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Zdravković, M., Trajanović, M., On the extended clinical workflows for personalized healthcare, International IFIP Working Conference On Enterprise Interoperability (IWEI 2013), March 27th - 28th, 2013, Enschede, The Netherlands. In: M. van Sinderen et al. (Eds.): IWEI 2013, LNBIP 144, pp.65-76, 2013
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On the extended clinical workflows for personalized
healthcareMilan Zdravković and Miroslav Trajanović
Faculty of Mechanical Engineering, University of Niš, Serbia
International IFIP Working Conference On Enterprise Interoperability (IWEI 2013), Enschede, The Netherlands
Electronic Health Record (EHR)• “The Electronic Health Record (EHR) is a longitudinal
electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports.”*
*Health Information Management Systems Society
Benefits from EHR
Benefits from EHR
• automation and streamlining of the clinical workflow
• evidence-based decision support for diagnosis or treatment prescription (based on accurate and complete record of a clinical patient encounter),
• support to other care-related activities such as billing, reporting and quality management
hospital administrator extracts the billing data
physician assesses the effectiveness of treatments
nurse reports a reaction
researcher analyzes the efficiency of medications
HER and clinical workflow
EHR and clinical workflow
Treatment managementService delivery
Registration
Admission
Order Lab services
Order Rad services
Order Pha servicesTreatment
planningTransfer or discharge
Order oth services
CPOE Entry
EHR
Master Patient Index - MPI
Registration, admissions, discharge, and transfer (RADT)
Computerized Physician Order Entries (CPOE) permit clinical providers to electronically order laboratory, pharmacy, and radiology services.
Each activity is facilitatedby a relevant system or systemmoduleEach of these systems mustcontribute to EHR
Virtual Physiological Human
The Virtual Physiological Human (VPH)
• a unifying framework that enables and practically benefits from the integration of inter-disciplinary data and observations about human’s biology – integration of– physiological processes across different length and time
scales– descriptive data with predictive models– across disciplines
• aiming at– personalized care solutions– preventative approach to treatment of diseases
Custom medical products
Custom medical products
Motivation and problems
Motivation and problems• Manufacturing of the custom medical products is considered
as one-of-a-kind manufacturing, where the customization requirements often affect not only a principal manufacturer but also its suppliers.
• The manufacturing of a custom medical product could also include high-tech services by different suppliers, which are based on the models which need to be exchanged– Typically, some of these services precede supply chain planning phase
because their results often determine the basic product’s topology.• “high complexity of the supply chain planning and execution
in custom medical products manufacturing”.
Methodology
Methodology
• Combine practices of collaborative networked organizations with clinical practices
• Steps– Define extended workflow in the context of
Electronic Health Records (EHR)– Identify systems infrastructure and
interoperability issues– Identify models infrastructure
Extended clinical workflow
VE’s Resource Planning System (VERPS)
VBE’s Resource Planning System (VBERPS)
Conceptual product design system (PDS)
Procedure/Treatment planning system (PPS)
Treatment managementService delivery
Registration
Admission
Order Lab services
Order Rad services
Order Pha services
Treatment planning
Transfer or dischargeOrder oth
services
EHR
Order cust services
Proc/Treatplanning
Custom prod design
Source product
Manufacture product
Deliver product
Installproduct
Clinical Information System (CIS)
VE formation
VE execution VE dissolutionVBE mngmtExtended clinical workflow (simplified)
CISClinical info
system
PPSProcedure
planning system
PDSProduct design
system
VBERPSVBE planning
system
VERPSVE planning
system
CISClinical info
system
PPSProcedure
planning system
PDSProduct design
system
VBERPSVBE planning
system
VERPSVE planning
system
Send EHR
Write procedure report to EHR;Read EHR from CIS
Send procedure plan
Read procedure features
Create orders;
Send procedure report
Associate selected partners to product concept
Report on the use of resources;Request VE change
Write product features;Annotate parametric CAD model
Allocate resources for procedure
Supply chainmodel
VBEmodel
Productmodel
Proceduremodel
EHRmodel
Systems interoperability issues
Case study
Case study: Custom orthopedic implants manufacturing
• Made of different types and designs of fixtures and scaffolds
• Associated services– Pre-operation planning, digital reconstruction of
the bone, analysis of biomechanical properties, ethical review
Systems and models infrastructure
SOURCE
Pre-OP-SysSystem for
pre-op planning
Impl-D-SysConceptual implant
design system
SC-CONF-SysSupply Chain
configuration system
Productontology
CAD Featureontology
Configuration problem ontology
Explicit SCOR Ontology
Implicit SCOR Ontology
Pre-Operation process ontology
Anatomy ontology
CI-SysClinical information
system
EHRontology
O
P
D
S
MDe
I
N
plan-part-sourcingplan-part-
manufacturing plan-part-delivery
plan-services-sourcing
plan-services-implementation
plan-services-delivery
source-scaffold
source-inner-fixture make-scaffold
make-inner-fixturesource-digital-reconstruction
source-bio-mechanical-analysis
implement-digital-reconstruction
implement-bio-mechanical-analysis
deliver-bio-mechanical-analysis
deliver-digital-reconstruction
deliver-scaffold
deliver-inner-fixture
make-custom-implant
deliver-custom-implantsource-custom-implant
MAKE
OpenERP-SysEnterprise Resource
planning system
Local OpenERP ontology
DELIVER
Systems and models infrastructure
Thank you for your attentionQ&A
Milan Zdravković and Miroslav TrajanovićFaculty of Mechanical Engineering, University of Niš, Serbia