Shorthand Context Problem

When a clinical note includes a structured field, the value of that structured field will often require context in order to place it correctly within patient's health record. For example, if a clinician types ".staging T2N0M0" then we need to understand: (1) is that about the current patient or a family member? (2) is that a repeat of initial diagnosis clinical staging or a representation of their current staging?

The answer to those questions is typically in the narrative but not in a structured form. For example:

"Clinical .staging T2N0M0" would be for the patient and be the clinical staging.

"Mother also had breast cancer diagnosed in 2010 clinical staging T2N0M0" would be for the patient's mother and be clinical staging.

How do we know the context when we capture the structured data fields within the user interface?

To define the types generically that we need to cover:

1. Who (patient or family member or some other person)
2. When (referring to something that just happened or already happened and may or may not already be captured in structured data or something that is planned to happen)
3. Where (new structured data elements entered by a clinician are assumed to have occurred at the facility running the Flux Notes instance; however, there may be cases when a procedure done at another hospital is referenced in a narrative for example)

The 3 items may not cover all the cases, but they cover all the cases we have thought of so far!