Re: [Gnumed-devel] Bugs in your doccie stuff

[Karsten Hilbert]

On Wed, Sep 20, 2006 at 08:22:09AM +1000, Richard wrote:

> > The underlying concept is "Any data you see always belongs
> > to the active patient." - unless explicitely labelled
> > differently such as in the provider inbox.
> 
> Whilst on this note - and remember I've pushed this before - I think it is 
> very very unwise having non patient-specific items apearing in your medical 
> record design.
Well, we don't, just as the concept above says. Except for
the Inbox people will naturally expect all sorts of incoming
messages.

> The Inbox is a provider (all patient - all stuff) thing. The 
> best solution for this that I've come up with as seen previously is the 
> listbook style of design, where all your clinical stuff live in one section, 
> and all stuff not explicity related to the patient lives elswhere - otherwise 
> it is just too confusing for the user.
I agree it needs to be clearly separated. That's why it is
in its own notebook tab.

I remember a time when we had all the clinical stuff inside
one notebook tab (the clinical window with its own plugins)
and everything non-clinical in other tabs. At that time I
seem to remember you claimed it was confusing to have this
sort of separation.

But never mind that, I strongly doubt there's more than the
average number of blokes among doctors. People do fine with
the Inbox concept in mail readers. They don't expect to see
only messages from the specific mailing list they are
currently viewing to show in their inbox. In fact, they are
expecting all incoming messages in their Inbox. I do believe
we can trust our fellow docs to be able to handle the
concept of "this is my Inbox where GNUmed tells me things I
need to know about". Come on.

> > > Interestingly there is no record in the progress notes that the user
> > > imported any documents for the patient - perhaps by design.
> >
> > Good idea. I didn't think of that. Any suggestions for the
> > wording of the entry ?
> 
> Any action within the medical record should appear.
This is a very useful concept from your EMR design. And of
course we do have the documents linked into our EMR
including the comments. The question is: "Do we want an
*explicit*, additional line inserted into the SOAP narrative
when inserting documents" ? It seems you are saying yes.

> In my program I used a 
> such simple words as "Three documents where imported into the medical record: 
> name1, name2, name 3 + comment if relevant.
Thanks, will heed that advice when improving upon this part
of GNUmed.

> uncannily like my office program/my open source designs which you have 
> rejected.
Richard, unless you provide at least one single piece of
evidence where your design was *rejected* the above is a
(hopefully not voluntary) falsehood (then customarily called
a lie). It has never been rejected. In fact, I constantly
refer back to it when thinking about how to implement
something.

> Above all, having played with all the data input/progress notes methods, my 
> thinking on these have crystalised somewhat. Some use the SOAP boxes like 
> gnuMed, some more like Ian and I's autoexanding SOAP,
For one thing "GNUmed SOAP boxes" *are* "Ian and I's
autoexpanding SOAP". OTOH the technical case study you
provided took quite some hacking to actually get working
acceptably and hasn't overall worked out all too well
(technically). But, yes, it does work for now.

> My current opinion (could change without notice) is that problem segregated 
> plain text field entry with ability to insert images and templates is the 
> most practical way to go. Whether the problems are segregated down the page, 
> or like we have on tabs across probably dosn't matter.
OK, thanks for that bit of advive. Good to know.

> Whereas strictly separated and saved SOAP notes may have some value in 
> enforcing a method of imput, they don't allow the user freedom to work how 
> they want,
When I get the time to work on that part again (it's high
but not top-priority right now) this will get better.

> and I think though perhaps should be allowed as an option for 
> insitutions needing that, or doctors wanting that,
Once I get to it it'll become a lot more flexible. The
flexibility was in fact intended and pre-worked into the
existing scheme, too, but proved not to be manageable
technically.

> So in summary I'd like an editable html type control (can insert piccies) + 
> templates + ian/my popup's (like you've sort of implemented crudely in your 
> soap). Data once saved is displayed in html in the progress notes.
Yep, the latter is on the TODO, too. At which point I will
come back and bug you about progress note HTML layout once
*again*.

> Each note 
> entry should be linked to a problem by the user (not by the system which you 
> use which dosn't work logically).
You must be misunderstanding something. The system does not
link entries to problems. How do you come to that conclusion
? How could it, really ?? Of course it's the user selecting
the problem to which to link entries to.

Karsten
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