Collaborative Care Team, Medical Model
and Informatics Object Model
( version 1.1 )
in low resources and Free Software Environments
- Medical Model:
- Patient centric, integration:
- A patient may need several healthcare professionals,
regardless of their locations across Internet.
- Rather than softwares exclusively targeted at specific
clients, as GP, specialist, nurse, pharmacist, ....
- That said different professional groups may need different
presentations from the common data base.
- Coordination of the patient health:
- ( 1 ) Start by the Global Coordination at Primary Care
- ( 2 ) Then when necessary, request advices and technical
procedures from specialists.
- Support of problems solving, Medical methodology:
- Look at the care process, rather than narrative reports
from successive patient contacts.
- Permanent maintenance of a global picture, intended for
- Iterative model between 3 steps:
- Observed facts
- Identification of
"problems", i.e. assessments about these facts. A problem being
well an abnormal finding needing
more analysis, as well a diagnose needing treatment.
- Activities decided in function of the identified
The results of these activities provide new observations to be worked
out during the next iteration.
- Iterative Care
process , Iterations and Patient record
- Clinical information:
- Support for the necessary attributes or "clinical
modifiers", degree of certainty, intensity, lateralization, .... rather
than the exclusively black or white simplifications intended for
- Contextual Training:
- Rather than textbooks, provide background medical
information related to the encountered cases.
- Development issues anywhere:
- Although low resource regions have particularly severe
needs, do not forget that similar issues also exist in developed
countries, where hospitals are full of excellent very hight-tech people
but where there may be relative poor coordination.
- Technical Model:
- Sharing know-how in Open Source:
- Most medical requirements are similar everywhere and many
software components are already freely available in open source.
- NGO and Health Ministries are non profit organizations and
are normally happy
when their resources benefit to as many people as possible. (as far as
they understand to Open Source issues). Why not call fot tenders
including an openess condition ?
- Although hundreds medical Open Source modules are available
in MEDFLOSS, http://www.medfloss.org/
, many are
independent very specialized applications.
- Different implementation sites may want slightly different
sets of modules, as well choices between different variant of the same
- Modularity ans standardization of interfaces are key issues
in order to progress. Modular
Architecture . The focus in my
current experimental work.
- An object model:
- A root class containing the most common properties. Object-Model: (pdf)
- Several levels of derived classes adding specific
- Well a common Database, but different professional groups
have different interests and need adapted presentations.
- A "View" as a selection of a sub-set of Items, to be
and displayed maybe in a specific way.
- In principle click on object you see in order to zoom in
- Possibility to navigate to related information, as a kind
of semantic web.
- Data organization:
- Allow navigation in kinds of "semantic web" networks.
Preference for nodes which can be linked in many ways, rather than
rigid hierarchic structures.
- Semantic links can be useful in 2 ways:
- For individual patient data in order to show in a natural
way an overview of the
relations between the observations, the problems and the ordered
activities: Patient record
- In order to navigate in the relations between concepts of
- Network :
- Avoid unnecessary centralization: A network of
relatively small servers. Any medical
center should have his own local server, going on even if long distance
communication are temporarily unavailable.
- Availability, where possible avoid single point of
- Preference for permanent user sessions at the server side,
containing the persistence and the logic of the applications. Among
other application will include display functions.
Rather than completely "stateless" web servers, handling sequences of
visual web pages, containing each a little logic.
- Event based: when needing something from an other
computer in network,
issue a request and expect an event back from the partner.
However if for any reason, no event is coming back, the user should not
- Experimental Prototypes:
- Version 2011: http://localhost:6540
. For example small isolated medical centers may have a microscope and
internet access but no pathology expert. The experimental generic
patient-centric record can open a sub-window interacting directly on
the server of the specialized IPATH project based in Switserland, in
order to get a second opinion from international experts.
- A new version is in preparations and will become available
on the web. Partners are very welcome to contribute to this
experimental work in a working group of the ISfTeH, mainly in