prEN revision M. Fogelberg WG II prEN System of Concepts Supporting Continuity of Care Magnus Fogelberg convenor CEN TC 251 WG II terminology and knowledge bases SVENSK FÖRENING FÖR MEDICINSK INFORMATIK SWEDISH FEDERATION FOR MEDICAL INFORMATICS

prEN revision M. Fogelberg WG II Not clinical terminology

prEN revision M. Fogelberg WG II Concepts in continuity of care

prEN revision M. Fogelberg WG II ENV CONTsys Approved by TC December 2000 Decision to revise to an EN by TC March 2003 Task force appointed First meeting 17 May, 2003 Now prEN Possible European Standard end 2004

prEN revision M. Fogelberg WG II GP Clinic A Clinic B A out-p A in-p B in-p HomeB out-p HomeGP CONTsys - a result of identifying, analysing and modelling different concepts whithin the continuity of care

prEN revision M. Fogelberg WG II Contents of CONTsys Actors in Continuity of Care Health Issues and their management Situations in Continuity of Care Concepts related to activity, use of clinical knowledge, and decision support in Continuity of Care Concepts related to responsibility in Continuity of Care Health Data Management in Continuity of Care

prEN revision M. Fogelberg WG II What use do you have of the CONTsys? How can you use the CONTsys in you daily work?

prEN revision M. Fogelberg WG II Implementation of continuity To use as objects in processes To make work flow descriptions comprehensive

prEN revision M. Fogelberg WG II SAMBA Swedish process modelling project Identify healthcare core process Analyse former process models Adapt process terminology to CONTsys

prEN revision M. Fogelberg WG II Processes in SAMBA One process identified which turns out to be quality managing In this process – as in others – CONTsys concept are identified

prEN revision M. Fogelberg WG II Process set of interrelated or interacting activities which transforms inputs into outputs (ISO 9000:2000)

prEN revision M. Fogelberg WG II Process Condition Goal Actor Responsible for the process Condition Timecourse

prEN revision M. Fogelberg WG II Process has one refinement object is value adding to someone has a defined goal/objective someone is responsible has resources at its own disposal has a time course has a clear starting point and end point set of interrelated or interacting activities which transforms inputs into outputs (ISO 9000:2000)

prEN revision M. Fogelberg WG II Actors in healthcare is supported by 1..* 0..*

prEN revision M. Fogelberg WG II Contact

prEN revision M. Fogelberg WG II Encounter

prEN revision M. Fogelberg WG II Contact, suggestion of revision

prEN revision M. Fogelberg WG II Contact, model minimising

prEN revision M. Fogelberg WG II Contact element period_of_service contact 1..n 1 encompasses episode of care contact element 1..n 1 1 is part of health issue 0..n1 is subject for healthcare service 11..n is performed in 1..n 0..n is usede against care mandate 11 concerns healthcare party 1..n 0..n is issued by health issue thread 0..n 1 delineates 1 0..n handles 1..*

prEN revision M. Fogelberg WG II Assessment of demand for care Declining with referral HC commitment --- * perceived condition 1:M Receive demand for care Receive demand for care Demand for care Performed HC activity ---- * Result Perform HC activity Perform HC activity Care assessment ---- * Degree of fulfillment * Remaining needs service repository hc provider Person / Patient Assessment of demand for care Assessment of demand for care Commitment plan ---- Program of care 1:M * Objective result/response Terminate commitment Terminate commitment Commitment end ”do we manage this?” Assess care need Care need Plan con- tinued care Create plan Assess with respect to plan objective Assess with respect to plan objective continue according to plan external actions Individual adaption ”fetch type descriptions” change / redefine HC commitment state demand for care

prEN revision M. Fogelberg WG II Flow chart / process model If a model handles more than one refinement object in a flow it is not a process model but a flow chart A flow chart may show several parallel processes

prEN revision M. Fogelberg WG II Process Communication process Decision process Core process Healthcare process

prEN revision M. Fogelberg WG II Process

prEN revision M. Fogelberg WG II Process

prEN revision M. Fogelberg WG II Process Communication process Core process HC provider process (Process of other HC provider) (Patient’s process) (Process of resources) Decision process

