CHOS-WG Scenario: Activity Management

• Introduction:
• The scope of this scenario is the ordering of an activity, regardless of the specific content of that activity.  The request to do do some activity and the management of the follow-up.
• An order need a unique order identification in a well defined environment.  A patient may have several orders.
  
• ...
• Description:
• Overviews:
• Overview of the care plan:
• Before ordering any new activity, one should have a look at the current care plan, if any. 
  
• At any time an overview of all the open orders should be available.
  
• Overview of worklist:  see below.
  
• Ordering:
• Preparation:
• An order is initially a kind of draft, as could be proposed by a secretary or a student.
• The most essential informations are:
• Who is responsible of the order.
• Who is the subject of care.
• Degree of urgency: by default not urgent.
• Optional motivation of the order:  desirable because the agent in charge of the execution would be better motivated and would apply the most appropriated procedures.
  
• The content of the required activity, what it may be (not discussed here).
  
• ...
  
• Validation:
• An order takes effect when it is validated by the authorized and responsible agent. 
  
• Transmission of the order:
• If possible the person creating the order should type the information directly in a computer form in the network.  Otherwise a paper form will be transcribed later.
  
• In the case of a lab, labels must be set on the sample as soon as the sample is created. 
  
• Scheduling:
• Optional booking of an appointment.  Usually not for a simple lab test or for a prescription, but some types of activities require a mandatory scheduling.
  
• Reception by the agent in charge of the order:
• Reception:
• The order arrive at the department in charge of the execution of the order.  If not earlier introduced in the computer, orders on paper are transcribed in the computer.
  
• Acceptation:
• The department in charge of an order will implicitly check if the order is possible and meaningful.  If not, a message should be returned to the requester, as a kind of empty report with the motivation of the denial.
• Confirmation that the order is ready for execution, i.e. the patient or a sample from the patient did arrive.
• Date and time of the activity.
• Identification of the agents doing the activity.
  
• Worklist:
• The persons in charge of the activities need an up to date overview of what is expected from them.  Therefore  maintenance of lists of cases in progress, with their status.  
• Retrieval of list according to the status of the orders, for example preliminary results waiting for validation.
  
• Retrieval of selected lists according to subtypes.  One order may generate several secondary worklists, e.g. in labs when several tests are required on the same sample, in pre-surgery check-up, ...
  
• Execution:
• The execution of the order depends on the specific nature of the activity.  In this common generic scenario the execution of an order is seen as a black box, which will be analyzed in a separate scenarios dedicated for every type of activity.
  
• Evaluation and report:
• Creation of the report:
• Patient care:
• A report can be created in several steps, e.g. by a junior assistant, reviewed by a senior, and/or reviewed by a consultant maybe through remote telecommunication.
• Continued education:
• The preparation of a report can be associated to education issues.  Beginners need access to background knowledge and support in order to discuss the aspects of the current case.  Comparisons with reference examples can be useful.
• The goal is that next time a similar case would arise, the beginner would become better able to handle the situation.
  
• Validation of the report:
• The final report must be validated by the responsible authority.
  
• Partial reports maybe validated when some things are finished earlier than others, e.g. in a lab.
• Transmission of the report:
• Activation of the communication:
• At the time of the final report.  Moreover sometimes maybe an interim report is sent earlier.
  
• Addressed to:
• Always to the initial requester of the order and optionally to a few other agents.
• Normally a report is automatically archived and remains available for at least a few years.  Entries in archive from:
• On patient ID
  
• On order nr, on date,
• On type of activity.
  
• From research and educational point of views, maybe a few other indexations, e.g. on type of disease.
  
• Mode of transmission:
• Printed on paper and sent via a postal service.
  
• If possible the report is made available through the network. 
  
• In that case a notification must be addressed as soon as the validation did take place. 
  
• Message on mobile phones could also be generated.
• Declarations:
• Normally after the activity has been completely executed.
• Destination:
• To the administration:
• Declaration of the services which have been performed for patients. At this level just a declaration of the facts without assumption about what could be charged at which price, to which insurance and how.
  
• If required to statistical databases intended for management and/scientific purposes:
• For confidentiality reasons, patient identification should alway be removed.
  
• ....
• Prerequisites:
• User Session:
  
• Patient Identification:
• Medical Data,
  
• Authorizations, 
• Activity
  
• ....