prEN 13940

1. prEN 13940 System of Concepts Supporting Continuity of CareMagnus Fogelbergconvenor CEN TC 251 WG II terminology and knowledge bases SVENSK FÖRENING FÖRMEDICINSK INFORMATIK SWEDISH FEDERATION FOR MEDICALINFORMATICS

2. Not terms of administration Not clinical terminology

3. Concepts in continuity of care

4. ENV 13940 CONTsys • 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 prEN 13940 • Possible European Standard end 2004

5. CONTsys - a result of identifying, analysing and modelling different concepts whithin the continuity of care Clinic A Clinic B Clinic B A in-p B in-p GP A out-p Home B out-p Home GP

6. Contents of CONTsys • 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

7. What use do you have of the CONTsys? How can you use the CONTsys in you daily work?

8. Implementation of continuity • To use as objects in processes • To make work flow descriptions comprehensive

9. SAMBA • Swedish process modelling project • Identify healthcare core process • Analyse former process models • Adapt process terminology to CONTsys

10. Processes in SAMBA • One process identified which turns out to be quality managing • In this process – as in others – CONTsys concept are identified

11. Process • set of interrelated or interacting activities which transforms inputs into outputs (ISO 9000:2000)

12. Actor Responsible for the process Goal Process Condition Condition Timecourse Process

13. Process 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

14. Actors in healthcare 0..* 1..* is supported by

15. Contact

16. Encounter

17. Contact , suggestion of revision

18. Contact, model minimising

19. contact care mandate period_of_service concerns encompasses 1 1 1 0..n 1 is issued by 1..n 1 1..n healthcare service contact element is performed in 1..n 1 0..n 0..n 1..n delineates is usede against is part of handles 0..n 1..n 1 1 health issue thread health issue episode of care is subject for 1 0..n Contact element 1..n healthcare party 1..* 1..*

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

21. Flow chart / process model • 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

22. Process Healthcare process Decision process Core process Communication process

23. Process

24. Process

25. Process (Patient’s process) (Process ofresources) Decision process HC provider process Core process Communication process (Process of other HC provider)

26. Process

27. Process Core process Decision process Communication process

28. 4 Quality management system ISO 9001:2000 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.

29. 4 Quality management system ISO 9001:2000 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.

30. Terminology CONTsys Connection SAMBA- CONTsys Processteps SAMBA Activities SAMBA Concepts CONTsys

31. The processes Core process refinement object: perceived patient condition/health issues Decision process refinement object: mandate, decisions Communication process refinement object: information

32. receive demand for care received d_f_care Demand for care Core process assess condition perceived condition Decision process d_f_c to be assessed decision on assessment d_f_c not to be assessed Communication process demand for care refer refer referred demand referred demand

33. Demand for care

34. receive demand for care received d_f_care Demand for care Core process assess condition perceived condition Decision process d_f_c to be assessed decision on assessment d_f_c not to be assessed Communication process demand for care refer refer referred demand referred demand

35. healthcare commitment Healthcare mandate identify health issues perceived condition match against service repository condition treatability d_f_c to be assessed decide on health- care mandate healthcare mandate no mandate received d_f_care refer refer referred case referred case

36. derives from 0..n 0..1 mandate 1 health care party is assigned to 0..n care mandate demand mandate 1 1..n is legi- timated by 1 Person has on own behalf 1

37. 1 health care party 1..n is assigned to issues is permitted by 1 0..n 0..n 0..n demand for care care mandate demand mandate 1 1..n is legiti- mated by 0..n 1 is sent to 1 healthcare provider Person har on own behalf 1 demand expressed by a health care party that health care services be provided to a subject of care. 1 issues 0..n 1 triggers 1 0..n 0..n is received by 1 is issued by 1

38. healthcare commitment Healthcare mandate identify health issues perceived condition match against service repository condition treatability d_f_c to be assessed decide on health- care mandate healthcare mandate no mandate received d_f_care refer refer referred case referred case

39. Health issue thread, hc objective get supplementary information health issues refined health issue collection delineate health issue thread to be treated, define healthcare objective healthcare objective healthcare mandate match objective against available services received d_f_care

40. issue related to the health of a subject of care, as defined by a specific health care party Healthissue

41. abstract construct linking several health issues, defined by a health care party Health issue thread

42. Health issue thread, hc objective get supplementary information health issues refined health issue collection delineate health issue thread to be treated, define healthcare objective healthcare objective healthcare mandate match objective against available services received d_f_care

43. Program of care conditions in care plans choose activities refined health issue collection establish program of care healthcare objective planning decision decide care planning program of care list of activities

44. Care planning, decision support global health issue 1..* clinical guidlines organisation health issue 1..1 protocol subject of care/ organisation health issue thread program of care subject of care/ healthcare professional health issue thread care plan

45. Healthcare objective, program of care

46. Program of care conditions in care plans choose activities refined health issue collection establish program of care healthcare objective planning decision decide usage of planned activities decide care planning program of care book resources, record program of care list of activities updated activity list

47. Healthcare activity

48. Healthcare service

49. Program of care conditions in care plans choose activities refined health issue collection establish program of care healthcare objective planning decision decide usage of planned activities decide care planning program of care book resources, record program of care list of activities updated activity list

50. Activities perform investigation assess condition conditions in care plans investigated condition assessed condition update health- care objective decision to perform healthcare objective match objective against available services updated activity list