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Comment by mythas | Hacker News Reader

Another example that happens surprisingly often in healthcare. A registration clerk will incorrectly enter a personal health number (PHN) into the system. Then the actuall holder of that PHN shows up. If this were the PK then the system just wouldn’t handle this case and the reg clerk would have a huge mess to sort out on the spot. A surrogate key on the Person table allows this registration to be made where 2 people have the same PHN in the system. Then cleanup can be handled after the fact to track down the first person, determine their correct PHN and update the record.

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Finding and eliminating duplicates is a very common software problem that is rarely solved in a reusable, user-friendly way that preserves history while eliminating redundant data. In fact, in 40 years of working with computers I can't think of a single UI that I'd want to emulate.

Ultimately the key is the business-modeling that captures "duplicates" as Things That Happen.

That's the precondition for any sane UI, and sometimes it's not even obvious because the "duplication" has been transformed, reified into its own concept.

One of the most surprising things I learned about the US healthcare system is how often everything is mutating or being retroactively updated (assume it applies to other countries too).

Things you'd think would be constant after Step 1 often aren't, and processes are tolerant of their being corrected / re-entered after Step 52 has already been completed.

This sounds like it should probably be a workflow instead. Modelling the intent here is actually important.

Care to expand on this thought? Curious what you have in mind!

(not parent)

Think about these different intentions, each deserving an audit trail with different attached metadata:

- brand new MRN for a newborn. The system should be able to provide info on the mother, at all points of care for the newborn.

- unknown person arrives in the emergency department unconscious. You’ll see imaging named John Doe in this case. The system should be able to retrieve info if and when identity is established.

- the machine-readable bracelet given at admission needs to be replaced. This is really two different cases: you intend to create a duplicate bracelet, or to correct an error in which all current info in the system needs to abruptly update.

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