WG II pr EN 13940 System of Concepts

WG II pr. EN 13940 System of Concepts Supporting Continuity of Care Magnus Fogelberg convenor CEN TC 251 WG II terminology and knowledge bases SVENSK FÖRENING FÖR MEDICINSK INFORMATIK pr. EN 13940 revision SWEDISH FEDERATION FOR MEDICAL INFORMATICS M. Fogelberg 2003 -06 -02 1

WG II Not clin ical ter pr. EN 13940 revision minolo gy M. Fogelberg 2003 -06 -02 2

WG II Concepts in continuity of care pr. EN 13940 revision M. Fogelberg 2003 -06 -02 3

ENV 13940 CONTsys WG II Approved by TC 251 19 December 2000 Decision to revise to an EN by TC 251 18 March 2003 Task force appointed First meeting 17 May, 2003 Now pr. EN 13940 Possible European Standard end 2004 pr. EN 13940 revision M. Fogelberg 2003 -06 -02 4

WG II CONTsys - a result of identifying, analysing and modelling different concepts whithin the continuity of care Clinic A GP A out-p Clinic B A in-p B in-p pr. EN 13940 revision Clinic B Home B out-p Home GP M. Fogelberg 2003 -06 -02 5

Contents of CONTsys WG II 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 pr. EN 13940 revision M. Fogelberg 2003 -06 -02 6

WG II What use do you have of the CONTsys? How can you use the CONTsys in you daily work? pr. EN 13940 revision M. Fogelberg 2003 -06 -02 7

Implementation of continuity WG II To use as objects in processes To make work flow descriptions comprehensive pr. EN 13940 revision M. Fogelberg 2003 -06 -02 8

SAMBA WG II Swedish process modelling project Identify healthcare core process Analyse former process models Adapt process terminology to CONTsys pr. EN 13940 revision M. Fogelberg 2003 -06 -02 9

Processes in SAMBA WG II One process identified which turns out to be quality managing In this process – as in others – CONTsys concept are identified pr. EN 13940 revision M. Fogelberg 2003 -06 -02 10

Process WG II set of interrelated or interacting activities which transforms inputs into outputs (ISO 9000: 2000) pr. EN 13940 revision M. Fogelberg 2003 -06 -02 11

Process WG II Actor Responsible for the process Condition Goal Process Condition Timecourse pr. EN 13940 revision M. Fogelberg 2003 -06 -02 12

Process WG II set of interrelated or interacting activities which transforms inputs into outputs (ISO 9000: 2000) 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 pr. EN 13940 revision M. Fogelberg 2003 -06 -02 13

Actors in healthcare WG II 0. . * 1. . * is supported by pr. EN 13940 revision M. Fogelberg 2003 -06 -02 14

Contact WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 15

Encounter WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 16

Contact , suggestion of revision WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 17

Contact, model minimising WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 18

Contact element WG II care mandate 1 contact period_of_service concerns encompasses 1 1 1. . n 0. . n 1 is issued by healthcare party 1. . n 1 1. . n healthcare service contact element is performed in 1. . n 1 0. . n 1. . n delineates is usede against 0. . n 1. . n health issue thread 1. . * handles pr. EN 13940 revision 1 episode of care 1 is subject for 1 is part of 0. . n M. Fogelberg 2003 -06 -02 19

Person / Patient WG II hc provider Receive demand for care Assessment of demand for care service repository ”do we manage this? ” Assessment of demand for care Demand for care HC commitment --- state demand for care ”fetch type descriptions” external actions Create plan Assess care need Care need Plan continued care Declining with referral * perceived condition 1: M Individual adaption result/response Commitment plan --- • Program of care • 1: M * Objective Perform HC activity Performed HC activity ---* Result continue according to plan Assess with respect to plan objective Care assessment ---* Degree of fulfillment * Remaining needs Terminate commitment Commitment end change / redefine HC commitment pr. EN 13940 revision M. Fogelberg 2003 -06 -02 20

Flow chart / process model WG II 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 pr. EN 13940 revision M. Fogelberg 2003 -06 -02 21

Process WG II Healthcare process Decision process Core process Communication process pr. EN 13940 revision M. Fogelberg 2003 -06 -02 22

Process WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 23

Process WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 24

Process WG II (Patient’s process) (Process of resources) Decision process HC provider process Core process Communication process (Process of other HC provider) pr. EN 13940 revision M. Fogelberg 2003 -06 -02 25

Process WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 26

Process WG II Core process Decision process Communication process pr. EN 13940 revision M. Fogelberg 2003 -06 -02 27

4 Quality management system ISO 9001: 2000 WG II 4. 1 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. pr. EN 13940 revision M. Fogelberg 2003 -06 -02 28

4 Quality management system ISO 9001: 2000 WG II 4. 1 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. pr. EN 13940 revision M. Fogelberg 2003 -06 -02 29

Connection SAMBA - CONTsys WG II Processteps SAMBA Activities SAMBA Concepts CONTsys Terminology CONTsys pr. EN 13940 revision M. Fogelberg 2003 -06 -02 30

The processes WG II Core process refinement object: perceived patient condition/health issues Decision process refinement object: mandate, decisions Communication process refinement object: information pr. EN 13940 revision M. Fogelberg 2003 -06 -02 31

Demand for care WG II Core process assess condition perceived condition Decision process decision on assessment d_f_c to d_f_c not to be assessed Communication process demand for care received d_f_care referred demand pr. EN 13940 revision M. Fogelberg 2003 -06 -02 32

Demand for care WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 33

Demand for care WG II Core process assess condition perceived condition Decision process decision on assessment d_f_c to d_f_c not to be assessed Communication process demand for care received d_f_care referred demand pr. EN 13940 revision M. Fogelberg 2003 -06 -02 34

Healthcare mandate WG II healthcare commitment perceived condition d_f_c to be assessed match against service repository identify health issues condition treatability decide on healthcare mandate received d_f_care healthcare no mandate referred case pr. EN 13940 revision M. Fogelberg 2003 -06 -02 35

WG II derives from 0. . n mandate 1 0. . 1 health care party is assigned to 0. . n care mandate 1. . n 1 is legitimated by Person on own behalf 1 demandate 1 has pr. EN 13940 revision M. Fogelberg 2003 -06 -02 36

WG II 1 health care party 1. . n is assigned to issues demand expressed by a health care party that health care services be provided to a subject of care. is permitted by 1 issues 0. . n demand for care mandate 1 triggers 1 is sent to 1 is issued by 1. . n 1 is legitimated by 0. . n is received by 0. . n 1 0. . n demandate 1 1 healthcare provider 1 Person on own behalf 1 har pr. EN 13940 revision M. Fogelberg 2003 -06 -02 37

Healthcare mandate WG II healthcare commitment perceived condition d_f_c to be assessed match against service repository identify health issues condition treatability decide on healthcare mandate received d_f_care healthcare no mandate referred case pr. EN 13940 revision M. Fogelberg 2003 -06 -02 38

Health issue thread, hc objective WG II health issues get supplementary information refined health issue collection delineate health issue thread to be treated, define healthcare objective healthcare mandate healthcare objective match objective against available services received d_f_care pr. EN 13940 revision M. Fogelberg 2003 -06 -02 39

Health issue WG II issue related to the health of a subject of care, as defined by a specific health care party pr. EN 13940 revision M. Fogelberg 2003 -06 -02 40

Health issue thread WG II abstract construct linking several health issues, defined by a health care party pr. EN 13940 revision M. Fogelberg 2003 -06 -02 41

Health issue thread, hc objective WG II health issues get supplementary information refined health issue collection delineate health issue thread to be treated, define healthcare objective healthcare mandate healthcare objective match objective against available services received d_f_care pr. EN 13940 revision M. Fogelberg 2003 -06 -02 42

Program of care WG II choose activities refined health issue collection healthcare objective decide care planning decision conditions in care plans establish program of care list of activities pr. EN 13940 revision M. Fogelberg 2003 -06 -02 43

Care planning, decision support WG II clinical guidlines global health issue 1. . * protocol organisation health issue 1. . 1 program of care subject of care/ organisation health issue thread care plan subject of care/ healthcare professional health issue thread pr. EN 13940 revision M. Fogelberg 2003 -06 -02 44

Healthcare objective, program of care WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 45

Program of care WG II choose activities refined health issue collection healthcare objective decide care planning decision conditions in care plans establish program of care book resources, record program of care list of activities pr. EN 13940 revision decide usage of planned activities updated activity list M. Fogelberg 2003 -06 -02 46

Healthcare activity WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 47

Healthcare service WG II pr. EN 13940 revision M. Fogelberg 2003 -06 -02 48

Program of care WG II choose activities refined health issue collection healthcare objective decide care planning decision conditions in care plans establish program of care book resources, record program of care list of activities pr. EN 13940 revision decide usage of planned activities updated activity list M. Fogelberg 2003 -06 -02 49

Activities WG II conditions in care plans perform investigation investigated condition assess condition decision to perform assessed condition update healthcare objective match objective against available services updated activity list pr. EN 13940 revision M. Fogelberg 2003 -06 -02 50

Activities WG II perform treatment assessed condition healthcare objective update program of care list of activities program of care decide usage of planned activities book resources, record program of care treated condition decision to perform updated activity list pr. EN 13940 revision M. Fogelberg 2003 -06 -02 51

Quality check WG II treated condition decision to perform evaluate result match condition against objective assessed condition check quality updated activity list quality assessment record activity perceived condition in relation to healthcare objective update healthcare objective record component Healthcare record process pr. EN 13940 revision M. Fogelberg 2003 -06 -02 52

End of process – objective fulfilled WG II perceived condition in relation to healthcare objective assessed as fulfilled perceived condition healthcare objective decide to discharge decision issue discharge message record component pr. EN 13940 revision discharge message M. Fogelberg 2003 -06 -02 53

End of process – objective not fulfilled WG II updated healthcare commitment perceived condition in relation to healthcare objective assessed as not fulfilled healthcare objective update healthcare mandate check health issues, identify new ones perceived condition healthcare mandate record component pr. EN 13940 revision M. Fogelberg 2003 -06 -02 54

Health issue thread, hc objective WG II repetition if objective is not fulfilled health issues get supplementary information refined health issue collection delineate health issue thread to be treated, define healthcare objective healthcare mandate healthcare objective match objective against available services record component pr. EN 13940 revision M. Fogelberg 2003 -06 -02 55

Referral to other healthcare provider WG II assess health is- refined health sues to be referred issue collection healthcare objective decide referral decision health issues in referral delineate health issue thread in referral no service available health issue thread issue referral pr. EN 13940 revision demand for care M. Fogelberg 2003 -06 -02 56

Other healthcare provider’s start WG II assess condition decision on assessment demand for care received d_f_care perceived condition d_f_c to d_f_c not to be assessed referred demand pr. EN 13940 revision M. Fogelberg 2003 -06 -02 57

To be considered in the revision WG II 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 pr. EN 13940 revision M. Fogelberg 2003 -06 -02 58

WG II Thank you! pr. EN 13940 revision M. Fogelberg 2003 -06 -02 59