Software, Design Principles

&

Healthcare

Bharadwaj PV

Agenda

• Introduction to Healthcare-IT• Design Principles

– What is software?– Designing software– Service orientation

• Health record management– Understanding EHR’s– Centralization of EHR’s

• Activity

Healthcare IT

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TREATMENT - CARE

HEALTH PROBLEM

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Nature of information generated in healthcare

• Patient centric• Sensitive and confidential

Demographic

Age, Gender, address, date of birth etc.

Clinical

Allergies, Health issues, operations (procedures) etc.

Understanding software

Understanding the 3 layers of software

User Interface (UI)

BusinessLogic

DataBase

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What is SDLC? (Software development life cycle)

Gather requirements

Analyze and

design software

Test software developed

Develop software

Why design software?

• Most software developers understand programming and not requirements of end users.

• To ensure that requirements are translated into proper screens.

• Designing is a phase on its own and requires specialized skills – functional knowledge and technical know how.

Design principles

Object oriented approach

• Object-oriented techniques view a system as a collection of self-contained objects which include both data and processes.

• An object is a person, place, event, or thing about which we want to capture information.

• Each object has properties (or attributes).

Example of an object

Design principles

PATIENT

NameAgeDate of birthGenderHeightWeightBlood group

Object

Attributes

Use cases

Design principles

Detailed Use case modellingUse case Register

patientsParent use case -

Description The system must provide the facility to register a patient who has arrived.

Actors Registration clerk / Nurses / Receptionists

Pre-Condition A set of unique identifiers must be availableSufficient information about the patient must be available

Post-Condition Patient will be registeredA unique patient identifier will be associated with the patients record

Use Case (Basic Flow)

Patient ArrivesProvides details requiredRegistration is completeUnique ID is generated

Exception(s) Alternative scenario(s)

A patients record alone may arrive for consultation from an external hospital

The nurse must be able to register such patients as external patients and store their information

Business Rules and Validation

A check must be done if the patients record exists in the system prior to registering a patientDate of birth cannot be a future date

Objects Patient, Carer, relationships.

Design principles

Steps in use case modeling

1. Identify use cases

2. Draw the system boundary

3. Place use cases on the diagram

Group use cases into packages

4. Identify the actors

5. Add Associations

Hospital (system boundary)

Register patient Admit patient Perform Surgery

Collect Fee & Discharge

ACTIVITIES

Some objects we can identify here1. Patient2. Admission3. Procedure (Surgery)4. Fee

Business process

Usability tips …

• Clinical safety – ensure that clinical information is always displayed in a manner that in no possible way could mislead the reader

• Prioritise information and highlight – ensure most important information is presented first and least important information is presented last to make effective use of clinician time

• Consistent look and feel

• Logically organized patient record

• Flexibility to cater to different users requirements

Activity

For the given scenario, identify the system boundaries, actors and use cases.

Associate the identified use cases to create a health care business process.

Microsoft Word Document

Service oriented approach

The Microsoft definition is: Service orientation is a means for building distributed systems. At its most abstract, service orientation views everything — from the mainframe application to the printer to the shipping dock clerk to the overnight delivery company — as a service provider.

Service providers expose capabilities though interfaces. Service oriented architecture maps these capabilities and interfaces so that they can be orchestrated into processes. The service model is ―fractal: the newly formed process is a service itself, exposing a new, aggregated capability.

HEALTHCARE

Demographic information management

Clinical Information Management

Managing knowledge and decision support

AdministrativeInformation Management

Materials Management

Cost Management

Diagnostics

Drugs

Problems

Allergy Information

Other Information

Prescribe a drug

View past medication

Services ACTIVITIES

The healthcare

domain viewed in a

service oriented approach

Drug name

Drug dosage

Frequency

Data Elements

Why an e-health care records? Facilitate the clinical care of individual patients by;

– Assisting the clinician to structure his or her thoughts and ma ke appropriate decisions

– Acting as an aide memoir for the clinician during subsequent consultations

– Making information available to others with access to the sa me record system who are involved in the care of the same p

atient– Providing information for inclusion in other documents (e.g. l

aboratory requests, referrals and medical reports)– Storing information received from other parties or organisatio

ns (e.g. laboratory results and letters from specialists)– Providing information to patients about their health and healt

h care

Source: Good practice guidelines for general practice electronic patient records (version 3.1) Prepared by The Joint General Practice Information Technology Committee of the General Practitioners Committee and the Royal College of General Practitioners

A patient record system that can be used to meet admini strative, legal and contractual obligations by;

• - Providing medico legal evidence (e.g. to defend against clai ms of negligence)

• Providing legal evidence in respect of claims by a patient ag ainst a third party (e.g. for injuries, occupational diseases an

d in respect of product liability)

• Meeting the requirements of specific legislation on subject a ccess to personal data and medical records

• Recording the preferences of patients in respect of access to and disclosure of information they have provided in confiden

ce

• Providing evidence of workload within a healthcare practice

• Monitoring the use of external resource usage (e.g. prescribi ng, laboratory requests and referrals)Source: Good practice guidelines for general practice electronic patient records (version 3.1)

Prepared by The Joint General Practice Information Technology Committee of the General Practitioners Committee and the Royal College of General Practitioners

Health record management

Chennai

+

Delhi

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Job TRANSFER

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Treatment history for 10 years

Worked in Chennai for 10 years

The problem …micro level

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Job Transfer

The problem …macro level

+ + +

System A

Developed by ABC corp.

System B

Developed by XYZ corp.

System C

Developed by MNO corp.

The problem with disparate systems

• Each system is designed in a different way and eventually fails to interact with other systems

• Leads to inefficient processes in hospitals

• Leads to availability of loopholes in the system (Insurance claims etc)

The case of NHS in UK

+ + +

System A

Developed by ABC corp.

System B

Developed by XYZ corp.

System C

Developed by MNO corp.

Centralized patient record with a commonly defined structure

Hospital 1 Hospital 2 Hospital 3

The solution• A consistent EHR must be designed and enforced by a

common body (Govt)

• The EHR must be maintained centrally as well as locally

• The central EHR must be updated on a regular basis with the info in the local records

• The central EHR must have appropriate security and must adhere to clinical information security standards (these standards must be laid out by a common body <Govt>)

• Ensuring online availability of records for respective stake holders

Who benefits?

Patients – information available centrally

Clinicians – Assistance to provide treatment

Government – Vast amounts of data available for research and planning of facilities

Insurance companies – Availability of accurate patient history

Activity

Design an EPR (electronic patient record) that addresses the following requirements for a GP clinic

– Assuming appointments are booked – a view to list patient appointments

– A view of a patients medical record with various information organised in tabs

– An option to enter patients complains and prescribe a drug