prEN revision M. Fogelberg WG II Process

prEN revision M. Fogelberg WG II Process Communication process Decision process Core process

prEN revision M. Fogelberg WG II 4 Quality management system ISO 9001: General requirements The organization shall establish,document,implement and maintain a qualitymanagement system and continually improve its effectiveness in accordance with the requirements of this International Standard. The organization shall a)identify the processes needed for the quality management systems and their application throughout the organization (see 1.2), b)determine the sequence and interaction of these processes, c)determine criteria and methods needed to ensure that both the operation and control of these processe are effective, d)ensure the availability of resources and information necessary to support the operation and monitoring of these processes, e)monitor,measure and analyse these processes,and f)implement actions necessary to achieve planned results and continual improvement of these processes. These processes shall be managed by the organization in accordance with the requirements of this International Standard. Where an organization chooses to outsource any process that affects product conformity with requirements,the organization shall ensure control over such processes.Control of such outsourced processes shall be identified within the quality management system. NOTE Processes needed for the qualitymanagement system referred to above should include processes for management activities, provision of resources, product realization and measurement.

prEN revision M. Fogelberg WG II 4 Quality management system ISO 9001: General requirements The organization shall establish,document,implement and maintain a qualitymanagement system and continually improve its effectiveness in accordance with the requirements of this International Standard. The organization shall a)identify the processes needed for the quality management systems and their application throughout the organization (see 1.2), b)determine the sequence and interaction of these processes, c)determine criteria and methods needed to ensure that both the operation and control of these processe are effective, d)ensure the availability of resources and information necessary to support the operation and monitoring of these processes, e)monitor, measure and analyse these processes, and f)implement actions necessary to achieve planned results and continual improvement of these processes. These processes shall be managed by the organization in accordance with the requirements of this International Standard. Where an organization chooses to outsource any process that affects product conformity with requirements,the organization shall ensure control over such processes.Control of such outsourced processes shall be identified within the quality management system. NOTE Processes needed for the quality management system referred to above should include processes for management activities, provision of resources, product realization and measurement.

prEN revision M. Fogelberg WG II Connection SAMBA - CONTsys Processteps SAMBA Concepts CONTsys Activities SAMBA Terminology CONTsys

prEN revision M. Fogelberg WG II The processes Communication process refinement object: information Core process refinement object: perceived patient condition/health issues Decision process refinement object: mandate, decisions

prEN revision M. Fogelberg WG II Demand for care demand for care receive demand for care received d_f_care decision on assessment d_f_c not to be assessed refer referred demand d_f_c to be assessed assess condition perceived condition refer referred demand Communication process Core process Decision process

prEN revision M. Fogelberg WG II Demand for care

prEN revision M. Fogelberg WG II Demand for care demand for care receive demand for care received d_f_care decision on assessment d_f_c not to be assessed refer referred demand d_f_c to be assessed assess condition perceived condition refer referred demand Communication process Core process Decision process

prEN revision M. Fogelberg WG II Healthcare mandate decide on health- care mandate no mandate identify health issues healthcare mandate refer referred case match against service repository condition treatability refer referred case healthcare commitment d_f_c to be assessed perceived condition received d_f_care

prEN revision M. Fogelberg WG II mandate 0..n0..1 derives from Person health care partycare mandatedemand mandate 1..n 1 is legi- timated by 1 on own behalf 1 has 0..n 1  is assigned to

prEN revision M. Fogelberg WG II is issued by healthcare provider 1 0..n is received by demand for care 0..n 1 is sent to 1 Person 0..n 1 health care party 1..n 0..n issues 1 0..n issues triggers care mandate 1 demand mandate 1..n 1 is legiti- mated by 1 0..n is permitted by 1 on own behalf 1 har 0..n 1  is assigned to demand expressed by a health care party that health care services be provided to a subject of care.

