CCTOS Common : Activities

• Objectives:
  • Management and follow up of activities, here at the top conceptual level.
• Summary:
  • Derived from MedicalData.
  • Activities have common properties as:
    • Agent responsible of the request.  May be different from the author of the Item.
    • Objectives and motivation of the request:
      • Link to one or several health issues.
      • Services as well intended for diagnoses as well intended for treatments.
      • Optional type of goals (eg diagnostic, treatment, palliative, curative, ...)
      • Optional mention of expected results and timing.
    • Mission:
      • Identification of the type and subtype of requested activity.
      • Content:
        • At this level we are here dealing with a kind of generic place holder.  The details about what is asked will be specified at a lower level in derived classes, e.g. lab, X rays, prescription, consultation, request for advice, ... 
    • Timing of Activities:
      • Options as one shot, or a repeating factor (e.g. once a day), or a conditional repetition,
      • In a time range from a begin to an end limit.
      • With an optional degree of emergency.
      • This mechanism is useful for many purposes for example a prescription for 3 doses a day during 10 days, as well for a vaccination every 10 years.
    • Work flow management:
      • Generic workflow:
        • The idea is that an activity object will go through several status:
          • Considered, order validated, having an appointment, receptioned, in progress, draft report, validated report, made available for authorized users, notified, declared to the administration, declared for statistics, etc ... which are not exclusive.
            
        • At different steps it may be necessary to call some services as, appointment, worklist, declaration to the administration, report to statistics, etc...
          
        • Remark:  this proposed approach is different from most traditional system with an architecture based on hospital departments.
          
      • Worklists:
        Worklists provide an overview of what is expected to be done by a given agent, person or department, for given patients, at given time.
        • Selections from worklists:
          • Per center of activity,
          • Per status (e.g. waiting for validation, ....)
          • Per patient,
          • .....
        • If necessary management of appointments: 
          • allocation of time slots in worklist.
          • Maintenance of available times of the diverse resources.
      • Management of requests for activities:
        • May be necessary for several reasons, as the comfort of the patient and the optimization of the resources.
        • A question of generic interest in various implementation contexts, as consultations by specialists, admissions, special examinations.  
        • In an integration perspective the idea is that an order for an Activity must first exist and that planning may be added if necessary.  A standalone appointment system would not make much sense.
          Planned activities should appear in the presentation of the Care Plan.
        • Management can be done in 2 ways:
          • As appointments at fixed reserved times, taking account of the availability of both the patient and the resources.
          • As items on a waiting list, usually first in first out, and taking account of urgencies.
      • The actual handling of the activity will be discussed in derived classes, depending on the specific aspects of the activity.
      • There is here a need for the standardization of requests.
        • Moreover the possibility to transfer a request to an other external organization.
    • Reports:
      • In general all activities produce a result in one way or an another, although not always recorded, eg a lab test report, a discharge letter, a note about the evolution of a treatment.
      • Again there is also a need of standardization about how to share the results of a request.
    • several Administration:
      • Activities have financial consequences.
      • In general all activities must to be declared to the administration, for billing and statistical purposes.
      • Medical and administrative issues are very different things and should be handled in different modules.  From the medical point of view, the interface must simply declare what has been done, regardless of current price or inclusion in package of prepaid services.
         
  • Groups of activities:
    • An "activity" may represent a set of elementary services.
      A kind of package including a set of related activities, e.g. an oncology treatment requiring a set of services as surgery, radiotherapy, chemotherapy, etc...
    • At this level of a global "approach", one should pay particular attention to define objectives and expected results in relation to a problem.
    • "Clinical paths" or more generally "Care Paths" are standardized set of activities, predefined for a typical Health Issue, e.g. hip replacement.  Such a global activity may include a set of related activities, which are intended to be solved as an industrial production center.
      However in reality many individual patients may need adaptations of his care plan, taking account of the presence of other Health Issues.  
  • The current "Care Plan" is an overview of all ongoing activities.
    
    
• Specific orders
• Derived from the generic order class.
• many derived classes to be defined here in function of the various types of orders, among others:
  • Request for lab test:
    • Which test, on which material, ...
  • Request for image, by RX or other imaging technologies:
    • Which image, for which reason, ...
  • Prescription of drugs:
    • Identification of the product and way of use, duration,...
  • Request for advices of a specialist:
    • The issue, the question expected to be answered, ...
  • Request for admission:
    • Motivations, ....
  • ....