Mission
Solving the Chronic Problems of Clinical Information Systems
Medicognos
enables the patient centered integration and management of clinical
care and research processes through a brand new generation of clinical
information system. Our systems are designed to make full use of
clinical decision support for quality and safety management of clinical
workflows: care pathways, disease management, research protocols and
clinical trials in a user-friendly manner. Medicognos promotes a
paradigm shift from the forty years old problem oriented medical record
to a formal knowledge based clinical process management platform.
The
Medicognos approach goes beyond the POMR paradigm introduced by
Lawrence L Weed [1] in 1968 and repurposed in many different versions.
Although the structured approach of POMR has proved to be effective in
a variety of computerized record environments a list of limitations of
the POMR has been meanwhile recognized:
- Problems are often linked in a causal way (pneumonia following a fall causing fractured neck of femur).
- The POMR only gives a crude measure of the state of a problem. In the real world problems tend to go in cycles
- Different clinicians, and indeed anyone with the right to view the clinical record, need different amounts of information from the record as well as different views
- Many different issues may be discussed within a single consultation (feeling short of breath after argument with spouse, for example) and information may legitimately belong to more than one problem
- Not all the problems are problems in the
strict sense of the word (for example ‘vaccinations’ is used to collect
all the entries related to vaccination history)
Several ideas have been put forward in order to overcome the limitations of linking related problems and multiple problems at any one encounter. These include timeline use, encounters, episodes and sub-problems. Medicognos is implementing all these features and is transforming the POMR into an evidence- and workflow-based management system, a new generation of electronic medical records named Clinical Process Management (CPM) System.
We believe that without knowledge about
the ongoing healthcare processes it is extremely hard, if not
impossible, to pursue goals of:
- Usability - To reach an outstanding level of usability, in terms of learnability [2] and memorability, it is desirable to reduce the semantic impedance between the software application and the users ensuring a good correspondence between the software artifacts and the mental model of the healthcare professionals. The alignment of the software behavior and the workflow of the healthcare providers is necessary for increasing efficiency;
- Quality and safety - A broaden use of EPR does not translate necessarily into an automatic diffusion of improved quality and safety of care. The only strategy that has been proven increasing the quality of care consists in the introduction of context-aware clinical decision support [Linder2007]. Patient safety can be dramatically improved by being able to accurately track the patient status and the ongoing healthcare process. Such information could then be used to identify system vulnerabilities and develop preventive strategies;
- Continuity of care and interoperability - Without the perspective on the ongoing medical and organizational processes it is prohibitive to implement process management and process integration. Process-awareness and a standardized/shared descriptions not only of data but also of the tasks performed by different professionals is crucial to efficiently coordinate the effort of multiple healthcare providers as well as to carry out performance analysis and process reengineering with the ultimate goals of continuity of care. Moreover, sharing the patient data together with the patient context and the clinical process in which the data has been originated is crucial to transform data exchange into valuable information exchange.
[2] Acording to ISO 9126, is the capability of a software product to enable the user to learn how to use it. Learnability may be considered as an aspect of usability, and is of major concern in the design of complex software applications.
History and Vision
The
project of a new generation of Electronic Patient Records (EPR) was
initiated in 2004 by Dr S Braga and Dr Alexaner Jenniges in
order to cope with the high level of frustration of physicians
that found really hard to introduce the usage of existing software
solutions in their daily practice. In fact the classical
Electronic Patient Records (EPRs) turned out to be hard to use because
of confusing and tedious interfaces, disconnection from the healthcare
process (requiring the physicians to change their workflow without
increasing their efficiency) and because of the critical lack of tools
for the creation and management of collaborative networks.
Since
2005 they joined forces with Mr. Paolo Ciccarese PhD to redesign the
classical EPR into a clinical process management Platform (CPM).
Te conceptual basis of CCP was largely explored and prepared through
the clinical guidelines computerization research in projects such as
the Guide project [Ciccarese2004]. Guidelines allow us to specify what
needs to be recorded, when to record it, how to evaluate/make decisions
(computer interpretable clinical guidelines), and what needs to be done
(workflow definitions that may include a combination of clinician and
system dependent actions). Workflow management systems support
process-orientation through the automated coordination of activities,
data, and resources. This coordination is based on a formal
representation – workflow model - of the process to be automated.
The team was progressively extended with medical , software engineering experts and management support (Link to the About us page).