METODOLOGÍA DE LA INVESTIGACIÓN
Módulo 3 sobre EdC 10 Creencias sobre cuestiones ligadas a la
4.3.4 Sistemática de contexto para NdC
In order implement the ideal system, a stakeholder analysis was performed to document the users of the system and identify issues that the system would need to resolve and benefits the system provides.
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Patient – The patient can be any individual who currently or previously has had an illness for which they wish to seek treatment. Also, the individual could be seeking to improve current health status in order to maintain a desired lifestyle.
The patient seeks to attain the most health benefit from the least cost. They also seek to minimize the amount of time spent in a health care provider office or medical treatment facility. Patients want minimal invasiveness, value privacy of medical data and require an intimate and trusting relationship with their medical services provider.
Table 2-4, Patient Issues/Benefits
Issue/Benefit System Solution
Minimize Cost Reduces cost through implementation of information technology to automate administrative and operations burden
Timely Treatment Reduces time to receive treatment by the analysis and input of health metrics without the requirement to be physically present in the medical treatment facility Accurate Treatment Patient history is maintained and utilized to assist with
diagnosis of current illness
Non-invasive Remote medical devices must be certified and approved by the Food and Drug Administration which regulates medical devices that consumers use without professional medical assistance to ensure safety and effectiveness.
Information Privacy System implements identity management and verification, information integrity checks and secure databases in order to maintain a secure environment for medical and personal information
Intimacy with Medical Service Provider
Implement controls to ensure that patient data is only available to authorized medical service providers.
Improve health status Remote medical sensors, environmental data and patient history can be used to monitor health status and be used to provide recommendation for improvement of health conditions.
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Medical Services Provider – The Medical Services Provider could be a degreed and certified medical doctor, nurse, nurse practitioner, pharmacist, or other trained professional. The Medical Service Provider’s primary task is to treat illness and promote health in a timely and accurate manner. They will receive the information presented to them in the form of health metrics or descriptive unstructured data from the patient and utilize education and experience to make a diagnosis. Upon reaching the correct diagnosis, an appropriate form of treatment can be prescribed. Doctors are bound by privacy regulations as well as the intimate relationships with their patients. Also, doctor’s and treatment facilities are bound by the principles of business. They are required to make a profit in some manner in order to remain in operation. They are also influenced by medical liability and obtain malpractice insurance to reduce risk of loss in case of a civil or criminal lawsuit.
Table 2-5, Medical Service Provider Issues/Benefits Issue/Benefit System Solution
Minimize Cost Reduces cost through implementation of information technology to automate administrative and operations burden
Increase Profit Allows option to execute the process without requiring patient to schedule appointment. Increases patient traffic to maximize income.
Timely Diagnosis Reduces time required to receive and analyze information to obtain diagnosis.
Accurate
Diagnosis Utilizes patient history and automated information sources to assist with accurate diagnosis
Medical History All patients’ history maintained and utilized to assist with future events.
Treatment
Prescription Automated links to treatment facilities allow transmission of prescriptions directly for timely and accurate treatment.
Medical
Malpractice With use of unsupervised home medical devices, medical service providers can require patients to formally accept responsibility for
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proper use. Maintaining control over treatment process does not increase malpractice liability over current paradigm.
Information
Privacy System implements identity management and verification, information integrity checks and secure databases in order to maintain a secure environment for medical and personal information
Intimacy with
Patient Doctor along with patient maintains control over entire diagnosis and treatment process. Automation provides assistance but stakeholders maintain decision authority.
Medical Treatment Facility – The Medical Treatment Facility can be the practice of an individual doctor or nurse practitioner, a pharmacy, a therapy center or any other facility where medical treatment is delivered to the patient.
In some cases, as in primary medicine, the patient can receive routine and non-invasive treatment under the direct supervision of their doctor. Some cases require medicine for treatment of the illness which the doctor will refer the patient to a pharmacy to obtain the prescribed medication. In other cases the patient may be referred to another facility for further examination such as a medical imaging center. Additionally, facilities such as physical therapy centers prescribe a course of treatment over a period of time in which the patient undergoes a regimen to recover from a physical injury. In any case, the medical treatment facility is bound by the same regulations and principles as medical service providers for quality, accuracy, intimacy, privacy, malpractice and business principles in order to remain in operation
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Table 2-6 Medical Treatment Facility Issues/Benefits Issue/Benefit System Solution
Minimize Cost Reduces cost through implementation of information technology to automate administrative and operations burden
Increase Profit Allows option to execute the process without requiring patient to schedule appointment. Increases patient traffic to maximize income.
Timely Treatment Reduces time required to receive and analyze information to prepare treatment
Accurate Treatment
Prescribe course of treatment received automatically from medical service provider eliminating errors in transcription
Medical History All patients’ history maintained and utilized to assist with future events.
Medical
Malpractice With use of unsupervised home medical devices, medical service providers can require patients to formally accept responsibility for proper use. Maintaining control over treatment process does not increase malpractice liability over current paradigm.
