MediCOM is a CRM software system for Healthcare Management. The system is customized for work-related healthcare evaluators, which adds specific conditions and regulatory constraints to standard requirements of general practitioners and hospitals.
The main objectives of the system are:
- Repository of health records and other information related to employee’s health and its compatibility with employee’s occupation
- Workflow-driven system for patient evaluation based on occupational risks and medical protocols
- Automatic tool for creation of sanitary documents –periodic comprehensive assessment reports on employee’s health, filed to the employer and overseen by a regulatory government authority
- Scheduling / Calendar system for patient visits, jointly managed by employer companies and physicians’ office
- Secured warehousing healthcare provider’s office documentation
Terms
Sanitary Document
The sanitary document is a report that contains detailed assessment of patient’s heath from the point of view of risks associated with patient’s work description (occupation and work duties) in the current period. The most important part of the assessment is doctor’s conclusion whether or not the patient’s health is compatible with the duties of his work description.
As sanitary document’s cover periods of patient’s life, patient’s life can be viewed as a chain of continuous uninterrupted and non-overlapping periods, each period associated with one sanitary document.
Since there is 1-to-1 correspondence between such periods and sanitary documents, sometimes term “sanitary document” is used to refer to a period rather than the document itself. For example we can say “current sanitary document” to denote records of medical information (such as appointments, test, vaccination, patient’s personal history, etc.) created within current period.
Risk
Government or other regulations mandate for each risk (or group of risks) how long the periods between two consecutive sanitary documents is, and what tests/procedures and vaccinations a doctor must administer to the patient.
Thus, if in a certain period a patient has professional risk A, and this risk requires that some test be taken, a doctor must include this test’s results in the sanitary document.
The system provides doctor a few easy ways of assigning risks to patients and tests for these risks. For this, a doctor can combine risks into a group (called homogeneous group of risks) and combine a list of tests/procedures and vaccinations into a group (called medical protocol)
One homogeneous group can be assigned a few medical protocols.
A patient can (but does not have to) be assigned one homogeneous group. A person must be assigned at least one (but can have multiple) medical protocol, either directly or via a homogeneous group. The patient then will inherit risks associated with these protocols. In addition doctor can assign individual (i.e. not coming from medical protocol) risks to the patient.
Key Types of patient’s medical information in the system
- Work medical history (one record is created per evaluation cycle)
- Personal medical history (one record is created per evaluation cycle)
- Family medical history (one record is created per evaluation cycle)
- General Test (one record is created per evaluation cycle)
- Specialized Test/Procedure (multiple records per evaluation cycle)
- Vaccination records (multiple records per evaluation cycle
- Attachments: sanitary documents themselves; test results; vaccination results or signed refusal to have vaccination, etc. (multiple records per evaluation cycle)
Cycle of Evaluation
A set of tests/procedures and vaccinations for the current period, along with all doctor’s appointments make a cycle of evaluation. This term is another 1-to-1 notation for sanitary document and its period.
Use Case
From execution flow standpoint, which is close to timeline but is not identical, doctor’s work on each patient within each period can be divided into three broad steps:
- Step 1: See patient, perform interview/general examination, give out referrals for tests/vaccinations
- Step 2: Collect all test and vaccination results
- Step 3: Complete the cycle of evaluation; close all records, generate and send sanitary document
Step 1
Per each cycle of evaluation a patient visits doctor on the appointment day scheduled in advance, and during this visit doctor:
- Adds Sanitary Document record, in which:
- Populates current work medical history record and makes its status “closed”
- Conducts interview and gives out questionnaire; based on this info populates current personal medical history record and makes its status “closed”
- Conducts interview and gives out questionnaire; based on this info populates current family medical history record and makes its status “closed”
- Conducts general examination of the patient and populates current general test record and makes its status “closed”
- Adds specialized test and vaccination records for patient, and gives patient referrals for these procedures; the status of records is “open”
- Populates duration of current appointment record; changes status of the record to “closed”, and links it to the current sanitary document
Step 2
After that patient takes specialized tests and vaccinations; and over short period of time the results are delivered to doctor.
