On Fri, Nov 28, 2014 at 10:55:31AM +0000, Thomas Beale wrote:
> in reality GPs sometimes prescribe without a diagnosis as such
In reality GPs (I am one) _often_ prescribe without a _diagnosis_.
The proverb "The Gods put the Diagnosis before any Treatment"
doesn't hold in GP land. However, GPs (better) never
prescribe without a _reason_. That reason very much is the
"patient problem at hand". There is _always_ a reason for
which to prescribe. (if the reason _isn't_ the patient
problem the patient may need another GP ;-)
If there doesn't appear to be a reason clinicians better
think again.
> administer drugs in hospital without always having an order. And of course
> historical records of such events can easily be incomplete, making it
> impossible to reconstruct data from a legacy EHR into the new required form.
While that seems like an excellent technical argument the
very nature of having documented (generated by import from
legacy data), say:
reason = "unknown" / "don't know" / "old stuff"
- drug 1
- order 2
- lab test 3
tells the clinician to think things over when needed and
re-arrange. Of course, one might say that it behooves the
system displaying such data to flag unlinked artifacts in the
above way.
> This Danish work was conceptually very good, but a bit naive
Are there links ? Thanks.
> , and we learned
> from that - provide appropriate information types, and make it possible to
> have process links but don't require them.
From a technical point of view it is probably very prudent
to not _require_ such links (as in, say, a non-nullable
foreign key) but the user-facing side of the system as a
whole (as long as it is used for individual-patient care
rather then epidemiology) should make it, like, "real hard"
to forego such links. I suppose I can agree with that
approach.
All in all this starts to remind me of whether NULLs should
be allowed to happen in a given relational schema or whether
any such schema should be further normalized to not require
NULLs, right ?
Karsten
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