COCA CoOperation, Concepts and Architecture Magnus Fogelberg, neurologist Project team leader President, Swedish Federation for Medical Informatics

OBJECTIVE To increase quality of health care information systems Better communication Users Decision makers System providers by means of a common language

Continuity concepts – CONTSYS Architecture – HISA ?

CONTSYS Static image of continuity concepts SAMBA Dynamic image of the process The process is the implementation of continuity

HEALTH CARE PROCESS Start: health care professional perceives demand for care Mandatory contact with service: assessment of demand for care Optional contacts with services: program of care, specific services, assessments Decision point: end process

PROCESS TERMINATION Decision point: 1.No further need for health care (recovered) 2.No more services applicable within the health care society 3.Responsible health care provider finds no more services applicable 4.Health care mandate withdrawn

HEALTH CARE PROCESS = CUMULATIVE EPISODE OF CARE (CONTSYS) ?

HISA

HISA/CONTSYS concepts health care actor / health care professional + other carer - / health care agent subject of care + patient / subject of care case / contact period + episode of care health characteristics + reason for contact / health issue + health issue thread …

person health care professional subject of careother carer

person health care professional subject of careother carer external actor

person sendDemandForCare(subjectForDemand : person) delineateHealthIssueThread(healthIssue[1..n]) demand mandate 0..n 11 possesses 0..n sendDemandForCare possesses active demand mandate

demand for care > person sendDemandForCare(subjectForDemand : person) delineateHealthIssueThread(healthIssue[1..n]) subjectForDemand : person reasonForCareNeed : health issue thread documentbears phone call bears personal visit bears sudden event bears health care provider distribute(businessIssue, receiver : health care professional) 0..n receives health care professional stateHealthCareCommitment() assessDemandForCare() 0..n assesses receives demand for care from {at least one of}

Person who is subject to demand for care Subject of care Person who is subject to demand for care Receives demand for care Defines health issue thread RefersDelineates health care commitment Created Being planned Destroyedresources? services available? no : care process : health care professional : person yes

Health care commitment a commitment to provide at least one health care service to a subject of care by interfering with at least one health issue encompassed in the health issue thread delineated by the health care professional stating the commitment

: person : health care provider : health care professional : care process : health care commitment sends demand for care distributes demand for care delineates health issue thread states

finds no applicable service available in the repositry : person : health care provider sends demand for care : health care professional distributes demand for care delineates health issue thread : care process

Further work mandates contacts health care services assessment of service outcome decision for terminating the health care process

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 organisation 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 Region-IT/ MA ”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