrospective) health 
issue. Are you asking whether to embed (i.e. copy) the entirety of 
*that* into the Crohn's Disease row?

I agree with your idea to NOT do that. It would be analogous, would 
it not, to a patient having 2 issues dealt with at the same visit, 
whose content you put into component encountlets? You would not copy 
the content of one progress note into the other!

A workflow question. As part of creating a phx item, would a 
selection of soap text of interest
"11/2004 heavy use of Ibuprofen for acute bout of chronic 
polyarthritis" be lost (unselected) as you type "phx" or would the 
selection be kept by virtue of some special key you would press 
before typing "phx" to invoke an edit area?