Notes exporter can create notes with misaligned information

[dehall]

A clinical review of some Synthea generated data revealed some irregularities in the notes for a patient, where it looks like there are discrepancies based on a retrospective look at the patient's record for a given encounter, vs what the patient's record actually looked like at that time. Examples below. It seems like symptoms and social factors stored in generic attributes without a time component are the root of the issue.

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Comments below are shared from that review by a nurse/clinical informaticist.

Patient record in question: Adrienne302_Zulauf375_1c83fb03-d139-4626-bb39-4a062c22b533.json.txt

At urn:uuid:234df0ab-cb00-4727-926b-c28cf77e0eba: age inconsistency with social history. Her birth date is 1979-05-08 so she is 1 month old. Also minor point, but there is a misspelling with quite instead of quit:

1979-06-12
 
# Chief Complaint
- Breast/Nipple Pain
 
 
# History of Present Illness
Adrienne302 is a 1 month-old non-hispanic white female.
 
# Social History
Patient quite smoking at age 16 and is an alcoholic.

At urn:uuid:e74e9498-997c-48cc-9932-1b93f9eaa2c5: patient is a 3-month old, has the same complain of breast/nipple pain, and is being treated with oral and chewable drugs whose drug dose and route is age-inappropriate (i.e.: a 3-month old has no teeth and can’t swallow pills)

1979-08-14
 
# Chief Complaint
- Breast/Nipple Pain
 
 
# History of Present Illness
Adrienne302 is a 3 month-old non-hispanic white female. Patient has a history of otitis media.
 
# Social History
Patient quite smoking at age 16 and is an alcoholic.
 
Patient comes from a high socioeconomic background. Patient currently has Anthem.
 
# Allergies
No Known Allergies.
 
# Medications
amoxicillin 250 mg oral capsule; acetaminophen 160 mg chewable tablet

At urn:uuid:2e7d79d7-d6b2-4219-8eef-a2a7b69d2022: Document type is a History and Physical, chief complaint is still Breast/Nipple pain after 19 years (which seems to have been the same since the patient was 1-month old) History does not indicate anything about hypertension (which is pretty rare, if statistically insignificant for a 19-year old female), however she has 2 anti-hypertensives/diuretic medications (tenoretic and hydrochlorothiazide) prescribed.

1998-07-07

# Chief Complaint
- Breast/Nipple Pain


# History of Present Illness
Adrienne302 is a 19 year-old non-hispanic white female. Patient has a history of streptococcal sore throat (disorder), otitis media, viral sinusitis (disorder).

# Social History
Patient is married. Patient is an active smoker and is an alcoholic. Patient identifies as heterosexual.

Patient comes from a high socioeconomic background. Patient is a college graduate. Patient currently has Anthem.

# Allergies
No Known Allergies.

# Medications
tenoretic-50 50 mg / 25 mg oral tablet; amoxicillin 250 mg oral capsule; penicillin v potassium 500 mg oral tablet; ortho tri-cyclen 28 day pack; hydrochlorothiazide 12.5 mg oral tablet; amoxicillin 250 mg / clavulanate potassium 125 mg oral tablet; acetaminophen 160 mg chewable tablet

# Assessment and Plan


## Plan
Patient was given the following immunizations: influenza, seasonal, injectable, preservative free.
The following procedures were conducted:
- medication reconciliation (procedure)
The patient was prescribed the following medications:
- tenoretic-50 50 mg / 25 mg oral tablet

At urn:uuid:e02e903e-d85f-4e3a-a86f-23ec960c4ba7: Chief complaint is still Breast/Nipple pain. Patient receiving the drug “Camila” (generally used to treat menstrual disorders), but has no equivalent problem in past medical history. Acute episodes are generally not included in a history of present illnesses. I think acute bronchitis was originally reported a couple of years prior. Plan lists administering a muscular injection but does not list the medication. Assuming that it is medroxyprogesterone acetate based on the medication list. Also consider whether the combination of the 2 estrogen-specific contraceptives, plus the progesterone drug is a representative protocol for a 29-year old female with no past history of gynecological conditions other than Breast/Nipple pain.

2008-11-25
 
# Chief Complaint
- Breast/Nipple Pain
 
 
# History of Present Illness
Adrienne302 is a 29 year-old non-hispanic white female. Patient has a history of streptococcal sore throat (disorder), acute bronchitis (disorder), whiplash injury to neck, otitis media, viral sinusitis (disorder).
 
# Social History
Patient is married. Patient is an active smoker and is an alcoholic. Patient identifies as heterosexual.
 
Patient comes from a high socioeconomic background. Patient is a college graduate. Patient currently has Anthem.
 
# Allergies
No Known Allergies.
 
# Medications
acetaminophen 325 mg oral tablet; tenoretic-50 50 mg / 25 mg oral tablet; amoxicillin 250 mg oral capsule; penicillin v potassium 500 mg oral tablet; errin 28 day pack; estrostep fe 28 day pack; ortho tri-cyclen 28 day pack; 1 ml medroxyprogesterone acetate 150 mg/ml injection; hydrochlorothiazide 12.5 mg oral tablet; amoxicillin 250 mg / clavulanate potassium 125 mg oral tablet; acetaminophen 160 mg chewable tablet; camila 28 day pack
 
# Assessment and Plan
 
 
## Plan
 
The following procedures were conducted:
- intramuscular injection (?? Missing medication details ??)