Deploying A Patient-Centered Medical Domicile Cyberinfrastructure
- A computerized wellness agent (CHA) that enables patients as well as clinicians to connect to the PCMH network via the Internet
- A next-generation electronic wellness tape (EHR) designed for each clinician's specific purpose as well as special, equally good equally a next-generation personal wellness tape (PHR), such equally the PHPro™.
In this scenario John, a forty yr onetime high schoolhouse instructor amongst type II diabetes, has been having problem managing his blood glucose, blood pressure, as well as cholesterol levels, despite taking medication. He lately changed to a dissimilar primary attention physician (PCP) who is involved inwards a PCMH network that uses the innovative cyberinfrastructure to aid back upwards as well as coordinate collaboration amidst a multidisciplinary squad of clinicians.
Day 1: John calls his PCP to schedule the offset constituent see for the next week. After scheduling his appointment, the receptionist sends him instructions for accessing a comprehensive whole-person (mind-body) wellness assessment as well as joining the PCMH network. She also asks John to allow the results of the assessment to travel sent automatically to the PCP; he agrees.
John thus goes to his estimator as well as opens his browser. He navigates to the PCMH spider web site as well as registers. After supplying the requested information as well as selecting a user elevate as well as password, he is automatically enrolled equally a patient inwards the PCMH network. The CHA as well as PHR are thus automatically downloaded as well as installed inwards his computer. The PHR thus begins displaying a serial of holistic wellness assessment questions on his screen.
After completing the detailed assessment, John's PHR automatically:
- Analyses the information using its mind-body wellness logic engine
- Stores the resulting biopsychosocial (biomedical as well as psychosocial) wellness information most securely inwards his estimator inwards an encrypted information file
- Generates a personal profile study providing him an integrated "big picture" stance of his physical as well as mental health—past, present, as well as in all probability future—as good equally evidence-based guidelines that enables him to sympathise his problems, risks, prognosis, as well as the relative pros as well as cons of dissimilar preventive as well as handling options.
John starts interacting amongst biopsychosocial profile study offline. The report, which is comprehensive as well as slow to understand, includes:
- A description his medical as well as emotional problems as well as risks based on the information he input into the PHR
- A warning that he was nether a swell bargain of stress due to problems at operate as well as inwards his personal life
- An warning that his high blood describe per unit of measurement area may travel exacerbated yesteryear a side-effect of a supplement he is taking
- An slow to sympathise visual depiction of his wellness status, treatments, as well as meaning life events on a timeline spanning many year
- A prognosis that give him realistic expectations yesteryear predicting how his wellness volition probable travel inwards the futurity if things travel on the agency they are going, as well as how probable his wellness volition improve if he takes effective steps to command his electrical flow problems as well as preclude his risks from becoming problems
- Information therapy containing explanations as well as evidence-based recommendations most his wellness as well as what to do, including how his mental stress may travel raising blood glucose as well as blood describe per unit of measurement area levels, equally good equally targeted actionable recommendations that anticipates his needs
- A listing of questions to inquire his physician to aid inwards shared decision-making.
John's CHA also sends a predefined subset of information from John's information file to his PCP's CHA via an encrypted information file. The PCP's CHA stores the file inwards his estimator inwards a folder (directory) containing the information files of other patients currently inwards treatment; the files of inactive patients are inwards roughly other folder. Whenever the PCP accesses his EHR as well as selects to stance John's wellness information, his information file is retrieved as well as the information it contains is presented inwards an interactive report.
Day 12: John meets his PCP for the offset fourth dimension as well as the 2 of them hash out the results of the initial biopsychosocial assessment. The physician thus gives John his annual physical as well as tells John that the results of the blood tests volition travel sent automatically to his PHR i time the physician receives them. In the hateful time, the PCP refers him to see a cognitive-behavioral psychotherapist, who is also inwards the PCMC network, to aid him to grip his stress. After the constituent visit, John calls the therapist as well as makes an appointment for afterwards that week.
Day 15: During his initial session amongst the psychotherapist, John authorizes an automatic electronic transmission of specific whole-person information from his PHR database to the therapist's EHR.
After the session, John returns domicile as well as clicks a few buttons on his PHR, which automatically sends the authorized wellness information to the therapist's database. At the same time, certainly information from the therapist's database are sent to the PCP's database to aid the PCP rail as well as coordinate John's care. In addition, the PCP is alerted that his database is updated.
The therapist requires dissimilar wellness information than the PCP. Since the cyberinfrastructure is configured to distribute the appropriate information sets based on each clinician's specialty, the information received yesteryear the therapist includes detailed information most John's mental wellness that the PCP did non receive. This information includes analyses of the connections betwixt John's thoughts, attitudes, emotions as well as behaviors; the nature of his electrical flow stressors as well as life problems; his coping skills as well as tendencies; certainly observations of daily living (ODL) data; equally good equally his psychosocial history as well as meaning yesteryear experiences. The therapist views this information through his EHR. He thus adds his professional person observations as well as psychological exam results into EHR, equally good equally information that is sent from his EHR to the PCPs.
