Working with Problem Knowledge Couplers

(adapted and used with permission from PKC Corporation literature. Copyright 1994, PKC Corp.)

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Problem Knowledge Couplers are Windows(TM)-based point-of-care information tools for identifying patient problems and risk factors, eliciting and recording patient findings, and considering and refining diagnostic and management strategies.

 Coupler Index screen (1)

 1 Couplers are defined in three ways:

Many Couplers provide both diagnostic and management information.

 Coupler Findings Sequence screen (2)

 2 Positive (observed) findings for the patient are elicited and recorded through the use of sequences of findings displays. The provider and patient respond to a series of questions or statements, each corresponding to or qualifying a finding that may or may not be present in the patient. A finding is set to positive by clicking on it with the mouse, or by entering its number via the keyboard. Repeating this action will set the finding to "uncertain"; a third click will reset it to negative.

 By clicking on toolbar icons or selecting pull-down menu choices, positive findings for the patient may be coupled with a medical knowledge base parsed from core and specialty medical literature and texts, kept current through periodic updates, to produce:

 Findings Summary screen (3)

 3 The Findings Summary includes all positive and uncertain findings entered for the patient. Positive findings are distinguished by check marks (ü), uncertain findings by question marks (?). Findings are listed in broad groupings specific to each Coupler.

 Comments directly relate each finding to one or more possible causes of the problem being defined, or give information for monitoring or further investigating the problem. One or more medical literature citations are associated with each comment.

 Cause Index Screen (4)

 4 When all findings have been entered and reviewed via the Findings Summary, a list of possible causes or relevant management options for the problem as it is currently characterized may be generated.

 The numbers at left for each cause indicate the number of positive (observed) findings for the patient, followed by the total number of possible findings in the Coupler, indicating the cause may be present.

 By clicking on any cause on this index, you may view all findings in the Coupler that may indicate the presence of that cause.

 Cause Detail screen (5)

 5 Findings that may indicate a specific cause are grouped into:

PRESENT and UNCERTAIN findings are those previously entered for the patient. ABSENT findings are other findings that may have indicated the cause had they been present.

Other considerations are relevant texts pulled from the Coupler's knowledge base that may have a bearing on the consideration of the cause but that are not specific to any single finding.

 The number in the right-hand column for each finding is the number of other causes in the Coupler's knowledge base indicated by that finding.

 Secondary Options screen (6)

 6 You may also generate menus of secondary options to pursue to further characterize the problem or to rule in or rule out a specific possible cause or management option. Procedural and informational details are presented for each option as it relates to the cause or management strategy under consideration.

Storing and retrieving coupler results

The set of positive and uncertain findings collected during a Coupler session for a patient can be saved in an electronic file for later recall and modification, or printed to give to the patient or to include in a paper record. There is no need for transcription: the printed text is a complete, structured record of the encounter.

 Each session is identified with patient ID, provider ID, date/time stamp, and an optional free-text comment.

 You can retrieve any stored session at any time to review the data or to add or delete findings. If you elect to re-store after modifying findings, the old session will not be overwritten: the modified session will be assigned a new date/time and stored as a separate session. You therefore maintain a complete audit trail.

 Patient and Coupler session information is saved in dBASE compatible files using FoxPro indexing. (Please call PKC for information about dBASE III Plus, dBASE IV and Clipper compatible index files.) If you are using Couplers on a network, a dBASE compatible file is created for each client station for each session.

System requirements

To realize maximum benefit, PKC also highly recommends: