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Customisation Environment for Multimedia Integrated Patient Dossiers

Objective

NUCLEUS is a project developing the prototype of an integrated patient dossier. This is based upon the intelligent Act Management concept developed in the ESPRIT project RICHE. Together with the prototype dossier, facilities are developed to allow customisation of the dossier and its contents for the various end-user categories.
The research concerns the development of a prototype of an integrated dossier which includes the professional information administration facilities en completeness and accuracy of patient data. Data protection and access control is addressed.

The work has concentrated on the domain of business analysis, user r the appropriate structure of the architecture. Important results were achieved o management and the technical facilities of the project. The activities on concep on the development of more detailed computational and engineering models, in pre actual development of the components of the prototype, were initialized and part the business analysis activity, the professional use of the patient dossier in t processes of the HCP was analysed and modelled. Typical case studies were formaluniform representation of the functional manipulations of the patient dossier wa Significant preparatory activities were performed on the development of key conc requirements activity, the user requirements for the patient dossier system were business analysis.

Subsequently, the end user abstraction level of the patient specified. The end user interactions with the system were identified and classif precise data exchanges on the occasion of such interactions. Moreover, the local constraints between end user interactions were pictured. This abstraction level has been published in a formal deliverable.

Detailed planning and management of work was performed, and guidance was provided on substance methodologies, techno organization of the respective activities.

An Architecture Base Document has be which the scope, structure and content of the architecture work have been specif
End-users of the NUCLEUS patient dossier system are all kinds of health professionals: key criterion is their need to maintain, communicate and access a patient dossier, probably beyond the scope of their own professional practice.

A patient in the hospital or its outpatient facilities has one unique patient dossier, containing all ever recorded data on his health status and on the care for his benefit. This patient dossier notion comprises the speciality or individual (paper) patient dossiers usually held by the respective health professionals. The RICHE patient dossier has implemented this patient dossier notion, with links between the various components of the dossier.

NUCLEUS starts on the premise that all data contained in the patient dossier are produced during the performance of (actual) acts for the patient's benefit, more precisely: on the occasion of (actual) act status changes. Data about the act and patient dossier data are stored in (metaphorical) "forms": as data objects. These implement the basis for the advanced structuring and navigation through the so-called Patient Reference Dossier (PRD). NUCLEUS develops a cross-section of the functions to manage the PRD.

Acts are performed by health professionals. They need the facilities to specify which acts they can perform, under what circumstances, and how these are represented in the patient dossier: they make a "catalogue" of their repertoire of services available to other health professionals wishing to request their services. NUCLEUS develops these Performer Act Customisation (PAC) facilities.

Health professionals (when duly authorised) require access to the patient dossier, as if it were one single entity, irrespective of its actual implementation. PRD acts as a major reference assisting in this access. Some of the access is structured: it follows the structures that have been recorded as the patient's case evolved. Other access is less structured: it requires efficient views of the patient dossier following queries in the mind of the health professional. Some of these views may be recurring, others may be ad-hoc. NUCLEUS develops these Access Customisation (AC) facilities.

Consistency, completeness and accuracy of patient dossier data are vital. Moreover, the required technologies cause significant system administration provisions to be planned. Authorisation control is a vital issue in the context of patient dossiers and their dissemination. For these reasons NUCLEUS develops Professional Information Administration (PIA) facilities.

Through Performer Act Customisation the health professional has complete freedom to specify the scope and content of his recordings in the patient dossier. Hence, NUCLEUS does not develop the content of a patient or medical dossier: it develops a structure and facilities to implement any such dossier, subject to the professional judgement of those involved, on the basis of strict application of Act Management concepts.

In its first year NUCLEUS has analysed the professional use of the patient dossier, formulated the user requirements for its solution, and developed the end-user interactions in detail. In its first and second year NUCLEUS further specifies the detailed conceptual, computational and engineering models for its solution. The architecture basis is fully conformant with that of the RICHE framework. In its second year NUCLEUS develops the respective components of its prototype; these are integrated towards the end of the second and in the beginning of the third year. Finally, the integrated prototype is demonstrated, and validated in the market of end-users.

NUCLEUS Features

NUCLEUS develops the structure of the integrated multimedia patient dossier, based on the principles of Intelligent Act Management, as explicated in RICHE. Moreover, NUCLEUS elaborates the facilities to customise the patient dossier according to the requirements of the respective health professionals in their various roles.

NUCLEUS aims to achieve these ambitions by developing an integrated demonstrator on the basis of the necessary components of a system that implements the required functions.
The NUCLEUS integrated multimedia patient dossier is available to all categories of health professionals. They can configure (their part of) the integrated dossier according to their needs, both structurally and ad-hoc. The latter permits them to create virtual dossiers, representing specific views of the actual dossier.

NUCLEUS considers health professionals as any health care worker with full professional qualifications (according to WHO or similar standards) who is qualified and capable to care for those suffering from or affected by illness, to prevent illness and/or to promote community and/or individual health. Health professionals include physicians, nurses, medical support staff, paramedical staff, etc. Moreover, certain categories of ancillary services' staff and administrative professionals may under certain conditions be considered as health professionals.