Day 19: After the PCP receives John's blood exam results from the lab, those information are automatically sent to John's information file. An warning appears on John's equally inwards icon on John's estimator notifying him that novel information is available for viewing via his PHR. Later that twenty-four hours John accesses his PHR as well as views his lab exam results inwards language, graphs, as well as movie he tin understand. As suspected, his A1c glucose levels are also high as well as his cholesterol levels are borderline. He clicks a link side yesteryear side to the abnormal levels as well as receives additional information therapy explaining the probable causes for his status as well as suggesting steps for him to take. In addition, he receives an warning that sent to him automatically yesteryear his PCP's CHA; it instructs him to contact his PCP to schedule a follow-up see ASAP, which he does online via the PHR.
Day 22: John goes to his PCP's constituent for the follow-up. He is prescribed novel medications equally recommended yesteryear the clinical guidelines displayed on the PCP's EHR. If his EHR implements the patient-centered cognitive back upwards (PCCS) process, a virtual human model would travel used to aid amongst guideline choice as well as generations of a holistic computer program of care. H5N1 wellness rider vehicle working inwards the PCP's office, who uses a dissimilar version of the EHR, thus sits amongst John, explains his self-management computer program of care, as well as answers John's questions.
Day 23: John goes to his psychotherapist for his minute session during which he as well as the therapist reviews his mental wellness study generated yesteryear the therapist's EHR. The study contains useful information that helps them create upwards one's heed handling goals as well as methods for achieving those goals. This information also suggests a diagnosis as well as assists the therapist inwards establishing a handling plan. The therapist thus gives John a homework assignment. He is asked to utilization the self-help work administration guide on his PHR to aid him inwards managing stress, improving his coping skills, as well as developing to a greater extent than effective ways dealing amongst his personal problems. This assistance augments as well as supports the attention rendered yesteryear his therapist.
Ongoing for the side yesteryear side viii weeks: John continues coming together amongst his psychotherapist weekly as well as uses his PHR equally a self-help tool. He also uses the PHR to collect observations of daily living (ODL) information on a regular basis. These information include his levels of stress, the situations inwards which the stress is high, his mood as well as idea processes when nether stress, his behavioral reactions to the stress, medication use, physical activity levels, diet, equally good equally his blood glucose as well as blood describe per unit of measurement area levels using domicile monitoring tools. The PHR analyzes these information automatically as well as displays a study explaining how John's heed as well as trunk are interacting, the changes taking identify inwards his physical as well as mental health, trends, projections, as well as warnings. Similar information are sent automatically inwards encrypted information files yesteryear John's CHA to his therapist as well as PCP's CHA. Their CHAs thus automatically update the versions of John's information file stored inwards their computers, thereby ensuring the most recent information available for viewing via their EHRs. In addition, the wellness rider vehicle receives a subset of the data, which updates John's information file stored inwards her computer. Each of these collaborating healthcare professionals are alerted whenever information on a patient is updated. When they stance their EHR reports, the novel information are automatically processed as well as warnings are displayed if newly discovered problems amongst John's wellness appear.
End of episode of care: Upon completion of his mental wellness treatment, John is alerted to utilization his PHR to practise an outcome assessment inwards which a portion of the initial assessment is repeated. The results are calculated automatically revealing positive changes inwards his degree of stress, mood, primal cognitions (attitudes as well as beliefs), coping skills, equally good equally inwards his glucose as well as blood describe per unit of measurement area levels; his cholesterol remains at a borderline level, however. The results are sent via his CHA to the PCP, psychotherapist, as well as wellness coach. In addition, the initial as well as outcomes information are de-identified as well as sent inwards a information file to a CHA connected to a enquiry database, which imports the data. The information are thus straightaway available to collaborating networks of researchers as well as clinicians studying attention outcomes as well as evolving the clinical guidelines for ever-better results.
Bottom line: This scenario exemplifies the practise goodness of delivering whole-person attention inwards a coordinated as well as integrated agency supported yesteryear as well as innovative cyberinfrastructure consisting of (a) a CHA that connect clinicians as well as patients to a PCMH network via the Internet as well as (b) next-generation EHRs as well as PHR. The final result is a happier as well as healthier person, who is a to a greater extent than productive employee, as well as who self-manages one's wellness to a greater extent than effectively. This benefits many yesteryear reducing utilization of healthcare services to lower employer overhead, insurer payouts, as well as the person's out of bag expenses. In addition, healthcare professionals practise goodness from improve outcomes, fewer errors, as well as to a greater extent than satisfied patients. And everyone benefits from greater peace of heed knowing that attention is well-coordinated as well as delivered competently.
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