Thanks Gerrie.

Very clear explanation.

If I had to inject my simple view of medical records, I would make the following key points;

1. Intuitively, editing history items from a view like the summary view with a "select", then "edit" would be great. This would do away with the edit visit dialog, yet retain the structure of visits for those clinics that wish to have medical records come under a visit hierachy.

2. I support a fusion of charges and medical records. I also acknowlege Gerries point about cluttered, over full records. The option to filter the summary remained on the top of the summary view as you scrolled up and down might adresss this.

3. Such filtering should be able to mix filtering restrictions. Ie. Not just show me this one type but rather choose which can be seen through a type of advanced filter with tick boxes (ie. "Show me all history notes but hide all charges and lab results"). As with all things, I beleive that if we did this a configurable default would address many of the concerns of implenetors and users with varying requirements.

As a side note about defaults, something I think would be an ultimate aim for any configurable default is to one day make them personalised. Ie. This is default setting for the practice, this is the default for this particular user logged on. In the example of medical records above, when you log on, all those history items you like are there, but not so for a different user. If no user based default has been defined then it resorts back to the clinic default.

4. One idea I have had is using the visits to form a type of contents column that listed all the visits as links, identified by their reason in reverse date order. The detail of the summary view would be next to this column. Clicking on these visit links would jump straight to that visit within the medical record, avoiding the need to page forward and back to get to a particular visit. Furthermore, the visit list would serve as a sort of summary for the clinician looking to get an idea of the long term medical history of patient.

5. Linkage of billed items and visits

This is a headache for me. The linkage between billed items and particular visits is something we have struggled with. Items are often found in the wrong visits through our error or through various states of In Progress and Completed. I think we have done a reasonable job with training but the system does not incorporate the failings of vets graciously in this respect. One idea put forward at one stage was the abolishment of visits all together and just using a date ordered list (like Netvet). This way billed items need not be linked. They just get listed along with any other records for that day.

I do like the idea of visits for the potential organisational benefit they may provide in the future, but I can't think of of a rock solid way to make sure they link to billings and provide a consistent medical history. Short of having a "Invoice Items" button on each visit header whioch opens a billing dialog.

Medical records is certainly one area that OpenVPMS has some work to do. I think this is a major project. Big enough to constitute a version number of its own. I'm sure that much discussion will go into this - maybe even in its own community page? I also think that our large animal practices will need to have a vocal part to make sure the solutions meet their needs also.

Matt C