Problem: no archiving

Patients naturally progress through life by accumulating some diseases and becoming cured from other diseases. The accumulated diseases are what we call “chronic diseases”. Typical examples are diabetes, rheumatoid arthritis, vascular disease, hypertension, etc. Other, temporary, diseases are for example: bone fracture, most infections, myocardial infarctions (except for the underlying vascular disease), and an increasing number of cancers.

When you look at a patient’s medical records, you do want to be alerted to his chronic diseases, since most of them are relevant in the context of diagnosing new problems or treatment of a new or old problem. You also want to be able to see a list of resolved temporary diseases or afflictions, in particular when you’re diagnosing something new and don’t know what you’re looking for. But most of the time, the resolved diseases or afflictions from times gone by only clog up the records and stand in the way when you try to form an accurate picture of the patient’s history.

As an example, you may find a patient with a history of urinary infections, maybe once a year, where the annotations due to urinary infections can form half or more of the total volume of text in the medical record. None of that is interesting when the patient presents with chest pains (for example), but it severely diminishes our ability to find the annotations that are relevant to the chest pains in between all that urinary bladder gunk.

It would be wrong to erase the information about urinary infections, of course, since the chest pain may possibly have something to do with it (unlikely), and it’s important to maintain a count of how frequent these infections are, since if they recur often and during a long period, they may indicate a more severe problem that may need more thorough investigation, but these infections definitely do not warrant occupying prime screen real estate when I’m clearly looking for something else. I should be able to see just a one-liner mention of “urinary tract infection” for each such infection, and be able to read all about it only if I explicitly asked the system to show me.

This sounds like it ought to be a piece of cake to do, but in reality it’s close to impossible, since the system doesn’t have a clue that the annotations for all these urinary infections all belong together, simply because, you guessed it, the EHR has no concept of “disease”.

You can also find this page on the iotaMed wiki, here.