prEN revision M. Fogelberg WG II Healthcare mandate decide on health- care mandate no mandate identify health issues healthcare mandate refer referred case match against service repository condition treatability refer referred case healthcare commitment received d_f_care d_f_c to be assessed perceived condition

prEN revision M. Fogelberg WG II Health issue thread, hc objective health issues delineate health issue thread to be treated, define healthcare objective healthcare objective match objective against available services get supplementary information refined health issue collection received d_f_care healthcare mandate

prEN revision M. Fogelberg WG II Health issue issue related to the health of a subject of care, as defined by a specific health care party

prEN revision M. Fogelberg WG II Health issue thread abstract construct linking several health issues, defined by a health care party

prEN revision M. Fogelberg WG II Health issue thread, hc objective health issues delineate health issue thread to be treated, define healthcare objective healthcare objective match objective against available services get supplementary information refined health issue collection received d_f_care healthcare mandate

prEN revision M. Fogelberg WG II Program of care list of activities decide care planning planning decision choose activities conditions in care plans program of care establish program of care refined health issue collection healthcare objective

prEN revision M. Fogelberg WG II Care planning, decision support clinical guidlines protocol program of care care plan global organisation subject of care/ organisation subject of care/ healthcare professional health issue 1..* health issue 1..1 health issue thread

prEN revision M. Fogelberg WG II Healthcare objective, program of care

prEN revision M. Fogelberg WG II Program of care list of activities decide care planning planning decision book resources, record program of care updated activity list decide usage of planned activities choose activities conditions in care plans program of care establish program of care refined health issue collection healthcare objective

prEN revision M. Fogelberg WG II Healthcare activity

prEN revision M. Fogelberg WG II Healthcare service

prEN revision M. Fogelberg WG II Program of care list of activities decide care planning planning decision book resources, record program of care updated activity list decide usage of planned activities choose activities conditions in care plans program of care establish program of care refined health issue collection healthcare objective

prEN revision M. Fogelberg WG II Activities assess condition investigated condition assessed condition decision to perform perform investigation update health- care objective healthcare objective match objective against available services conditions in care plans updated activity list

prEN revision M. Fogelberg WG II Activities perform treatment treated condition list of activities update prog- ram of care program of care book resources, record program of care updated activity list decide usage of planned activities decision to perform assessed condition healthcare objective

prEN revision M. Fogelberg WG II Quality check evaluate result assessed condition check quality quality assessment match condition against objective record activity record component perceived condition in relation to healthcare objective update health- care objective Healthcare record process treated condition decision to perform updated activity list

prEN revision M. Fogelberg WG II End of process – objective fulfilled perceived condition decide to discharge discharge decision issue discharge message discharge message healthcare objective healthcare objective assessed as fulfilled perceived condition in relation to healthcare objective record component

prEN revision M. Fogelberg WG II End of process – objective not fulfilled perceived condition update healthcare mandate healthcare mandate healthcare objective healthcare objective assessed as not fulfilled check health issues, identify new ones updated healthcare commitment perceived condition in relation to healthcare objective record component

prEN revision M. Fogelberg WG II Health issue thread, hc objective repetition if objective is not fulfilled health issues delineate health issue thread to be treated, define healthcare objective healthcare objective match objective against available services get supplementary information refined health issue collection record component healthcare mandate

prEN revision M. Fogelberg WG II Referral to other healthcare provider no service available decide referral decision issue referral demand for care health is- sue thread assess health is- sues to be referred delineate health issue thread in referral health issues in referral refined health issue collection healthcare objective

prEN revision M. Fogelberg WG II Other healthcare provider’s start demand for care receive demand for care received d_f_care decision on assessment d_f_c not to be assessed refer referred demand d_f_c to be assessed assess condition perceived condition refer referred demand

prEN revision M. Fogelberg WG II To be considered in the revision All concepts must be checked for compliance to process description New concept: healthcare commitment Care mandate is established by a demand for care accepted with a healthcare commitment Mandate container for healthcare objective and program of care After each activity/service, the mandate shall be confirmed and its contents updated Healthcare objective fulfilled basis for decision to terminate the process

prEN revision M. Fogelberg WG II Thank you!