Profiles of care are sets of guidelines developed through medical consensus and a retrospective analysis of medical records. The identification of the diagnostic steps and the associated procedures and therapies, may lead to an approach of resource management and control based on the monitoring of the clinical process. A prototype is to be developed and tested in different European clinical environments. Telematics' requirements for the exchange of data with existing information systems of the partner hospitals along with data structure requirements for transmission of data within future European networks will be identified.
An innovative universal tool is being developed to enable a critical m economical assessment of past cases and to guide in the selection of the most ef when confronted with a new patient.
Clinical and medical work produced the data the profiles of care (POC) approach in respect of the 2 clinical domains: cancer diseases. Data from these exercises has been compared and reviewed so as to deve model. The sequence of clinical activities has been identified to provide an app being implemented on a prototype informatics system. Differences in approaches a at different sites and different countries have been identified. Work was undert a sound framework within which clinicians and medical teams at different sites c particularly to procedures and common terminology.
The deliverables supporting are:
system macro specification;
The technical approac require the early establishment of a prototype which can be built and replicated under different organisational and technical circumstances. This equipment will a telecommunications capability permitting the exchange of relevant data between to form the basis for future opportunities through wide area networking. The sys to be technically robust, be built upon an effective platform capable of enhance of being utilized in open systems mode.
The deliverables supporting this activi macro specification;
At a clinical providing a valuable contribution to developing effective methods of providing e care. In relation to telematics, the project is supporting the emerging standard to health informatic standards.
TECHNICAL APPROACH AND KEY ISSUES
Two medical domains are being considered. These are (a) cancers for which treatment protocols exist and (b) cardiovascular disease, for which several therapeutic options may exist for the same condition. The incidence of both is high in most European countries, giving rise to a high morbidity and a significant premature death rate. Project objectives relate to the accurate identification and appropriate treatment of a condition which is most likely to result in efficient use of resources and a successful result for the patient.
The retrospective analysis of treated cases for each speciality area is to provide the frequency distribution of treated cases. Using this analysis as its foundation, a first draft of the profiles of care was prepared and discussed by the Medical Teams. Consensus is to be reached on the contents of each profile through project meetings, project workshops and concerted actions at the Programme level, when appropriate.
A key issue for effective collection and exchange of medical data, is the availability of a coding and classification system to reduce variability in terminology and clinical practice. Various options, already available on the market have been considered. Experimental use of the READ classification system is underway.
The project infrastructure consists of dedicated computer facilities, linked within different partner hospitals. Information and telecommunication technology, conforming to accepted OSI standards, is being used to support development. The system is being designed and constructed to allow and encourage maximum accessibility for clinicians whose participation is considered vital in developing the demonstration prototype with the potential to become a marketable product. The results of the system will be tested for functionality, and will also be reviewed against medical, scientific and ethical criteria, as part of the project's quality assurance methods.
RELATIONSHIP TO PREVIOUS WORK
The proposal is a natural development of the interests of the various partners and a follow- through of work being carried out by them. During the development phase of the conceptual model of the profiles of care system existing iso-resource and iso-severity systems have been analysed and assessed for their applicability to the objectives of the project.
The European clinical partners associated with this project identified the clinical activities and associated information needed to construct a generic profile of care model. This model incorporates: treatment objectives, principal or secondary diagnoses, treatment procedures and therapies, working or final diagnoses. Partners also expect to gather representative data describing different characteristics of hospital services and to develop, on this base, a set of indicators and criteria for quality assurance. A permanent European network may be established to continue the exchange of key data and information relevant for future developments and studies.
RELATIONSHIP TO OTHER PROJECTS AND ACTION
The project is undertaking concertation activities as appropriate under the current phase of the AIM programme. Initiatives are underway with Project Line 7. Future actions will include a closer working relationship with GEHR and DILEMMA for the development of consensus on clinical protocols and Project Line 1 for discussions on the medical records.
TESTBED AND VERIFICATION
Technical and medical acceptance of the system will require conformance to existing and emerging standards for the recording, processing and transmission of medical information. To achieve this, the system must have the capacity to list disease processes and process entities reliably and sensibly and also have the capacity to be able to yield a measure of the relative burdens and benefits of the alternative intervention modalities. The system must have the capacity to capture good quality and appropriate data, conforming to accepted classification and coding systems. It must incorporate the terminology and nomenclature of different strata of health care, whether technical or medical, yet be expandable to allow for progressive development. It must be secure and have the requirements to meet patient confidentiality.
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