As the results of tests/vaccinations keep coming in, doctor attaches test/vaccination result documents to the specialized tests and vaccination records; populates a few fields with his conclusions, and changes status of the records to “closed”
Step 3
After all specialized tests and vaccination records are closed, doctor:
- Populates Summary record in the sanitary document as to whether or not patient’s health is compatible with his work duties, and changes status of the Sanitary Document to “closed”
- Generates sanitary document report for this period and sends it to employer
- Adds a new appointment record for next cycle of evaluation
Notes
From the standpoint of timeline, the process may be slightly different from the execution flow standpoint given above, in that:
- A doctor may conduct some or all of specialized tests and administer some or all of vaccinations himself during patient’s appointment, thus steps 1 and 2 will occur at the same time
- Conversely, it may be that for various reason step 1 takes more than one appointment, or doctor himself wants to perform some of specialized tests and vaccinations on a different day. In such case a doctor creates another appointment record for the patient; links it to the current sanitary document record and if so desired to the original appointment record. The original appointment record may be marked as “follow-up appointment scheduled” to draw doctor’s attention
- Before the patient’s visit a doctor may already have a sanitary document record created for the current cycle of evaluation. The reason for that is b/c patient’s work description – information to be entered to the work medical history record – usually comes in advance from the employer, and it is doctor’s choice to keep it on file and enter it in the system at the time of patient’s visit, or do so upfront.
Entities
The information below is description of information stored in entities rather than database objects.
Patient
Patient’s entire medical record (a.k.a. chart) is stored in the system. One patient has one chart.
Terms “chart” and “patient” can be used interchangeably when referring to patient’s medical information.
The patient’s chart contains the following information:
| # | Information | # of RecsIn chart | Notes |
|---|---|---|---|
| 1 | General information | 1 | Name, date of birth, addresses, phones, etc. |
| 2 | Work Medical History | 1 per cycle of evaluation | Position; duties performed; medical protocol; homogeneous group; risks; tests required; vaccinations required (as medical history record fills in, results are entered in tests/vaccinations) |
| 3 | Family Medical History | 1 per cycle of evaluation | Patients fills in standard questionnaire once per cycle of evaluation; doctor may add his comments |
| 4 | Personal Medical History | 1 per cycle of evaluation | Patient fills in questionnaire and verbally describes his:- overall health and abnormalities (pathological history)- personal life (physiological history)- accidents/disabilities (accidents history) |
| 5 | General Test | 1 per cycle of evaluation | Doctor performs one general check-up on patient’s vitals health systems:- general (height, weight, etc.)- skin / head / neck- cardiovascular system- respiratory- gastrointestinal system- nervous system, etc. |
| 6 | Specialized Test | N per cycle of evaluation | Based on patient’s risk factors, a number of tests/procedures must be completed before doctor can issue sanitary document for current period |
| 7 | Vaccination | N per cycle of evaluation | Unless otherwise, vaccinations will be stored along with specialized tests, and for purpose of differentiation marked by a flag |
| 8 | Summary | 1 per cycle of evaluation | Doctor’s conclusion (patient can or can’t perform his work duties); additional comments; and a couple of fields for record-keeping purposes, such as “sanitary document generated on date XYZ”; “sanitary document sent on date XYZ” |
| 9 | Attachments | N per cycle of evaluation; also some attachments may not relate to cycles | Example of documents:- Sanitary documents- Test results- Vaccination results- Signed refusal to have vaccination |
Sanitary Document
Sanitary document as described above is a slice of patient’s information per one cycle of evaluation. As such it contains the following information:
| # | Information | # of RecsIn sanitary document | Notes |
|---|---|---|---|
| 1 | General information | 1 | Snapshot from patient’s data: Name, date of birth, address, etc. |
| 2 | Work Medical History | 1 | |
| 3 | Family Medical History | 1 | |
| 4 | Personal Medical History | 1 | |
| 5 | General Test | 1 | |
| 6 | Specialized Test | N per cycle of evaluation | |
| 7 | Vaccination | N per cycle of evaluation | |
| 8 | Summary | 1 | |
| 9 | Attachments | N |
Appointment
Appointments are used strictly for scheduling. The record has same information as appointment in Outlook if not less; what’s important is date-time started, finished, purpose of visit. Details of appointment, such as general test results, etc. are entered into Sanitary Documents immediately, and not duplicated in the appointment record itself.
Colored lookups are used to mark appointment based on various criteria, such as status (open/closed/followup required), overdue/rescheduled, and so on.
Appointments are always linked to a patient; appointments may not be linked to a sanitary document but this is very unlikely.
Specialized Test & Vaccination
Test and Vaccination records have date and time similar to Appointments but rather than scheduling the purpose of the records is to make sure patients don’t go unprotected b/c a condition is unchecked or a vaccination period has expired.
For what information is available at present, test and vaccination records contain just a few fields (mostly lookup – typology of test; status; etc.) and result status (OK / not OK / need more focused examination)
Test and Vaccination records almost certainly have attachments, which should also be linked to the parents sanitary document.
Tests and Vaccinations are always linked to a patient and to a sanitary document.