importance of protocols
DESCRIPTION
Hemant Shah [email protected]. Importance of Protocols. BUMP The Missing Link. Processes in Healthcare. Unconnected - Islands. Process A. Process B. Process C. Proxy Clinical Process. Proxy Clinical Process. Processes in Healthcare. Proxy Processes. The Clinical Process. - PowerPoint PPT PresentationTRANSCRIPT
Importance of Importance of ProtocolsProtocolsImportance of Importance of ProtocolsProtocols
Hemant [email protected]
Hemant [email protected]
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