Cross-enterprise TeleHome Monitoring Workflow Definition
This supplement is written according to the specific template defined for Workflow Definition profiles. The structure of this document differs from a PCC Content Profile. In particular the XTHM-WD Profile establishes a common set of rules to share between participants involved in a telemonitoring workflow. The telemonitoring process, and workflow related to it, is applicable to many different sharing infrastructures. In this profile we present a specific XDS based use-case.
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The workflow related to the management of patients with chronic diseases (e.g., heart failure, COPD, diabetes) followed by a telemonitoring service is a cross-enterprise workflow since many different individuals from different enterprises can be involved: specialists and physicians, working in hospitals, rural areas or urban areas, general practitioners (GP), and general caregivers, as well as the telemonitoring centre’s staff.
For the correct management of these patients, each of these individuals, managing his part of the telemonitoring workflow, should have also the possibility to share and manage the patient’s complete clinical history. However, at the moment there are no technical specifications allowing this to be done in a standardized manner.
This profile provides guidelines to define this kind of cross-enterprise workflow using the XDW profile, allowing every participant involved in a patient's care to share the complete telemonitoring workflow, including all related documents produced for each event occurring during the process (data sending, request for a visit, change of therapy), and the related workflow status.
This proposal focuses on the Cross Enterprise TeleHomeMonitoring Workflow Definition in support of telemonitoring workflow document and status management.
The key elements are:
- managing telemonitoring cross-enterprise workflow, tracking all events and related documents;
- managing workflow specific status with relationship to one or more documents;
- tracking status of all events in telemonitoring process (in progress, completed, etc.).
With the increase in the elderly population and the consequent increase in the prevalence of patients with chronic diseases (as diabetes, chronic heart failure and COPD), the introduction of a telemonitoring service for these patients, with good workflow management, as defined in this profile, would entail a considerable advantage in terms of quality of life for patients and cost savings.
To demonstrate the scale of the problem, an analysis has been performed on some European data about the most relevant chronic diseases: now COPD affects approximately 44 million people (Eur Respir J 2011); heart failure affects about 15 million people (ESC 2008). The introduction of a telemonitoring service for these patients, with good workflow management, as defined in this profile, would entail a considerable advantage in terms of quality of life for patients and cost savings.
The general telemonitoring process flow can be described with the following steps:
A. The Telemonitoring process starts when a GP or a general caregiver requests the activation of a telemonitoring service for his patient to a telemonitoring service provider. In this initial phase of the process the GP defines the telemonitoring protocol for the patient and produces a telemonitoring Workflow Document with a “Request Activation” task as the first entry.
B. The service provider now evaluates and approves the physician's request and activates the service; the workflow document is updated with a new “Approve Request” task.
C. The patient starts to collect the required clinical parameters at his home or place of residence. The data collected is transmitted to the service provider that manages the data, making them available to any clinicians involved in the process. The Workflow Document is updated with a “Telemonitoring” task.
D. If the data sent by the patient goes outside the threshold levels defined in the protocol, the service provider alerts the referring physician and updates the Workflow Document with a “Consult Request” task.
E. The physician analyses the patient's data and decides if the patient needs to change their therapy, to have a specialist visit, or if there is no need to perform any action. The Workflow Document is updated with a task that depends on the decision taken by the clinician:
Template:PadE1. “Analyze and Request Visit”;
Template:Hidden textE2. “Analyze and Change Protocol”;
E3. “Analyze and Take Clinical Action”;
E4. “Analyze and Take No Action”.
F. Depending on the resulting task from step E, two options can result:
F1. If the decision is to schedule a visit, an eReferral process is activated. When the eReferral workflow ends the clinician that performed the referral updates the Workflow Document with the task “Visit Result”.
F2. If the result includes a need to change the protocol, the service provider receives the protocol from the clinician and activates it, updating the Workflow Document with the task “New Protocol Activation”.
G. If needed the Telemonitoring service can be closed by the Service Provider or by the referring physician according to a shared management of the service closing: if the request of closing is started by the referring physician, the Service Provider has to confirm the closing; if the request of closing is started by the Service Provider, the referring physician has to confirm the closing. This allows to acknowledge about the service closing both these actors that have in charge the patient during the telemonitoring process, the Service Provider from the technical point of view, the referring physician from the clinical point of view.
The patient now continues with the telemonitoring service. These steps can be tracked in eleven different tasks throughout the workflow:
- Request Activation: tracks step A, performed by the patient’s clinician;
- Approve Request: tracks step B, performed by the telemonitoring service provider;
- Telemonitoring: tracks step C, performed by the telemonitoring service provider;
- Consult Request: tracks step D, performed by the telemonitoring service provider;
- Analyze and Request Visit: tracks step E1, performed by the patient’s clinician;
- Visit Result: tracks step F1, performed by the patient’s clinician;
- Analyze and Change Protocol: tracks step E2, performed by the patient’s clinician;
- New Protocol Activation: tracks step F2, performed by the telemonitoring service provider;
- Analyze and Take Clinical Action: tracks step E3, performed by the patient’s clinician;
- Analyze and Take No Action: tracks step E4, performed by the patient’s clinician.
- Close Telemonitoring Service
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