EMR


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


The next stage: Unicist Patient Centered Management

Patient Centered Management (PCM) is an organizational meta-model that allows empowering the work processes in healthcare institutions. It is homologous to Client Centered Management that is the natural model to guide work processes in businesses that was developed in the eighties.

Patient Centered ManagementOn the one hand, it works as a conceptual action guide to design work processes and, on the other hand, it is the main catalyst for continuous improvement, change management and innovation management.

PCM is driven by patient orientation. The purpose of the model is to assure results, and includes a quality assurance system that sustains the value added.

The information technology that sustains the PCM implies the integration of the three concepts that underlie healthcare IT:

  • EMR, to sustain physicians’ activities
  • EHR, to deal with the diseases
  • EPR, to provide a safety environment for patients

Based on the functional and legal context, this integration works in a different way in each culture.

The PCM provides a conceptual structure of rules that makes an optimal integration of these IT solutions possible and introduces the concept of adaptive interfaces in order to ensure adapting to the feedback.

Meta-models require being extremely focused in order to avoid being perceived as meaningless. By definition they need to be ambiguous because they need to allow adapting to the specific operation of different environments.

Meta-models describe the natural structure of an activity. Therefore, they are cross-cultural, needing to establish the operational rules respecting the characteristics of the environment. These meta-models make the saying “design globally, operate locally” become real.

The specific PCM is mainly focused on satisfying the needs of the patients within an environment where all participants win. The purpose of the model is to establish the unified field of the therapeutics process, taking advantage of all the technologies available and minimizing the participation of different “health” providers to solve the patients’ problems.

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


Ontological approach to Electronic Health Records

The approach to EMR/EHR needs to include both administrative and adaptive aspects in order to work as a driver for patient oriented healthcare.

We strongly recommend accessing the paper on the adaptive aspects of EHR prepared by Lowell Vizenor, Barry Smith and Werner Ceusters representing:

1. Institute of Formal Ontology and Information Science, University of Saarbrücken, Germany
2. University at Buffalo, Department of Philosophy, Buffalo, New York, USA
3. European Institute for Ontological Research, Saarbrücken, Germany

“Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task remains of ensuring that the right sorts of information reach the right sorts of people.

In what follows we defend the thesis that efforts to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations, and that the communication of healthcare information and knowledge needs to rest on a sound ontology of social interaction.

We illustrate this thesis in relation to the HL7 RIM, which is one centrally important tool for communication in the healthcare domain.”

Access the complete paper at:
http://ontology.buffalo.edu/medo/HL7_2004.pdf

Learn about the trend of ontology based solutions for businesses at:
http://unicist.net/obs.shtml


Unicist Cybernetics: The Unicist Standard for EMR/EHR

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.

unicist 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:

a)    Diagnoses
b)    Cures
c)    Palliatives
d)    Patients evolution
e)    Prevention
f)     Decision making
g)    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.