Source of care, was: Re: [Gnumed-devel] Re: GNUmed vaccination stuff

[Karsten Hilbert]

On Sat, Jan 07, 2006 at 08:32:15AM -0800, Jim Busser wrote:

> IMO it would add a lot of function & utility to be able to input 
> information about what a patient had *elsewhere* for example a person 
> (especially a child) who has moved into the neighborhood and begins 
> receiving care.
Sure, that's always needed. There's going to be a whole lot
of this stuff that will end up in Soap rows. Another wad of
it is going to be in blobs tables. Yet other data will be
structured and can be entered into proper tables - those
always offer a comment field which can be used to flag such
data as having originated/care having been given elsewhere.

> Is there any reusable approach to documenting (structuring) how, 
> where or from whom patients received testing or treatments?
Given that in a GP setting most of this will either be

1) oral accounts which should go into Subjective
2) referral/etc letters which go into blobs.doc_med
3) incoming structured data (lab) which goes into the proper tables

it doesn't seem to make too much sense to invent to much of
an infrastructure for 1).

I rarely feel the need to use anything but Subjective and
sometimes Plan ("advised to continue chemotherapy but to
discuss with oncologist compatibility of concurrent
rheumatic pain management inititated today").

> I am 
> thinking vaccinations, drug therapies, operations/procedures there 
> could be value to a consistent approach. Options could include one, 
> or multiple, among the generic "someone else" and "somewhere else" 
> outside of the surgery or the practice, and/or free text input into 
> one or two fields, and/or a table in which is maintained other 
> doctors/people/orgs from whom the patient did receive / is receiving 
> care.
As soon as we try to model this we are going beyond the
scope of the original GNUmed and turn it into a community
health record - quickly sloping into a secondary health
information repository. Let's replace the existing
methodology first, then make interchange safe and easy,
*then* change the methodology.

> Does the schema already have a table in which we can maintain (e.g) 
> which other doctors any patient is seeing?
Not yet, but *that* bit just may be of value, eg tracking
"the patient's urologist/cardiologist/...". IOW secondary
(as far as GNUmed is concerned) care givers. IOW a social
web of contacts.

Karsten
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