Talk:Emergency Department Encounter Record

Issue Log

Open Issues

1. Patients frequently leave the ED prior to documentation being finalized. Triggers in workflow vary. How should the Draft vs. Final Status be handled?
   
2. Potential for multiple entries.
   
3. Timetable for CCD harmonization?
   
4. Target systems discussion.
   
   1. EDIS  CDR  RHIO
      
   2. EDIS  RHIO  Ambulatory EHR
      
   3. EDIS  Ambulatory EHR
      
5. Potential need for LOINC codes for new elements.
   
6. Use of Co-occurrence Constraint [Conditional Restraint] for Disposition elements.
   
7. Snomed vs. DEEDS for Disposition?
   

Closed Issues

1. Content vetted by full Patient_Care_Coordination Technical Committee.
   
2. The EDER is a multi-authored (but singly attested?) document. How should this best be implemented/reflected: Document to be attested to by ED attending physician.
   

TCON 04-05-2007

Attending

Rich Hardell, Wellsoft; Benjamin Greco, Wellsoft; Todd Rothehhouse; Keith W. Boone; Karen Lipkind

Todd has updated the LOINC codes. They look pretty good. Keith sent him the latest version of the TF (still being edited). The intention is to make that available on the wiki at some point in time in the future -- dates TBD.

Karen provided the following information, which we should review on the next call:

• http://www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm is the link to our Ambulatory Care website.
• http://www.cdc.gov/nchs/data/ad/ad372.pdf is the latest Emergency Department Advance Report.

The 2004 version of the questionnaire is contained in it.

• http://www.cdc.gov/nchs/data/ahcd/nhamcs100-ED-PRF-web.pdf is the link to the 2007 questionnaire.

Kboone 16:14, 5 April 2007 (CDT)

Don't over step with the H&P elements!

There is a temptation to try and over-specify what this document will contain in regards that is counter productive. Listing elements of the H&P, while appealing, are problematic for several reasons.

There is no consensus on how to order/organize/lump H&P elements. Is peripheral capillary refill belong under “skin exam,” “hand exam,” “extremity exam,” “vascular exam,” “cardiovascular exam” or “cardiac exam?”

Placing a fixed specification at this level of detail (i.e. specifying the components of the ROS or physical exam) isn’t going to be of use, and will only slow down the adoption of any specification.

Simply specifying the content of a document at a much higher level, whether it is defined as a collection of other documents (as it appears to be now) from multiple individuals, or a document unto its own right, is going to be challenging enough without this added level of distraction.