The methodology and theory of Problem Oriented Portablke Patient Record: the beginig of the way of personalized health

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‘‘Governance of anGovernance of an InteroperableInteroperable
ProvincialProvincial
Electronic Health Record LessonsElectronic Health Record Lessons
Learned inLearned in an Evolving Governancean Evolving Governance
ModelModel’’
A supplement the lecture:
Authors: Bonnie S. CochraneBonnie S. Cochrane, Michelle Gignac, Mike Barron
PS2.2 * Health 2011 Enabling Conference
May 29 – June 1, 2011 TorontoHealthy Outcomes

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‘…eHealth Governance and Benefit:
Good governance increases decision-making transparencyincreases decision-making transparency, encourages
communication and helps define where project/program teams need to look
for guidance. …’
Benefits Realization & Achievement International Network (2009, White Paper)
The characteristic features of the health XXI. century:
- The increasing number of patients needing care, diseases are more complex;- The increasing number of patients needing care, diseases are more complex;
- Health care options have been expanded, widened the areas of application;- Health care options have been expanded, widened the areas of application;
-- In medicineIn medicine the border areas widenedthe border areas widened,,
- T- Thehe medicalmedical informatics and the clinical and management become an integral partinformatics and the clinical and management become an integral part
In modern medicine, the dominant principle of care: should be grouped
around the patient a possible and necessary medical specialties:

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PP
PP PP
PP
PP
PP
PP
PP
PP
PP
PP
PP PP
PP
PP
PP
PP
PP
PP
PP
PP
PP
PP
PP
PP
Patients who are practically
healthy.
Patients who require
continuous care.
Patients who need
emergency care
Patients who need
chronic carePP
Patients who need
rehabilitation

4. Identification ofIdentification of
actual healthactual health
statusstatus
DiagnosticsDiagnostics
investigationinvestigation
Intervention,Intervention,
operation,operation,
treatment,treatment,DDiiagnosisagnosis
makingmaking
OutcomesOutcomes
of careof care
ControlingControling
QualityQuality
assuranceassurance
Quality controlQuality control
PP
PP
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on the patient– physician meeting pointon the patient– physician meeting point
The workflow of the care activitiesThe workflow of the care activities
The networks ofThe networks of
physician workplacesphysician workplaces

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PP
Identification ofIdentification of
actual healthactual health
statusstatus
DiagnosticsDiagnostics
investigationinvestigation
Intervention,Intervention,
operation,operation,
treatment,treatment,
DDiiagnosisagnosis
makingmaking
PP
OutcomesOutcomes
of careof care
ControlingControling
QualityQuality
assuranceassurance
Quality controlQuality control
Current health
information,
anamnesis
Diagnostic
tests details
The medical
indications
indicator data
The actual
medical
protocoll
The outcome of care
indicator information
Interventions,
surgery
information
Detailed patient
account
Nursing information,
care plan
Medications
therapy information
Medical
Final
Report
EElectroniclectronic HHealthcareealthcare RRecord of a clinics episodeecord of a clinics episode::
includes the history, diagnosis, disease status, therapy,
treatment outcome and the status of the most important information.
The goal: to find the relevant information to the
SSubjectiveubjective OObjectivebjective AAssesmentssesment PPlan - Recordlan - Record

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Health care activities on the patient– physician meeting points:
Individual health
insurance risk
analyzing,
evaluating.
Individual health
insurance risk
analyzing,
evaluating.
Previous health
insurance
episodes
Previous protocol
quality control
Previous protocol
quality control
Previous
outcome
information
Previous treatment,
care medical records
Previous treatment,
care medical records
Previous
treatment, care
medical
records
Previous
medical
indications and
protocols
Previous
medical
indications and
protocols
Previous
medical
indications and
protocols
Previous
diagnostic
data
Previous
diagnostic
data
Previous
health
status
information
Previous
health
status
information
Previous
health
status
information
Previous
health
status
information
Previous health
status
information
Current health
information,
anamnesis
The medical
indications
indicator data
The
actual
medical
protocoll
The outcome of care
indicator information
Interventions,
surgery
information
Detailed
patient account
Nursing
information, care
plan
Medications
therapy information
Medical
Final
Report
Diagnostic
tests details
INDIVIDUALINDIVIDUAL
EPIDEMIOLOGYEPIDEMIOLOGY
MODELSMODELS
FORFOR
FOLLOWING OFFOLLOWING OF
HEALTHHEALTH
STATUSSTATUS
The previousThe previous
medicalmedical events,events,
processes,processes,
informationinformation
sources –sources – EHREHR
archive analysingarchive analysing
EditingEditing andand
runningrunning problem-problem-
andand task-orientedtask-oriented
virtualvirtual informationinformation
modulesmodules
MEDICAL CAREMEDICAL CARE
PROGRESSIVITPROGRESSIVIT
Y INDICATIONSY INDICATIONS

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Health care activities on the patient– physician meeting points:
Previous protocol
quality control
Previous protocol
quality control
Previous
outcome
informationPrevious
diagnostic
data
Previous
diagnostic
data
Previous
health
status
information
Previous
health
status
information
Previous
health
status
information
Previous
health
status
information
Previous health
status
information
Current health
information,
anamnesis
The outcome of care
indicator information
Medical
Final Report
Diagnostic
tests details
The medical
indications
indicator data
The actual
medical
protocol
Interventions,
surgery
information
Detailed patient
account
Nursing information,
care plan
Medications
therapy information
Individual health
insurance risk
analyzing,
evaluating.
Individual health
insurance risk
analyzing,
evaluating.
Previous health
insurance
episodes
Previous treatment,
care medical records
Previous treatment,
care medical records
Previous
treatment, care
medical records
Previous
medical
indications
and protocols
Previous
medical
indications
and protocols
Previous
medical
indications and
protocols
INDIVIDUALINDIVIDUAL
EPIDEMIOLOGYEPIDEMIOLOGY
MODELSMODELS
MEDICAL CAREMEDICAL CARE
PROGRESSIVITPROGRESSIVIT
Y INDICATIONSY INDICATIONS
FORFOR
FOLLOWING OFFOLLOWING OF
HEALTHHEALTH
STATUSSTATUS
ProblemProblem-and-and task-orientedtask-oriented
virtualvirtual informationinformation modulesmodules

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eHealth Governance
“The implementation of effective eHealth systems and services
hinges on the successful collaboration of multiplesuccessful collaboration of multiple
stakeholdersstakeholders with a diverse range of interests and agendas. It is
therefore critical that governments establish sound governance
mechanisms to manage the complex process ofmanage the complex process of
collaborationcollaboration, which will lead to successful implementation of
eHealth systems and service.”
Benefits Realization & Achievement International Network; 2009
necessary the knowledge basenecessary the knowledge base for the health of people finding andfor the health of people finding and
following, whichfollowing, which
 ensure the realization of the pprogressive medical carerogressive medical care
 allows the individualindividual and the complex epidemiologicalcomplex epidemiological
analysisanalysis for eHealth Governance
 facilitate the enforcement of the personalized healthpersonalized health [phealth][phealth]
The recommended IT methods for the supplying of the complex
evaluating and effective care of health is: