E) Complexity in Healthcare


Transforming EMR into Adaptive Patient Centered Systems

Medical efficacy implies that physicians need to work within the complexity of human biology. They work in the field of adaptive systems. This implies that their efficacy curve has to be functional to deal with low programmed activities. Protocols sustain this essentially low programmed activity.

healthcare-cyberneticsParadoxically, there is a widespread perception that EMR/EHR has a low added value for medical practice. This perception hinders the upgrade of medical practice.

But:

1)  Is it that EMR and EHR have little added value or is it that they were designed as administrative systems?
2)  Is it possible to transform administrative EMR and EHR into adaptive systems with administrative information?
3)  How can the misuse of the transparency of the system be avoided?

These are some of the questions that can be solved using an object driven approach to healthcare.

The objects included in the EMR and EHR should emulate the problems physicians need to solve in their minds in medical practice. The basic objects are:

  • Diagnoses
  • Cures
  • Palliatives
  • Patients evolution
  • Prevention
  • Decision making
  • Knowledge bank

Objects driven EMR or EHR are such when they become a necessary part for physicians practice such as a golf stick is for the golfer or a racket is for a tennis player.

There have to be objects for exclusive private use with no access to anyone, such as the decision making alternatives a physician considers, and other objects that can be shared.

Administrative EMR or EHR can only be information reservoirs, legal defendants and control systems. The integration of object driven systems including adaptive objects with administrative functions is the conceptual answer to the problem. Basically, a new concept for interfaces is required.

Changing the interfaces is the first step to enter in the new stage where the computer is a natural part of the physician’s practice.

Diego Belohlavek

NOTE: The Unicist Research Institute was the pioneer in complexity science research and became a private global decentralized world-class research organization in the field of human adaptive systems. http://www.unicist.org


Homology between Unicist Concepts and Stem Cells

The function of stem cells in the human body is homologous to the function of concepts in the field of human actions. While stem cells can give rise to specialized cells and thus organs, essential concepts allow building unicist objects.

Essential ConceptUnicist objects are adaptive systems that have a concept and generate added value within a quality assurance system to fulfill the purpose of the concept. Unicist objects are interdependent entities that integrate a complex adaptive system.

The knowledge of the essential concepts is basic to build unicist objects because these objects are the materialization of a concept.

Under certain conditions, organs can be transplanted and this is also the case of unicist objects that can be replicated as long as they belong to homologous and analogous entities.

Objects are inserted into processes to produce specific results. The same way stem cells have the potential capacity to give birth to human organs, concepts can give birth to objects to produce results.

The knowledge of the Unicist Theory allows using a double dialectical approach to reality to emulate the organization of nature using an object driven organization.

Nature is organized by objects which can be observed in the ecosystem. The human body is an example of the organization of nature, where organs are homologous to unicist objects. That is why the transplantation of organs became possible.

While the structure of the different organs of the body derives from the stem cells, the unicist objects derive from the essential function of an entity that is defined by its concept.

Properties of Stem Cells and Concepts

Stem Cells

Concepts

They are unspecialized They are universal
They are capable of self-renewal They are timeless
They can give rise to specialized cells They allow building operational functions

Thus, stem cells and concepts are homologous. While essential concepts allow the construction of objects to insert into human adaptive processes, stem cells allow the building of organs that work as unicist objects to sustain the functionality of a complex adaptive system such as the human body.

Peter Belohlavek

NOTE: The Unicist Research Institute was the pioneer in using the unicist logical approach in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems. It has an academic arm and a business arm.
http://www.unicist.org/repo/#Unicist


Evolution is Purpose Driven: The Discovery of the Ontogenetic Intelligence of Nature

Darwins finchesThis research began in 1976 with the hypothesis that in nature there are mutations that are random but others that are driven by a purpose.

If this hypothesis was confirmed and there were a purpose, Peter Belohlavek concluded that there would have to be an intelligence that defined such purpose.

For this reason, Belohlavek researched on the essential structure implicit in nature’s intelligence to be able to predict and exert influence on the evolution of complex adaptive systems when possible.

Charles Darwin demonstrated the adaptation process of species that, having the same structural constitution, developed adaptive changes to live in a certain environment.

The hypothesis of Belohlavek’s research was that these changes were driven by an intelligence that underlies nature.

The Unified field of the Ontogenetic Intelligence of NatureHe concluded that each living creature’s evolution is ruled by its ontogenetic intelligence, that defines it as unique both in its species and individuality and that the essential structure of this intelligence is integrated by a purpose, an active principle (entropic function) and an energy conservation principle.

The research was focused on the unified field of living beings.

The basic assumption that sustains this development is that the evolution of living beings, their behaviors, actions and deeds are driven by the same logical structural framework.

This implies that there is an intelligence that defines the structural behavior of any entity that integrates this framework that allows predicting the behavior of all the entities where this intelligence is known.

You can find the complete document on the “Discovery of the Ontogenetic Intelligence of Nature” at: http://www.unicist.org/repo/#Unicist

Unicist Press Committee

NOTE: The Unicist Research Institute was the pioneer in using the unicist logical approach in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems. It has an academic arm and a business arm.
http://www.unicist.org/repo/#Unicist


Proteins and Amino Acids: Discovery of the Unicist Ontology of Amino Acids

The Unicist Ontology of amino acids allows understanding its functionality and the possibilities of their integration to build proteins. Their purpose is given by the side chain which defines the different functions amino acids can fulfill.

Amino Acids

It has to be considered that the Unicist Ontology emulates the ontogenetic intelligence of nature that was discovered which defines that there is always a purpose, an active and entropic principle and an energy conservation principle. The unicist ontology of amino acids is a demonstration of how this intelligence works.

The active function of an amino acid is given by the carboxyl group that establishes a supplementary relationship with the R-group. The energy conservation function is given by the amino group, which establishes a complementary relationship with the R-group.

Amino acids are biologically organic compounds integrated by amine and carboxylic functional groups, driven by a side-chain specific to each amino acid. The key elements of an amino acid are carbon, hydrogen, oxygen, and nitrogen, though other elements are found in the side-chains of some amino acids.

Amino acids are the building blocks of peptides and proteins. They are composed of amine and carboxylic acid groups, separated by the alpha-carbon but the side chains on the alpha carbon vary with the acid. They are the subunits of proteins: amino acids make peptide chains, peptide chains make polypeptides, polypeptides make proteins.

Amino Acid StructureAmino acids are the structural units that build proteins. They join together to form short polymer chains called peptides or longer chains called either polypeptides or proteins. These polymers are linear and unbranched, with each amino acid within the chain attached to two neighboring amino acids.

Peptide Formation

Amides can be thought of as forming from the reaction of an amine and a carboxylic acid. In the same way, two amino acids can combine to form a dipeptide, held together by a peptide bond.

Peptides

A fourth amino acid would form a tetrapeptide, a fifth would form a pentapeptide, and so on. Short chains are referred to as peptides, chains of up to about 50 amino acids are polypeptides, and chains of more than 50 amino acids are proteins. Amino acids in peptide chains are called amino acid residues.

Classification of Amino Acids

Acidic amino acids and their amides: aspartic acid, asparagine, glutamic acid, glutamine.

Basic amino acids: histidine, lysine, arginine.

Aromatic amino acids: phenylalanine, tyrosine, tryptophan.

Sulfur containing amino acids: cysteine, methionine.

Imido acid: proline.

Hydrophobic side chains: glycine, alanine, valine, leucine, isoleucine.

Hydroxylic amino acids: serine, threonine, (tyrosine).

Learn more about amino acids at: http://www.biology.arizona.edu/biochemistry/problem_sets/aa/aa.html

Unicist Press Committee

NOTE: The Unicist Research Institute was the pioneer in using the unicist logical approach in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems. It has an academic arm and a business arm.
https://www.unicist.org/healthcare/wp-content/uploads/2015/02/turi.pdf


The Unicist Double Dialectical Logic to deal with Complexity

Complexity in Businesses

It is necessary to define complexity in the field of business. It needs to be understood to develop and use adaptive systems:

Knowledge of Adaptive SystemsWhen you have to add 1 + 1 the problem is simple; 1 + 1 = 2. There is only one possible solution and all you have to do is follow a method.

But the problem becomes complex if you reverse the equation (2 = ???) because you need to produce a result. In this case there are infinite solutions and the problem is complex because you have to find the equation that optimizes the process of producing results. That is why using methods is simple but ensuring results is complex.

We define a complex system as an open system, which defines the functionality of a unified field through the conjunction of objects and/or subsystems.

Complexity Science Organizations

There are three main organizations in the world that are fully focused on complexity science and its application in the field of human complex adaptive systems.

We strongly recommend comparing their approaches to choose the one that is functional to your needs. We suggest beginning by accessing their institutional page to apprehend the concept of adaptiveness they manage:

Santa Fe Institute – Empirical approaches
https://www.facebook.com/pages/Santa-Fe-Institute/125124501057

New England Complex Systems Institute – Empirical approaches
https://www.facebook.com/pages/New-England-Complex-Systems-Institute/112297818808432

The Unicist Research Institute – A unicist logical approach (based on a pragmatic, structuralist and functionalist framework)
https://www.facebook.com/unicist

Dealing with Businesses as Complex Adaptive Systems

Businesses are typical adaptive systems. Businesses need to adapt to the environment in order to achieve their goals.

The Unicist Logical Approach allows emulating the dynamics of a business in mind that allows managing it as an adaptive system. Thus this approach permits defining reliable scenarios, develop diagnoses, build strategies and design business architectures.

The more adaptive a system is, the less energy it consumes to generate a predefined value. Adaptive systems require using predictors to deal with the adaptive aspects of the reality that is being managed. This requires using a unicist logical approach to define the rules that regulate adaptiveness and allow designing the architecture of the system.

Designing adaptive systems implies dealing with the complexity of such systems and developing operational solutions that can be managed by everyone to expand businesses and save energy. Complexity science can be defined as the scientific approach to complex adaptive systems.

The Unicist Logical Approach to Complexity Sciences

Learn about the Unicist Logical Approach at: http://www.unicist.net/clipboard

The unicist logical approach manages the adaptive aspects of business as unified fields based on the knowledge of their ontogenetic maps.

The knowledge of the ontogenetic map of a business, its market and the context allowed managing the fundamentals that define the possibilities of business actions.

The future scenario building became possible based on the knowledge of the ontology of evolution and the ontogenetic maps of a business and its restricted and wide contexts.

This knowledge allowed defining synergic maximal strategies, to expand beyond the boundaries of a business, and minimum strategies to work within them.

Adaptive business processes became reliable based on the use of ontology based business objects. The use of objects upgraded the role of human work in business.

The integration of fundamental analysis and technical analysis allowed building reliable business knowledge, transforming uncertainty into risk and integrating the knowledge of the possibilities of success with its probabilities.

All the solutions, business objects, technologies and knowledge provided by The Unicist Research Institute are based on the unicist logical approach and generate significant energy saving effects.

Steps to Manage Businesses as Adaptive Systems:

  1. Forecast the future of the adaptive system that is being influenced.
  2. Diagnose adaptive systems to define the possibilities of what can be achieved and how to do it.
  3. Develop the necessary strategies that allow developing both maximal strategies to expand the boundaries of the system and minimum strategies to ensure survival.
  4. Design the architecture of the solution in order to obtain the results that are necessary and possible to be achieved.

This requires having a conceptual approach to apprehend the unified field of the business and being able to transform adaptive aspects into operational solutions.

The Unicist Healthcare Confederation is now expanding worldwide providing unicist object driven technologies to deal with the adaptive aspects of businesses. www.health.unicist.net

Peter Belohlavek

NOTE: The Unicist Research Institute was the pioneer in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems.
https://www.unicist.org/healthcare/wp-content/uploads/2013/11/turi.pdf


Adaptive EHR: simplifying medical practice as a complex system

We would like to introduce adaptive EMR/EHR as a way to materialize Patient Centered Management as a solution to sustain the upgrade introduced in Healthcare in the US.

This implies dealing with predictive interfaces transforming operational EMR/EHR into adaptive systems. We would like to discuss with colleagues the possibility of introducing these alternatives considering medicine as the most complex professional field.

Unicist Patient Centered OrganizationPlease access the approach to complexity: “Applying Complexity Science to Health and Healthcare” of the University of Minnesota:
http://goo.gl/C3pcb9

and the Unicist Logical Approach to complexity you can find at:
www.unicist.net/clipboard/

The basics of medicine are patient centered. That is why the regulation of the activity focusing on patients is just a back to basics. Patient Centered Management is an object driven solution to structure patient orientation.

Electronic Patient Records are the paradigmatic sign of this approach. Electronic Healthcare records are their natural complement in order to include the aspects that deal with the diseases that are being considered.

Electronic Medical Records, being focused on medical activity, allow putting this patient orientation into action. The EMR are the natural step to start with a structured patient orientation.

The debate I suggest is about alternatives to simplify complexity in medical practice with people who might be interested in this approach.

Peter Belohlavek

NOTE: The Unicist Research Institute was the pioneer in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems. https://www.unicist.org/healthcare/wp-content/uploads/2013/10/turi.pdf


Homology of the DNA of living beings and Unicist Ontologies

The unicist ontology of an institution is essentially analogous to the DNA of a living being. They both define the nature of the being, have an implicit purpose and materialize the action and the energy conservation principles.

Genetic Map

Being aware of the unicist ontological structure that underlies and rules the behavior and evolution of an institution it is possible to define the taxonomies and action plans to ensure the functionality of an organization respecting its nature .

The difference between the DNA of different species is minimal although the physical difference might be enormous.

The same characteristic is given at the unicist ontological structure of institutions. Subtle differences generate different species.

That is why the accuracy of diagnoses of the conceptual structure of an institution is determinant. It defines its species and the possibilities and probabilities of its evolution.

Unicist algorithms for the genetic engineering of institutions

The functionality of algorithms is to provide a logical structure to understand and influence reality in a secure way. Following ontological algorithms an individual is respecting the rules of ontogenesis.

Algorithms describe and explain the natural functionality of a reality and establish the relationships of the objects that are part of such reality based on the ontogenesis of the evolution process.

They provide the natural way to influence institutions. Using unicist ontologies to influence institutions implies dealing with the genetic engineering of the institution.

Therefore, the use of unicist technologies in institutions is based on “change without changing”. That means introducing changes that respect their nature and do not try to change their essential concepts.

Peter Belohlavek

NOTE: The Unicist Research Institute was the pioneer in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems.
https://www.unicist.org/healthcare/wp-content/uploads/2013/09/turi.pdf


What is the Unicist Approach to Healthcare Businesses?

Ontogenetic Intelligence of Nature

The discovery of the unicist ontogenetic intelligence of nature allowed defining the triadic structure that regulates any entity. It included the discovery of the complementation and supplementation laws. 

These discoveries established the groundings to develop the unicist double dialectical logic that underlies all systems in nature.

The use of the double dialectical logic made the emulation of the organization of nature possible, developing objects to install into human adaptive systems to make them faster, safer and reliable.

The unicist double dialectical approach to medicine allowed (*):

Pyramid of Ethical Intelligence1) Defining and managing diagnoses as adaptive systems and transforming them into medical objects integrating the triadic structure of cures, fundamental diagnoses and technical-analytical diagnoses.

2) Managing therapeutics as a complex adaptive system, integrating the triadic structure defined by cures, palliatives and recovery.

3) Managing the triadic structure of Health IT integrating software, hardware and peopleware.

4) Integrating the triadic structure of electronic records for medical practice, integrating EMR, HER and EPR.

5) Managing drugs as medical objects integrating their functionality with the adverse effects and the positive side effects.

6) Managing the triadic structure of patient centered management integrating the patient, medical practice and management.

7) Installing the Object Driven Organization Metamodel to materialize the Patient Centered Management.

8) Developing a unicist scorecard to monitor the metrics of the medical business activities.

(*) A condition to manage the unicist approach is to go beyond the use of dualistic logic and use the double dialectical logic in order to be able to emulate dynamic processes in mind. It implies leaving behind the use of the disjunction “or” substituting it by the use of the functional conjunction “and”.

Healthcare: the use of Unicist Adaptive IT Architectures

Adaptive IT solutions are systems that have been designed to interact with the external and internal environment. Nowadays, there are multiple programming solutions available to sustain the unicist adaptive architecture. The solutions include aspect objects architecture with unicist logical inferences to manage adaptiveness.

Adaptive IT ArchitectureThe evolution of Information Technologies allowed integrating the adaptive aspects of business management in the operational systems of hospitals.

The integration of the unicist logical approach and the resulting business objects included in the business processes within an adaptive IT environment allows driving business processes to the next level.

To be able to organize by objects it is necessary to use both adaptive and administrative systems to organize the work processes. This widened the possibilities of hospitals to expand the boundaries of their activities within an environment of assured quality.

There are four levels of adaptiveness that can be managed:

1) Analogical drivers

This level is based on the recognition of the significant behavioral patterns of the segments of patients.

2) Rules based drivers

This level is based on the use of analogical patterns and the logical rules defined by the fundamentals that influence the processes.

3) Empirical drivers

This level is based on the previous level and the integration of mathematical models to infer behavior based on the observable aspects of the fundamentals of the processes.

4) Objects based drivers

This level is based on the previous level plus the use of medical objects that work as interdependent drivers to influence the attitude of patients. The feedback is defined by the results produced by these objects.

The level of adaptiveness varies according to the needs of the system. Adaptiveness is based on the medical, therapeutics and disease segmentation.

Unicist Press Committee

NOTE: The Unicist Research Institute was the pioneer in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems. http://www.unicist.org


The Unicist Standard for Accountable Care Organizations

Alliances define the essential characteristics of Accountable Care Organizations in the US. Alliances have a high level of entropy. That is why it is necessary to be fully aware of this characteristic ACOs have in order to manage them.

AlliancesAlliance building is the way to strengthen the action of an organization when it is being threatened or needs to gain market.

Alliances are essentially transitory situations that require building a “natural” way to achieve the goal that has been established.

Some concepts of alliances may be useful:

  1. Alliances are agreements between colleagues, competitors and/or enemies to attack a common adversary.
  2. Alliances are useful to gain influence in a market but they break after the goal has been achieved.
  3. They need to be transformed into formal societies to avoid their disappearance after the influence they needed has been achieved.

Alliance building is a proof of maturity and adaptiveness. Building alliances implies leaving aside an existing confrontation to build a pathway towards growth or the defense from an external threat.

The Unicist Standard for Accountable Care Organizations allows building stable alliances based on the use of adaptive object driven technologies to deal with the unique characteristic of the healthcare market.

Peter Belohlavek

NOTE: The Unicist Research Institute was the pioneer in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems. http://www.unicist.org


Unicist Logical Approach: Diagnoses managed as medical objects

Medical objects are encapsulated adaptive processes that have the necessary quality assurance to generate a predefined result.

Diagnostics Quality AssuranceMedical diagnoses happen within the scope of medicine but are regulated by the functional rules of universal diagnostics and are driven by the semiotic signs the diagnostician identifies.

Diagnoses can be considered from two different points of view. Seen from the diagnostician’s standpoint, they are a process that needs to be done to identify the problem that needs to be cured. But seen from the point of view of the therapeutic process, they are a medical object that defines the objective of the therapeutic process.

As a medical object, they need to have the necessary quality assurance to be fully reliable. To achieve this reliability they need to be based on reliable knowledge and develop the necessary destructive and non-destructive tests to confirm their validity.

As an object, they work as an adaptive system that modifies the diagnosis based on the feedback from the environment until the therapeutic process has shown its accuracy. The destructive tests are necessary to evaluate the limits of validity of the diagnoses while the non-destructive tests are done to confirm their functional validity.

To manage diagnoses as medical objects it is necessary that the EHR includes the possibility of managing them as adaptive systems.

Diego Belohlavek

NOTE: The Unicist Research Institute was the pioneer in complexity science research and became a private global decentralized leading research organization in the field of human adaptive systems. http://www.unicist.org