James F Fleck, MD, PhD

Collective Intelligence Applied to Medicine

GLOBAL NEEDS IN THE HEALTHCARE SYSTHEM

Digitizing clinical problem-solving methodology

(the inclusive Global e-PHR methodology)1

Global e-PHR initiative proposed an electronic clinical problem-solving methodology embedded in a patient-centric Digital Health Record (DHR). Representative healthcare stakeholders were brought together using a pictorial allegorical puzzle to generate collective intelligence. The basic premise was a healthcare system centered on patients’ needs and rights. In Global e-PHR, a comprehensive health record would belong to the patient, like an identity document (ID). Patient would be required to fulfill the register and work at the privacy module of the proposed DHR. Everything else would be provided by attending and consulting physicians, who are responsible for clinical data quality. Physicians were oriented to create a problem list, according to a simplified version of the worldwide known problem-oriented medical record described by Lawrence Weed. A data base composed by clinical history, physical exam and some preliminary laboratory data would support each listed problem. Based on each numbered problem, physicians would define their intervention planning, which should be kept under surveillance and recorded in progress notes until it is resolved. Additionally, reports, images and videos of diagnostic exams would be uploaded into the designated modules. Patients would be stimulated to actively interact with their physicians to better qualify the problem list. The DHR would also provide to the patient an automatic generated timeline of events and a summary including all uploaded information. Patient access to their DHR would be based on exclusive username and password, making it accessible in real time and anywhere in the world. Only the patient would have the right to share their clinical information. At patient’s discretion, sharing clinical data would be restricted to professionals or institutions directly involved in their healthcare. The algorithm incorporated into DHR, as described above, has digitized clinical problem-solving methodology, proposing a global standardization for a patient-centric care model.

1 For a better understanding of Global e-PHR methodology go to www.ephr.org

Health is a state of harmony with the fractal expression of nature

GLOBAL NEEDS IN THE HEALTHCARE SYSTHEM

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James F Fleck, MD, PhD

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Privacy

• Here, you review the authorization to allow access, viewing and editing of your personal and clinical data, as recommended by the General Data Protection Regulation (GDPR). Here, you can check the authorization time, date and IP number of the device.

Registry

• Here, all your personal data are stored, including preliminary clinical information such as ABO and Rh group systems, allergies, immunizations, and long-term use medications. In the registry, you will also find your attending physician’s name and license number.

Problem List

• Here, the attending physician will create a list of problems as described by Lawrence Weed. Before introducing a new problem, the doctor will review the entire list, avoiding repetition. Each problem listed is automatically followed by the date it was added.

Data Base

• Here, the attending physician points out the clinical and laboratory findings that support each problem listed. These are preliminary data obtained in the anamnesis, physical examination, lab, and imaging tests brought by the patient.

Planning

• The information provided in the database generates diagnostic hypotheses and recommendations. In this module, the attending physician requests additional tests to increase diagnostic accuracy. The attending physician also recommends consulting physicians, promoting comprehensive care, and adapting the proposed treatment plan.

Progress Notes

• Here, the attending physician enters progress notes. Each note is associated with a specific problem. Under this module, you will also find progress notes edited by consulting physicians, automatically dated and linked to their respective specialties. The module also allows the issuance of electronic prescriptions for outpatient use.

Exams

• Here, exams are stored. Exams are uploaded by consulting physicians responsible for previously agreed laboratories and imaging clinics, which are classified into categories and subcategories. The access is provided by the consulting physician’s unique username and password, and the device’s IP number is registered at each intervention.

Medical Report

• Medical reports are detailed descriptions of a patient’s clinical case, indicating the level of evidence for each recommendation. This may be a report issued by the attending physician containing a comprehensive clinical analysis of the information uploaded into the patient’s DHR or a specific recommendation given by a consulting physician.

Timeline

• This function is automatically generated by the system. By clicking on this module, you will see all dated activities performed sequentially on the patient’s DHR.

Summary

• This function is automatically generated by the system. Here you will see a summary of uploaded clinical data, organized in a chronological format.