On the extended clinical workflows for personalized

healthcareMilan Zdravković and Miroslav Trajanović

Faculty of Mechanical Engineering, University of Niš, Serbia

International IFIP Working Conference On Enterprise Interoperability (IWEI 2013), Enschede, The Netherlands

Electronic Health Record (EHR)• “The Electronic Health Record (EHR) is a longitudinal

electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports.”*

*Health Information Management Systems Society

Benefits from EHR

Benefits from EHR

• automation and streamlining of the clinical workflow

• evidence-based decision support for diagnosis or treatment prescription (based on accurate and complete record of a clinical patient encounter),

• support to other care-related activities such as billing, reporting and quality management

hospital administrator extracts the billing data

physician assesses the effectiveness of treatments

nurse reports a reaction

researcher analyzes the efficiency of medications

HER and clinical workflow

EHR and clinical workflow

Treatment managementService delivery

Registration

Admission

Order Lab services

Order Rad services

Order Pha servicesTreatment

planningTransfer or discharge

Order oth services

CPOE Entry

EHR

Master Patient Index - MPI

Registration, admissions, discharge, and transfer (RADT)

Computerized Physician Order Entries (CPOE) permit clinical providers to electronically order laboratory, pharmacy, and radiology services.

Each activity is facilitatedby a relevant system or systemmoduleEach of these systems mustcontribute to EHR

Virtual Physiological Human

The Virtual Physiological Human (VPH)

• a unifying framework that enables and practically benefits from the integration of inter-disciplinary data and observations about human’s biology – integration of– physiological processes across different length and time

scales– descriptive data with predictive models– across disciplines

• aiming at– personalized care solutions– preventative approach to treatment of diseases

Custom medical products

Custom medical products

Motivation and problems

Motivation and problems• Manufacturing of the custom medical products is considered

as one-of-a-kind manufacturing, where the customization requirements often affect not only a principal manufacturer but also its suppliers.

• The manufacturing of a custom medical product could also include high-tech services by different suppliers, which are based on the models which need to be exchanged– Typically, some of these services precede supply chain planning phase

because their results often determine the basic product’s topology.• “high complexity of the supply chain planning and execution

in custom medical products manufacturing”.

Methodology

Methodology

• Combine practices of collaborative networked organizations with clinical practices

• Steps– Define extended workflow in the context of

Electronic Health Records (EHR)– Identify systems infrastructure and

interoperability issues– Identify models infrastructure

Extended clinical workflow

VE’s Resource Planning System (VERPS)

VBE’s Resource Planning System (VBERPS)

Conceptual product design system (PDS)

Procedure/Treatment planning system (PPS)

Treatment managementService delivery

Registration

Admission

Order Lab services

Order Rad services

Order Pha services

Treatment planning

Transfer or dischargeOrder oth

services

EHR

Order cust services

Proc/Treatplanning

Custom prod design

Source product

Manufacture product

Deliver product

Installproduct

Clinical Information System (CIS)

VE formation

VE execution VE dissolutionVBE mngmtExtended clinical workflow (simplified)

CISClinical info

system

PPSProcedure

planning system

PDSProduct design

system

VBERPSVBE planning

system

VERPSVE planning

system

CISClinical info

system

PPSProcedure

planning system

PDSProduct design

system

VBERPSVBE planning

system

VERPSVE planning

system

Send EHR

Write procedure report to EHR;Read EHR from CIS

Send procedure plan

Read procedure features

Create orders;

Send procedure report

Associate selected partners to product concept

Report on the use of resources;Request VE change

Write product features;Annotate parametric CAD model

Allocate resources for procedure

Supply chainmodel

VBEmodel

Productmodel

Proceduremodel

EHRmodel

Systems interoperability issues

Case study

Case study: Custom orthopedic implants manufacturing

• Made of different types and designs of fixtures and scaffolds

• Associated services– Pre-operation planning, digital reconstruction of

the bone, analysis of biomechanical properties, ethical review

Systems and models infrastructure

SOURCE

Pre-OP-SysSystem for

pre-op planning

Impl-D-SysConceptual implant

design system

SC-CONF-SysSupply Chain

configuration system

Productontology

CAD Featureontology

Configuration problem ontology

Explicit SCOR Ontology

Implicit SCOR Ontology

Pre-Operation process ontology

Anatomy ontology

CI-SysClinical information

system

EHRontology

O

P

D

S

MDe

I

N

plan-part-sourcingplan-part-

manufacturing plan-part-delivery

plan-services-sourcing

plan-services-implementation

plan-services-delivery

source-scaffold

source-inner-fixture make-scaffold

make-inner-fixturesource-digital-reconstruction

source-bio-mechanical-analysis

implement-digital-reconstruction

implement-bio-mechanical-analysis

deliver-bio-mechanical-analysis

deliver-digital-reconstruction

deliver-scaffold

deliver-inner-fixture

make-custom-implant

deliver-custom-implantsource-custom-implant

MAKE

OpenERP-SysEnterprise Resource

planning system

Local OpenERP ontology

DELIVER

Systems and models infrastructure

Thank you for your attentionQ&A

Milan Zdravković and Miroslav TrajanovićFaculty of Mechanical Engineering, University of Niš, Serbia