Importance of Protocols

1. Hemant Shah hemant_100@hotmail.com Importance of Protocols BUMP The Missing Link

2. Processes in Healthcare Unconnected - Islands Process A Process B Process C

3. Proxy Clinical Process Proxy Clinical Process Processes in Healthcare Proxy Processes

4. The Clinical Process Processes in Healthcare The Missing Link

5. Why is a Process Model needed? • Core for all healthcare activities • For Clinical specific tasks to be identified as distinct from others • Care and diseases span across boundaries • Synergism & Coordination between different agencies • Software Development • All mentioned above • Patient-oriented systems • Integration of Disparate Areas of development in Medical Informatics

6. Are there Any Models? • None for the clinical context • Most 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

7. The Truth Is: The King has no Clothes!

8. What Should be Model’s Scope? • Only the Interaction of the Clinician with the beneficiary • Should provide the smallest block • For building large things by assembling • Allowing anchors for other processes to be hitched to it • This also gives the definition

9. The Clinical Interaction Data Decision • Exchange of Information between the clinician and beneficiary Implementation Data-Collection Action Action

10. Decision-making Implementation Data-Collection The Clinical Process Decision Data • Connected Interactions Action Simple! Almost a truism!

11. Action Decision Could it be Simpler? Decision-making Data Data-Collection May be, Because decision-action are two sides of the same coin.

12. Action Data Could it be Simpler? Decision-making Decision Data-Collection Alternatively, action-data are also two sides of the same coin. But…

13. Decision Action Data Information System Decision Data

14. Decision Action Information System • Action & IS are the key players • Data & Decisions are Messages between them • Information System interfaces with the Action (real world) via • data (input) • Decisions (output) • For IS the action is represented by its 2 aspects • Data • Decisions Data

15. Could it be Simpler? Information World Decision-making Decision Data Implementation Data-Collection Action Concrete World But Actions Require real world!

16. Decision Data Data Decision Could it be Simpler? Information World Action Concrete World Yes, Because we can play around as we wish in abstract world! (unlike the real one)

17. The Clinical Process - Chain Information World Action Action Decision Data Data Decision Action Action Concrete World A Clinical Process Plan with a defined start and end is a Protocol

18. Data Decision Data Decision The Clinical Process - Chain Information World Action Action Concrete World

19. Data Data Data Decision Decision Decision Action – The Middleware Domain A Action Domain B Action Action

20. Clinical Process as a Skeleton Associated Process • Few things that cannot be mapped to the elements of Core Process • Proves that clinical process is the core • Gives unlimited extensibility Data Data Decision Action Decision Action Core Process Action Action

21. Future Present The Protocol (Clinical Process) • Medical Informatics Tools • AI & DS • Vocabulary Tools • Telemedicine • Data Standards • Multimedia Access • Data Entry • EPR Attached Processes Protocol – The Great Integrator

22. Clinical Process - Ingredients Data Sources • Symptoms • History • Findings • Clinical Signs • Results of Tests • Record of Action • Just action being performed may be all that needs to be recorded at times

23. Clinical Process - Ingredients Data Characteristics • May be • “No data” • Non clinical data • Processes and decisions • Non-linear • Ad hoc • Uncertain • Incomplete • Inaccurate

24. Clinical Process - Ingredients Data Contributes to • Decision-making • When? • Immediate – Trigger • Future • How? • Directly • In combination with other data • May be part of input-set of several different decision-making operations

25. Clinical Process - Ingredients Decision-making Inputs • Patient-Data • Immediate past • Combined with previous data • Setting-Data • Knowledge • Actions that are possible in a given situation • Relative Risks & Benefits of each Action & Inaction

26. Clinical Process - Ingredients Decision-making Outputs • Decision-action couples • One or more • May be done

27. Clinical Process - Ingredients Decision-making Characteristics • May be done by different actors • Machine • Local inference tool • Remote inference tool • Human • Clinician • Local referred expert • Remote expert • Immediate or deferred

28. How a decision is made? Action • The inference mechanism based on the external information changes the abstraction • The inference mechanism then decides what action to implement and also takes into consideration the abstraction changes brought about most recently Abstraction

29. Clinical Process - Ingredients Decision Characteristics • Abstract version of action • May have varying level of confidence • May be more than one

30. Clinical Process - Ingredients Action Characteristics • Concrete version of decision • Not always an outcome of decision • Middleware of Clinical Process • Links sub-processes • Links processes in different layers

31. Clinical Process - Ingredients Action (Continued) Characteristics • Always returns data – Diagnostic and Treatment actions are same • Will have Time, Place and Actor • Different from action as in OO representations (not on an object)

32. Clinical Process - Ingredients Action Outputs • Data

33. Thank You

34. Decision Data Action Proteus and Clinical Process Decision-making Abstraction and Inference making LUME Inference PIDEs • Connected Interactions Action Data-Collection Implementation Implementation Data-Collection CIPHER and Proteus