The NUCLEUS patient dossier for a patient contains all recorded data on the patient's past, present and planned health situation, and on the past, present and planned care for the patient's benefit, irrespective of the ownership of these data, their physical location, their format and their medium. The NUCLEUS patient dossier comprises all specific (speciality, departmental, etc.) patient dossiers usually held by individual health professionals and departments.

Every patient has one unique NUCLEUS patient dossier. In practice, every patient has one unique NUCLEUS patient dossier in the scope of one single institution.

The NUCLEUS patient dossier is integrated: it is a representation of the patient dossier that allows everything contained or referenced in the patient dossier to be accessed, extracted and retrieved as if the dossier where one single entity: irrespective of the applied format and irrespective of the originally supplying health professional (subject to functional requirement and access authorisation).

The NUCLEUS patient dossier is based on extensive application of the "electronic forms" metaphor: in these forms, associated with the historic evolution of the patient's health case (structured in actual acts), the professional data are recorded, together with information about links with other professional data, and typical methods to manipulate the dossier data. NUCLEUS electronic forms are (composite) data objects, exploiting an object oriented formalism which allows optimum structuring of the implementation of and navigation in the patient dossier.

NUCLEUS develops two kinds of customisation: - through Performer Act Customisation, it allows health professionals in the performer role to specify and customise the content and rules of "their" activities for the patient's benefit; through Access Customisation, it allows health professionals to construct views of the patient dossier according to specific information needs.

Performer Act Customisation provides the following facilities:
- The facilities to adapt the knowledge about classes of acts to the professional paradigm of the performing health professional: Performer Act Customisation of the knowledge about classes of acts.
- The facilities to adapt and relate the recording of patient dossier data (particularly of Act Professional Contents) to the professional paradigm of the performing health professional: Performer Act Customisation of the Act Professional Contents.
- The facilities to support the usage of customised Act Professional Contents by the performing health professional and other authorised users (like, for example, requesters): the effects of Performer Act Customisation when feeding data into customised Act Professional Contents.

Access Customisation provides the facilities to request, access, retrieve and present patient dossier data in line with the professional paradigm and requirements of the user who needs to consult the patient dossier.

The NUCLEUS patient dossier is structured by means of the Patient Reference Dossier: these functions convert a heterogeneous and distributed physical storage of patient professional data (usually in the direct environment of the "owner" health professional) into a notion of the patient dossier which makes it appear homogeneous and integrated to any authorised health professional in the hospital.

Special attention is given to aspects of authorisation, security and consistency preservation of the integrated dossier. Facilities to communicate dossier extracts between application modules (across the nodes of distributed networks) are provided. Facilities of dynamic manipulation of (partial) data models in order to specify the dossier view required by a health professional are provided. Technology for the exploitation of structural and virtual links between dossier data objects are applied. These activities are largely developed in the frame of Professional Information Administration.

Plans

NUCLEUS is planned to terminate in the course of 1994. Until its completion the following summarises the plans of the project: -
- (Continuation of) development and maintenance of consistent conceptual data and process models for the NUCLEUS Patient Dossier system.
- Finalisation of the detailed computational models for the main components of the NUCLEUS Patient Dossier system.
- Further development and finalisation of detailed engineering models (in particular interface standards and interworking protocols) for the main components of the NUCLEUS Patient Dossier system.
- Development of common services for the NUCLEUS Patient Dossier prototype system and its components.
- Development of prototypes of the main components of the NUCLEUS Patient Dossier system.
- Finalisation of the development, and quality assurance of prototypes of the main components of the NUCLEUS Patient Dossier system.
- Integration of the main component prototypes into a single working prototype of the NUCLEUS Patient Dossier system.
- Post-integration testing and quality assurance of the single working prototype of the NUCLEUS Patient Dossier system.
- End-user acceptance, quality assurance and validation, demonstrations of the single working prototype of the NUCLEUS Patient Dossier system.
- The project is appropriately managed, guidance is given to the work of the project on material, conceptual, methodological and other issues, and proper concertation and co-ordination with the AIM Programme as a whole and with other parallel projects and programmes is assured.
- Preparations and plans are made for the integration and quality assurance of the component prototypes and of the single working prototype of the NUCLEUS Patient Dossier system.
- Appropriate technical management of the project is provided, covering development and integration issues, and in particular co-ordinated application of the various technology platforms.
- Adequate publications and presentations of the mission, objectives, progress and results of the NUCLEUS project will be made.

Coordinator

Groupe RICHE S.C.
Address
C/o Sig Services B.v., P.o Box 14074
3508 SC Utrecht
Netherlands

Participants (6)

ACTIR-Santé SA
France
Address
68 Route De Versailles
78430 Louveciennes
Bull Europe
France
Address
68 Route De Versailles
78430 Louveciennes
Groupe RICHE S.C., c/o VanderWerff Consult B.V.
Netherlands
Address
Vrouwgeestweg 20
2481 KN Woubrugge
IRISH MEDICAL SYSTEMS
Ireland
Address
18, Avoca Ave, Blackrock
Dublin
Information Management Centre of the NHS
United Kingdom
Address
15 Frederick Road Edgbaston
B15 1JD Birmingham
Università Cattolica del Sacro Cuore
Italy
Address
Largo Agostino Gemelli 8
00168 Roma