CCTOS: Problems Solving Issues

• Issues:
  • Up to now many medical archives, as well on paper as well on electronic media, contain essentially descriptive and narrative data.  Events, like consultations and admissions, are described as separate reports, one report for every new contact.  In fact not much more than a simulation of the old methodology on paper.
    
  • Many medical records systems contain a lot of raw data, but often lack any synthesis of the problems.
    
  • Many regions have a great shortage of experienced healthcare staff, particularly in developing regions.  Remote small health centers must relay on persons having relatively short nursing education.
    
  • Some advanced decision support system already exist, but are not yet largely available. Standardization of the observations remains a major issue.
    
• Approaches:
  • Since the essential healthcare goal is to contribute to solve problems, the essential goal medical information management, going beyond simple narrative documentation.  Today informatics technology makes that possible.
    
  • Medical "work methodology":
    • Collaborations in a Care Team require agreements about how to manage and to share patient information. 
      
    • Clear guidelines are particularly important for beginners.
    • Orderly managed patient information is a prerequisite before access to medical knowledge bases would become useful.
    • Orderly managed information is always a factor of care quality.  It prevent that some issues would be forgotten and neglected.
      
    • Also a prerequisite before advanced decision support could be implemented in the future.
      
  • The recommended approach is to make at least clear distinctions between Observations, Problems and Activities and to pay attention to the links between these 3 types of informations.
    
    • Observations:
      • Record the facts, as what the patient did say, what you did see, what has been measured, etc...  Take notes about what is obvious and should initially be token without any assumptions.  Beginners can learn relatively quickly how to take notes about observations.
        
    • Health Issues assessments:
      • Given the available observations, assessments will be made about one or more health issues.  Heath Issues may be preliminary concerns about a set of abnormal finding.  May later become a diagnose.  Health Issue include also risk factors.
      • All care provider whatever they roles, should have a minimum of overview of the problem list.  Of course depending on their specialised roles, will go deeper in the details of their domain.
        
    • Activities:
      • Decision about activities are based on the current understanding of the Health Issues by the doctor, often not yet any obvious diagnose but just provisional hypothesis. 
        In the future some Activities will become automatically proposed on the basis of the current Health Issues so far identified.  For example which next questions to the patient, or which test seems to have the highest priority, on the basis of what is already known as possible Health Issues.
        
      • Activities include a wide range of possible procedures, as well intended for more explorations, as well for treatments. 
        
      • Since Activities necessitate resources, they have to be declared to the administration who need to make invoices.
      • In principle all activities will result in some kind of conclusion, as e.g. a lab report or a note about the effect of a treatment.  These results will increment the above set of Observations and may introduce a next iteration of assessments and new activities.
  • Schemas:
    
    • Semantic web technologies will be here very useful in order to represent:
      • Inside the patient record, the links between Observed facts, identified Health Issues and ordered Activities.
      • Links from the patient problems to external medical knowledge bases.
        
    • Schematic model:
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