Information
Privacy System implements identity management and verification, information integrity checks and secure databases in order to maintain a secure environment for medical and personal information
Intimacy with Patient
Doctor along with patient maintains control over entire diagnosis and treatment process. Automation provides assistance but stakeholders maintain decision authority.
Insurance Company – As described above in section 2.4 and 2.6, the insurance company is the financial institution responsible for payment for the greatest portion of medical services on behalf of the patient. For the purposes of this effort, the insurance company can be considered a commercial business or a public entity such as Medicare, Medicaid or CHIP with the main differences between private and public institutions being the direct source of revenue and the business objectives. Private insurance companies receive their income directly from the sales of benefit plans or through investments. Their main
objective is to generate profit and they are bound by privacy regulations just as
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any other medical institution. Public institutions receive their funding through annual congressional authorizations and are bound to fiscally operate within the budget authorized. Public institutions receive their funding indirectly through sales of supplemental benefit plans, payroll taxes and taxes on medical services and equipment. Although they are not allowed to generate profit, public
institutions must still operate within fiscal constraints and are therefore required to minimize administrative and operational costs.
Table 2-7, Insurance Company Issues/Benefits Issue/Benefit System Solution
Minimize Cost Reduces cost through implementation of information technology to automate administrative and operations burden
Increase Profit Increased patient traffic for medical service providers translates to increased sales of benefit plans which increases income.
Timely Payment Reduces time required to complete diagnosis and treatment processes. Automated links to various facilities in the process reduces time to complete payments.
Accurate
Payments Through use of automated systems, diagnosis and treatments are transmitted to financial institutions for payments which reduces transcription errors.
Medical History Generic patient history can be utilized to analyze common
treatment plans and use large-scale information for implementation of efficient processes within network of medical service providers.
Information
Privacy System implements identity management and verification, information integrity checks and secure databases in order to maintain a secure environment for medical and personal information
Public Health Institution – Public Health is the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Public Health Institutions are chartered to implement the objectives of public policy. Public health
professionals analyze the effect on health of genetics, personal choice and the
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environment in order to develop programs that protect the health of individuals in a community. Overall, public health is concerned with protecting and
improving the health of entire populations as small as a local neighborhood or as large as an entire country. Public health professionals try to prevent problems from happening or re-occurring through implementing educational programs, developing policies, administering services, regulating health systems and some health professions, and conducting research, in contrast to clinical professionals, such as doctors and nurses, who focus primarily on treating individuals after they become sick or injured. It is also a field that is concerned with limiting health disparities and a large part of public health is the fight for health care equity, quality, and accessibility.
The field of public health is highly varied and encompasses many academic disciplines. However, public health is mainly composed of the following core areas:
Behavioral Science/Health Education
Biostatistics
Emergency Medical Services
Environmental Health
Epidemiology
Health Services Administration/Management
International/Global Health
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Maternal and Child Health
Nutrition
Public Health Laboratory Practice
Public Health Policy
Public Health Practice
Public health professionals are bound by the same objectives, rules and
regulations as commercial medical providers however they are not required to generate profit.
Table 2-8 Public Health Institution Issues/Benefits Issue/Benefit System Solution
Minimize Cost Reduces cost through implementation of information technology to automate administrative and operations burden
Increase Patient
Capacity Allows option to execute the process without requiring patient to schedule appointment. Reduces amount of time required to treat each patient which increases overall patient capacity.
Timely Diagnosis Reduces time required to receive and analyze information to obtain diagnosis.
Accurate
Diagnosis Utilizes patient history and automated information sources to assist with accurate diagnosis
Medical History All patients’ history maintained and utilized to assist with future events.
Treatment Prescription
Automated links to treatment facilities allow transmission of prescriptions directly for timely and accurate treatment.
Medical
Malpractice With use of unsupervised home medical devices, medical service providers can require patients to formally accept responsibility for proper use. Maintaining control over treatment process does not increase malpractice liability over current paradigm.
Information
Privacy System implements identity management and verification, information integrity checks and secure databases in order to maintain a secure environment for medical and personal information
Intimacy with Doctor along with patient maintains control over entire diagnosis
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Patient and treatment process. Automation provides assistance but stakeholders maintain decision authority.
Population-Based
Medical Research Generic patient history at the macro-level can be used to develop or modify public policy. Also can be used to analyze information about outbreaks of disease in order to develop response plans for disease containment.
2.12 Requirements
A requirements analysis was performed and top-level system requirements were identified. These are only the initial top-level requirements of the system and were used to guide the development of the WeCare® system architecture.
In future development efforts, these requirements will be refined and lower-level requirements derived. This will allow for the system functionality to be accurately defined and documented prior to any design activities taking place. Also, requirements will be re-analyzed to ensure that validity is maintained throughout initial and subsequent development efforts.
Table 2-9, Top-level System Requirements Requirement
Identification
Requirement Text
R001 The system shall be capable of receiving data from external devices R002 The system shall store raw data received from external devices R003 The system shall post-process received data
R004 The system shall be capable of performing analytics on information R005 The system shall be capable of performing medical modeling on
information
R006 The system shall enable medical providers to perform diagnostics R007 The system shall be able to disseminate information to public
informatics systems
R008 The system shall interface with external health service payment providers
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