Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES)

[James Busser]

following on from
        http://lists.gnu.org/archive/html/gnumed-devel/2008-08/msg00281.html

If a user were to wish to create habits entries (likewise family  
history entries) for more than one habit or more than one family  
history concern, the options that seem currently available would be:

1. --- If the special "placeholder" health issue that is Unattributed  
will permit >1 episode to keep the status "open" (Karsten?) --- then  
each attribute of interest (smoker, problem drinker of alcohol,  
unhealthy diet, family history of each of breast cancer, colon  
cancer, premature cardiac disease) could be nicely listed within this  
branch of the EMR tree. In order to keep the components clustered  
together, users could prepend a space or a hyphen or other character,  
and could use an additional naming convention to include "habit:" or  
"fam hx:" within the episode name:

EMR of patient ...
        Unattributed episodes
                fam hx: breast ca
                fam hx: colon ca
                fam hx: premature coronary disease
                habit: problem drinking
                habit: smoking
                        encounter 1
                        encounter 2
                habit: unhealthy diet

A further advantage is among Unattributed episodes is that upon their  
closure (say, a patient has quit smoking for sufficiently long to be  
convincing) it would automatically disappear from the problem list.  
Until such a time, it would remain visible it the problem list except  
at times that the tree was fully closed. An additional advantage to  
managing such _potential_ issues is that they could be associated /  
attributed at a later time. For example if a patient should later  
prove to have developed breast cancer it could be chosen to attribute  
the family history under the health issue of breast cancer. I know...  
the issue of breast cancer did not cause the family history...

If a patient had quit smoking and the clinician closed the  
Unattributed episode "smoking", does the schema prevent the episode  
being re-opened if it should later prove that the patient is again  
smoking?

2. (alternative approach) make each one its own health issue.

        issue "smoking"
        issue "alcohol intake"
        issue "exercise"
        issue "diet"

or
        issue "habit: smoking"
        issue "habit: alcohol intake"
        issue "habit: exercise"
        issue "habit: diet"

        issue "fam hx: breast cancer"

I suppose the decision could be whether or not the smoking /  
alcohol / diet have contributed to clinical problems in which case  
the importance of attacking the risks becomes more, and maybe at that  
point they warrant to be issues of their own right.