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Re: [Gnumed-devel] Medication lists - Duration
From: |
Busser, Jim |
Subject: |
Re: [Gnumed-devel] Medication lists - Duration |
Date: |
Fri, 26 Jul 2013 00:26:58 +0000 |
On 2013-07-25, at 2:32 PM, Jim Busser <address@hidden> wrote:
> I am just realizing that
>
> Duration
>
> ambiguates
My apologies, by the way, for all the "pressure" that I might seem to be
creating to revise the current medication section. … I owe the flurry to my
having tried really hard lately to use GNUmed, except finding it is still needs
more work in order to work more clearly, more fully etc.
Coming back to Duration, the following are the potential 'time segments" of
interest which fall between the ...
1) actual date start … now
2) now … when to next review / reassess (while still on the medication)
3) now … when to discontinue the medication
Whether we are talking about an in-praxis visit, or whether we are talking
about a chart review where we reach to a new insight or decision about a
patient, it seems to me that the frame of reference in the clinical decision
making is always "now".
In the case of hypertension, for example, I may
- in the case of a patient whose BP is not yet under control, I may wish to
make a decision 2 weeks into the future whether I am satisfied with the current
dosage
- in the case of a patient whose blood pressure *is* under good control, I may
be satisfied to approve their use of some medications for 3 or 6 months into
the future
despite that, in both cases, the same medications remain check-boxed "long
term".
It is both possible, and common, to be able to make such decisions without
always knowing when a medication started.
I very strongly think, therefore, that what we should be capturing is not
"intended total duration"
but
'duration into the future" = 'extension forward from now"
which, in the case where we are starting the drug today, is the same as the
total duration anyway. ***But*** we need to unambiguously provide for all the
cases where the start date was earlier than now, including when it was unknown
and not realistically possible to identify.
I would point out that over in the Allergy section, the admitted possibility
that patients do not know when (exactly) was their adverse reaction accounts
for why the tooltip says:
When did the patient note the onset of the reaction.
If unknown, use the date when it was reported to you.
So ... can we please refactor what we will mean by "duration" so that, perhaps
as part of the 1.4 upgrade, the interval value becomes replaced by
value = original interval - (the time elapsed between started and now)
essentially making this the "time remaining" until next drug re-assessment, or
change, or discontinuation?
The result will be the calculation of a "target date" and will require a
decision whether this will be handled in a column dedicated for this purpose,
and whether 'duration' remains a column in the schema, or simply a "field" in
the middleware that is back-calculated and auto-populated from the "target
date" when non-NULL.
-- Jim
- [Gnumed-devel] Medication lists - Duration, Busser, Jim, 2013/07/25
- Re: [Gnumed-devel] Medication lists - Duration,
Busser, Jim <=
- Re: [Gnumed-devel] Medication lists - Duration, Busser, Jim, 2013/07/25
- Re: [Gnumed-devel] Medication lists - Duration, Busser, Jim, 2013/07/26
- Re: [Gnumed-devel] Medication lists - Duration - Started, Busser, Jim, 2013/07/29
- Re: [Gnumed-devel] Medication lists - Duration - Started, Karsten Hilbert, 2013/07/29
- Re: [Gnumed-devel] Medication lists - Duration - Started, Busser, Jim, 2013/07/29
- Re: [Gnumed-devel] Medication lists - Duration - Started, Karsten Hilbert, 2013/07/29
- Re: [Gnumed-devel] Medication lists - Duration - Started, Busser, Jim, 2013/07/29