On 13-Jan-08, at 12:50 PM, Karsten Hilbert wrote (in reply to J
Busser's q):
would items that were
entered via progress notes always appear either in free-standing
episodes
or in their own line *with* triangles beside them to show that
they are
episodes with 1 or more encounters?
Progress note items would appear as belonging to either
- a freestanding episode
- an episode belonging to a health issue
root
issue
episode
encounter
episode
encounter
issue
episode
encounter
Please remind me whether "root" serves as the underlying,
foundational, fundamental medical disorder (such as a disease that
can affect multiple systems, such as sarcoidosis or systemic lupus
erythematosis) that can be found any any stage of a patient's health
to explain multiple issues whose cause may until then have been
without explanation ("idiopathic") ...
... or does "root" above refer to "clin_root_item" which is not meant
to be used for any "clinical" purpose except to make possible the
electronic "inheritance" function of being able to link related parts
across multiple tables?
The reason that I ask is because a patient could, for example,
present with hematuria that turns out to be due to kidney stones and
that episode may subside over a few encounters, only to become active
after many months or a few years with more problems, so these may be
considered multiple episodes of kidney stones where kidney stones
(nephrolithiasis) is entered as the "issue" (= clin_health_issue?)
So... what happens if the patient develops pancreatitis and is found
to have elevated calcium (hypercalcemia) and it turns out they they
have hyperparathyroidism. It is probably reasonable to be able to
record in the EMR tree that this patient has had issues of
- hematuria (although maybe this is disagreed, from the point of view
that, as a manifestation of the kidney stones, the hematuria was just
a symptom and it is satisfactory to just leave hematuria as the name
(label) of the enclosing episode that becomes nested under kidney
stones)
- kidney stones as an "issue" which is believed to have caused the
hematuria (even though the kidney stones themselves may have been
caused by hypercalcemia caused by hyperparathyroidism)
- pancreatitis (although again could be hidden as an episode label
inside hyperparathyroidism)
- hyperparathyroidism (later found to be a parathyroid adenoma)
Basically what I am appreciating is that if a patient's many
manifestations of their problems become "hidden" by virtue of their
living at the level of the episode names, then when one reviews a
patient, for example presenting with some abdominal pain, and the
doctor looks at their EMR tree, they will not see pancreatitis unless
they click open sufficient numbers of the child-indicator triangles.
This suggests to me that we may need a control that will at least
expand all child items to their first level. Could/should such a
control "live" in the right-click (control-click) contextual menus
that are already offered in the EMR tree? I am thinking that at the
level of the top-most item (the patient name which doubles as the EMR
menu) we can offer "Open all to..." and then a submenu "issue level /
episode level / encounter level". At successively more-deeply nested
levels of the tree (for example at the level of any one health issue)
the menu item would just say "Open to..." instead of "Open all to..."
and the options would be fewer. For example at the level of the
"9/2000 extraterrestrial infection", the existing "Health Issue Menu"
items
Edit details
Delete
would be joined by
Open to...
with submenus
episode level
encounter level
Lastly is there a desire to avoid keyboard bindings like Command/
Control/Alt + key for example modifier+O for Open, modifier+E for edit?
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