importance of protocols

Importance of Importance of ProtocolsProtocolsImportance of Importance of ProtocolsProtocols

Hemant Shahhemant_100@hotmail.com

Hemant Shahhemant_100@hotmail.com

BUMPThe Missing Link

BUMPThe Missing Link

Processes in HealthcareProcesses in Healthcare

Unconnected - IslandsUnconnected - Islands

Processes in HealthcareProcesses in Healthcare

Proxy Clinical Process

Proxy Clinical Process

Proxy ProcessesProxy Processes

Processes in HealthcareProcesses in Healthcare

The Missing LinkThe Missing Link

Why is a Process Model needed?Why is a Process Model needed?

Core for all healthcare activitiesFor Clinical specific tasks to be identified as distinct from othersCare and diseases span across boundaries

Synergism & Coordination between different agencies

Software DevelopmentAll mentioned abovePatient-oriented systemsIntegration of Disparate Areas of development in Medical Informatics

Are there Any Models?Are there Any Models?

None for the clinical contextMost deal with Organizational aspects of healthcare and not for clinical process

Examples:• Newman and Sorenson, 1985• Wolford, Brown and McCool 1993

Even these are not effective in many ways because they skirt the clinical issue

The Truth Is:The Truth Is:

The King

has no Clothe

s!

What Should be Model’s Scope?What Should be Model’s Scope?

Only the Interaction of the Clinician with the beneficiaryShould provide the smallest block

For building large things by assemblingAllowing anchors for other processes to be hitched to it

This also gives the definition

The Clinical InteractionThe Clinical Interaction

Exchange of Information between the clinician and beneficiary

Data

Action

Data-Collection

Decision

Action

Implementation

The Clinical ProcessThe Clinical Process

Connected Interactions

Data Decision

Action

Decision-making

ImplementationData-Collection

Simple! Almost a Simple! Almost a truism!truism!

Data

Decision-making

Data-Collection

Could it be Simpler?Could it be Simpler?

ActionDecision

May be, Because decision-action are May be, Because decision-action are two sides of the same coin.two sides of the same coin.

Decision-making

Data-Collection

Could it be Simpler?Could it be Simpler?

DataAction Decision

Alternatively, action-data are also two Alternatively, action-data are also two sides of the same coin. But…sides of the same coin. But…

Action & IS are the key playersData & Decisions are Messages between themInformation System interfaces with the Action (real world) via

data (input)Decisions (output)

For IS the action is represented by its 2 aspects

DataDecisions

Information World

Concrete World

Data Decision

Action

Decision-making

Implementation Data-Collection

But Actions Require real world!But Actions Require real world!

Could it be Simpler?Could it be Simpler?

Information World

Data Decision

Concrete World

Action

Yes, Because we can play around as we Yes, Because we can play around as we wish in abstract world! (unlike the real one)wish in abstract world! (unlike the real one)

Could it be Simpler?Could it be Simpler?

Data Decision

Information World

The Clinical Process - ChainThe Clinical Process - Chain

Data

Action

Data Decision

Action

Action

Concrete World

Action

Decision

A Clinical Process Plan with a A Clinical Process Plan with a defined start and end is a defined start and end is a

ProtocolProtocol

Information World

The Clinical Process - ChainThe Clinical Process - Chain

Action

Concrete World

Action

Data Decision Data Decision

Domain B

Domain A

ActionAction – The Middleware – The Middleware

Action

Action

Data Decision Data Decision

Data Decision

Action

Clinical Process as a SkeletonClinical Process as a Skeleton

Few things that cannot be mapped to the elements of Core ProcessProves that clinical process is the coreGives unlimited extensibility

Data

Action

Data DecisionActionDecision Action

ActionCore Process

Associated Process

Protocol – The Great IntegratorProtocol – The Great Integrator

The Protocol (Clinical Process)

The Protocol (Clinical Process)

Attached ProcessesAttached Processes

Medical Informatics Tools•AI & DS•Vocabulary Tools•Telemedicine•Data Standards•Multimedia Access•Data Entry•EPR

Medical Informatics Tools•AI & DS•Vocabulary Tools•Telemedicine•Data Standards•Multimedia Access•Data Entry•EPR

Clinical Process - IngredientsClinical Process - Ingredients

SymptomsHistoryFindings

Clinical SignsResults of Tests

Record of Action Just action being performed may be all that needs to be recorded at times

Data

Sources

Clinical Process - IngredientsClinical Process - Ingredients

May be“No data” Non clinical dataProcesses and decisionsNon-linearAd hocUncertainIncompleteInaccurate

Data

Characteristics

Clinical Process - IngredientsClinical Process - Ingredients

Decision-makingWhen?

• Immediate – Trigger• Future

How?• Directly• In combination with other data• May be part of input-set of several

different decision-making operations

Data

Contributes to

Decision-making

Clinical Process - IngredientsClinical Process - Ingredients

Patient-DataImmediate pastCombined with previous data

Setting-DataKnowledge

Actions that are possible in a given situationRelative Risks & Benefits of each Action & Inaction

Inputs

Decision-making

Clinical Process - IngredientsClinical Process - Ingredients

Decision-action couplesOne or more

May be done

Outputs

Decision-making

Clinical Process - IngredientsClinical Process - Ingredients

May be done by different actorsMachine

• Local inference tool• Remote inference tool

Human• Clinician• Local referred expert• Remote expert

Immediate or deferred

Characteristics

How a decision is made? How a decision is made?

The inference mechanism based on the external information changes the abstractionThe inference mechanism then decides what action to implement and also takes into consideration the abstraction changes brought about most recently

ActionAction

Abstraction Abstraction

Clinical Process - IngredientsClinical Process - Ingredients

Abstract version of actionMay have varying level of confidenceMay be more than one

Characteristics

Decision

Clinical Process - IngredientsClinical Process - Ingredients

Concrete version of decisionNot always an outcome of decisionMiddleware of Clinical Process

Links sub-processesLinks processes in different layers

Characteristics

Action

Clinical Process - IngredientsClinical Process - Ingredients

Always returns data – Diagnostic and Treatment actions are sameWill have Time, Place and ActorDifferent from action as in OO representations (not on an object)

Characteristics

Action

(Continued)

Clinical Process - IngredientsClinical Process - Ingredients

Data

Outputs

Action

Thank Thank YouYou

LUMELUMELUMELUME

Proteus and Clinical ProcessProteus and Clinical Process

Connected Interactions

Decision-making

Implementation

Data Decision

Action

Data-Collection

CIPHER and ProteusCIPHER and Proteus

Abstraction and Inference making

Implementation

PIDEs Inference

ActionData-

Collection