Healthy Living Deploying A Patient-Centered Medical Domicile Cyberinfrastructure
- A computerized wellness agent (CHA) that enables patients together with clinicians to connect to the PCMH network via the Internet
- A next-generation electronic wellness tape (EHR) designed for each clinician's specific piece of work together with special, equally good equally a next-generation personal wellness tape (PHR), such equally the PHPro™.
In this scenario John, a xl twelvemonth erstwhile high schoolhouse instructor with type II diabetes, has been having problem managing his blood glucose, blood pressure, together with cholesterol levels, despite taking medication. He of late changed to a dissimilar primary aid physician (PCP) who is involved inwards a PCMH network that uses the innovative cyberinfrastructure to assist back upwardly together with coordinate collaboration alongside a multidisciplinary squad of clinicians.
Day 1: John calls his PCP to schedule the start piece of work see for the next week. After scheduling his appointment, the receptionist sends him instructions for accessing a comprehensive whole-person (mind-body) wellness assessment together with joining the PCMH network. She also asks John to allow the results of the assessment to live on sent automatically to the PCP; he agrees.
John thence goes to his estimator together with opens his browser. He navigates to the PCMH spider web site together with registers. After supplying the requested information together with selecting a user advert together with password, he is automatically enrolled equally a patient inwards the PCMH network. The CHA together with PHR are thence automatically downloaded together with installed inwards his computer. The PHR thence 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 together with psychosocial) wellness information virtually securely inwards his estimator inwards an encrypted information file
- Generates a personal profile study providing him an integrated "big picture" thought of his physical together with mental health—past, present, together with likely future—as good equally evidence-based guidelines that enables him to empathise his problems, risks, prognosis, together with the relative pros together with cons of dissimilar preventive together with handling options.
John starts interacting with biopsychosocial profile study offline. The report, which is comprehensive together with slowly to understand, includes:
- A description his medical together with emotional problems together with risks based on the information he input into the PHR
- A warning that he was nether a slap-up bargain of stress due to problems at piece of work together with inwards his personal life
- An alarm that his high blood describe per unit of measurement area may live on exacerbated past times a side-effect of a supplement he is taking
- An slowly to empathise visual depiction of his wellness status, treatments, together with pregnant life events on a timeline spanning many year
- A prognosis that give him realistic expectations past times predicting how his wellness volition probable live on inwards the hereafter if things maintain the means they are going, together with how probable his wellness volition improve if he takes effective steps to command his electrical flow problems together with preclude his risks from becoming problems
- Information therapy containing explanations together with evidence-based recommendations virtually his wellness together with what to do, including how his mental stress may live on raising blood glucose together with 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 assistance 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 merely about other folder. Whenever the PCP accesses his EHR together with selects to thought John's wellness information, his information file is retrieved together with the information it contains is presented inwards an interactive report.
Day 12: John meets his PCP for the start fourth dimension together with the ii of them hash out the results of the initial biopsychosocial assessment. The physician thence gives John his annual physical together with tells John that the results of the blood tests volition live on sent automatically to his PHR ane time the physician receives them. In the hateful time, the PCP refers him to reckon a cognitive-behavioral psychotherapist, who is also inwards the PCMC network, to assist him to handgrip his stress. After the piece of work visit, John calls the therapist together with makes an appointment for afterwards that week.
Day 15: During his initial session with 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 abode together with clicks a few buttons on his PHR, which automatically sends the authorized wellness information to the therapist's database. At the same time, sure enough information from the therapist's database are sent to the PCP's database to assist the PCP rail together with 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 past times the therapist includes detailed information virtually John's mental wellness that the PCP did non receive. This information includes analyses of the connections betwixt John's thoughts, attitudes, emotions together with behaviors; the nature of his electrical flow stressors together with life problems; his coping skills together with tendencies; sure enough observations of daily living (ODL) data; equally good equally his psychosocial history together with pregnant past times experiences. The therapist views this information through his EHR. He thence adds his professional person observations together with 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 alarm 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 hr menstruation John accesses his PHR together with views his lab exam results inwards language, graphs, together with motion-picture demo he tin understand. As suspected, his A1c glucose levels are besides high together with his cholesterol levels are borderline. He clicks a link adjacent to the abnormal levels together with receives additional information therapy explaining the probable causes for his status together with suggesting steps for him to take. In addition, he receives an alarm that sent to him automatically past times 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 piece of work for the follow-up. He is prescribed novel medications equally recommended past times the clinical guidelines displayed on the PCP's EHR. If his EHR implements the patient-centered cognitive back upwardly (PCCS) process, a virtual human model would live on used to assistance with guideline alternative together with generations of a holistic programme of care. Influenza A virus subtype H5N1 wellness omnibus working inwards the PCP's office, who uses a dissimilar version of the EHR, thence sits with John, explains his self-management programme of care, together with answers John's questions.
Day 23: John goes to his psychotherapist for his minute session during which he together with the therapist reviews his mental wellness study generated past times the therapist's EHR. The study contains useful information that helps them decide handling goals together with methods for achieving those goals. This information also suggests a diagnosis together with assists the therapist inwards establishing a handling plan. The therapist thence gives John a homework assignment. He is asked to exercise the self-help work administration guide on his PHR to assistance him inwards managing stress, improving his coping skills, together with developing to a greater extent than effective ways dealing with his personal problems. This assistance augments together with supports the aid rendered past times his therapist.
Ongoing for the adjacent eight weeks: John continues coming together with his psychotherapist weekly together with 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 together with idea processes when nether stress, his behavioral reactions to the stress, medication use, physical activity levels, diet, equally good equally his blood glucose together with blood describe per unit of measurement area levels using abode monitoring tools. The PHR analyzes these information automatically together with displays a study explaining how John's hear together with trunk are interacting, the changes taking identify inwards his physical together with mental health, trends, projections, together with warnings. Similar information are sent automatically inwards encrypted information files past times John's CHA to his therapist together with PCP's CHA. Their CHAs thence 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 omnibus 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 thought their EHR reports, the novel information are automatically processed together with warnings are displayed if newly discovered problems with John's wellness appear.
End of episode of care: Upon completion of his mental wellness treatment, John is alerted to exercise his PHR to exercise an outcome assessment inwards which a portion of the initial assessment is repeated. The results are calculated automatically revealing positive changes inwards his marker of stress, mood, telephone commutation cognitions (attitudes together with beliefs), coping skills, equally good equally inwards his glucose together with 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, together with wellness coach. In addition, the initial together with outcomes information are de-identified together with sent inwards a information file to a CHA connected to a enquiry database, which imports the data. The information are thence similar a shot available to collaborating networks of researchers together with clinicians studying aid outcomes together with evolving the clinical guidelines for ever-better results.
Bottom line: This scenario exemplifies the exercise goodness of delivering whole-person aid inwards a coordinated together with integrated fashion supported past times together with innovative cyberinfrastructure consisting of (a) a CHA that connect clinicians together with patients to a PCMH network via the Internet together with (b) next-generation EHRs together with PHR. The resultant is a happier together with healthier person, who is a to a greater extent than productive employee, together with who self-manages one's wellness to a greater extent than effectively. This benefits many past times reducing utilization of healthcare services to lower employer overhead, insurer payouts, together with the person's out of bag expenses. In addition, healthcare professionals exercise goodness from improve outcomes, fewer errors, together with to a greater extent than satisfied patients. And everyone benefits from greater peace of hear knowing that aid is well-coordinated together with delivered competently.
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