Here's another question for the fellow GNUmedders:
Basically there's two approaches to associating narrative with
codes from coding systems (LOINC, ICD, ICPC, Ozcode, ...):
1) Have a table "coded_narrative". This table stores a
text item, a code and a coding system.
Advantages:
- code-narrative association can be used to code narrative
regardless of source table
- codes are only stored once per narrative
- code - narrative association lifetime is patient independant
- once-coded narrative always reusable without recoding
- avoids code-narrative association mismatch when narrative is changed
Disadvantages:
- cannot associate different codes to same narrative
depending on patient (is this needed ?)
- this could be mitigated by introducing a link stage
table that allows for selection of which code-narrative
association is to be *applied* to a patient's actual
narrative
- code-narrative association might get broken up while
still needed somewhere else (eg no referential integrity
link into patient narrative)
2) Have a table "lnk_code2narr". This table stores a link to a
narrative item in the patient EMR, a code and a coding
system.
Advantages:
- allows for patient-specific code-narrative association
- cannot accidentally delete code-narrative association
while in use (eg. referential integrity maintained)
Disadvantages:
- difficult to allow linking into several narrative source
tables
- codes per narrative are stored as many times as the
narrative is coded, eg quite redundant
- code-narrative association lost when narrative is deleted
- prone to code-narrative mismatch after change of narrative
- once-coded narrative may get lost for recoding if deleted
Problem with both approaches: They do not allow to specify
a *part* of a narrative row a certain code is to stand for.
Whether that is really needed remains to be seen. What *is*
possible, however, is to associate several codes with a given
narrative without regard for the fact that some may apply to
part of the narrative only.
I certainly favour approach #1.
What do other people think ?
Karsten
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