Re: access to review audits (was Re: [Gnumed-devel] encounter edit before final save)

[Karsten Hilbert]

On Tue, Aug 12, 2008 at 12:59:33PM -0700, James Busser wrote:

> Not long ago, I was temporarily very unhappy with the trainee doctors  
> managing a patient under my care, on account for having begun a patient 
> on antibiotics for what they *insisted* was Staph aureus growing in the 
> patient's blood. Together we re-examined the patient's hospital record 
> and the computer advised us that the blood cultures were "no growth". 
> Only after pursuing the lab were we able to find out that the lab *did* 
> originally post a result saying that the blood cultures were growing 
> Staph aureus (which the student saw) but the lab then realized it was 
> posted in error and *replaced* it (without telling anybody) with the "no 
> growth" result.
>
> Can we therefore add, and agree, that the ability to edit progress  
> notes, and the ability to review the audited (edited) notes, needs to be 
> implemented together?

Sounds like a reasonable request to me. Flagging notes as
edited is relatively easy. Providing access to versions is a
lot more involved. However, the versions exist in the
backend in any case, so if dispute arises over a flagged
note pgadminIII can always come to the rescue.

Jim, feel free to add "flag edited narrative" the the 0.4 roadmap.

However, on account of your above story: I would have
expected the trainee to document

"culture shows Staph, started i.v. antibiotics".

Later, when you reviewed, you'd write another note

"culture DOESN'T show Staph at the moment
- assess why ABs were started"

Those two notes would certainly not override each other but
rather coexist. A simple confirmative phone call to the lab
would resolve the situation. I am not sure I quite
appreciate how this relates to editing narrative. After all
one doesn't assume the trainee is involved in a deliberate
coverup of something.

Karsten
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