使用CommonCADS对荷兰紧急医疗服务进行建模分析

2010-02-01 00:00:00 评论(0)
这是我在读“Business Intelegence and Knowledge Management”这门课时所写的一篇使用CommonCADS方法论对荷兰紧急医疗服务系统所进行的一个案例分析,完稿于2009年4月20日。
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Modeling Emergent Medical Service in

the Netherlands with CommonCADS



Wenchao He

School of Information Systems and Technology

Faculty of Informatics, University of Wollongong, Australia




1   Introduction

Emergent Medical Service in the Netherlands has experienced difficulties in saving acute myocardial infarction patients’ lives by avoiding delay for treatment. A new knowledge system should be introduced to the organization to improve their business processes. Before a proper solution to the problem is developed, an insight into the organization is necessary. In this paper, CommonKADS methodology (Schreiber et al. 2000) is used to perform a scoping and feasibility study and an impact and improvement study by modeling the organization from different aspects.



2   Scoping and Feasibility Study

2.1    OM-1: Problems and Opportunities

EMS aims to quickly transfer patients in need to hospital to receive proper medical treatment. To deal with the problem of delay of GP, they have an opportunity to allow citizens to call them directly. However, a new problem has to be expected, which is the increasing number of direct calls from patients.

Organisation Model

Problems and Opportunities Worksheet OM-1

Problems

* Delay of patient, GP and treatment

* Increasing calls to EMS

* Difficult triage of really urgent cases

* Knowledge of assessing emergency by telephone is heuristic

* Dispatches that do not result in patient transport to the hospital

Opportunities

* Response to patients’ medical treatment request bypassing the GP

* Triage knowledge management

* Development of protocols for assessing emergency by telephone

Organisational Context

Mission

Provide AMI patients with proper in-time treatment

External Factors

Patients’ preferences, GP’s practice, public traffic

Strategy

Proper decision and action should be made after assessing individual calls to EMS, in despite of increased number of calls from patients because of their bypassing the GP.

Value Drivers

Reducing morbidity and mortality from AMI and making the therapy available to the patients in time

Solutions

* Solution 1: allow citizens to make a call directly to the Emergency Medical Service

* Solution 2: develop priority service system for AMI patients and only let this kind of patients bypass the GP



2.2 OM-2: Organisation Focus Area Description

The structure of the organisation is not complicated. Relationship between each subpart is clear and well defined. The business process is straight forward. The number of roles in the organisation is not large. The following table depicts the basic information about the organisation in more detail:

Organisation Model

Variant Aspects Worksheet OM-2

Structure


Process


People

Managers of Dispatch Centre and Ambulance Service, Nurse Dispatchers, System Manager, Paramedics, Drivers, etc.

Resources

* IBM RISC/600/320 machines under Unix

* An information support system that handles on-line emergency calls, and off-line reservations, reviews, finance, statistics, etc.

* Fully-equipped Ambulances

Knowledge

* Emergency call answering

* Triage

* Process of emergency handling

* Diagnosing and treating AMI

Culture & Power

* Dispatchers control ambulance personnel without being formally in charge of them

* Dispatchers and ambulance personnel do not socialise

* Paramedic is higher in the hierarchy than the driver

* Manager of the ambulance service holds power over the paramedic and the drivers

* Manager of the dispatch centre holds power over the system manager and over the dispatchers



2.3    OM-3: Process Breakdown

EMS’s main business processes can be broken down into seven main tasks which are described in the following table:

Organisation Model

Process Breakdown Worksheet OM-3

No.

Task

Performed By

Where?

Knowledge Asset

Knowledge Intensive?

Significance

1

Call Answering

Dispatcher

Dispatch Centre

online call system operation, call answering techniques

Medium

Medium

2

Emergency Assessment

Dispatcher

Dispatch Centre

Triage

High

High

3

Patient Information Sent to Ambulance Personnel

Dispatcher

Dispatch Centre

Internal Communication

Low

Low

4

Ambulance Dispatched

Driver and Paramedic

Ambulance Service

Ambulance Driving, Medical Care Preparation

Low

Medium

5

Patient Pick-up

Paramedic

Patient’s Location

Assistance for patient’s getting on ambulance

Medium

Medium

6

Ambulance Back to Hospital

Driver

-

Ambulance driving

Low

Medium

7

Medical Care on Ambulance

Paramedic

Ambulance

Emergent medical care techniques

Medium

High



2.4    OM-4: Knowledge Assets

The tasks mentioned in OM-3 are all based on specific knowledge assets. Without the knowledge, the staff member will not perform the task properly. These knowledge assets for EMS’s main tasks are described below:

Organisation Model

Knowledge Assets Worksheet OM-4

Knowledge Asset

Possessed By

Used In

Right Form?

Right Place?

Right Time?

Right Quality?

Online call system operation

Dispatcher

Task 1

Yes

Yes

Yes

Yes

Call answering techniques

Dispatcher

Task 1

Yes

Yes

Yes

Yes

Triage

Dispatcher

Task 2

No, triage of AMI may no be processed via telephone properly

No, triage of AMI may no be processed at Dispatch Centre

Yes

No

Internal Communication

Dispatcher and Paramedic

Task 3

Yes

Yes

Yes

Yes

Ambulance Driving

Driver

Task 4 & 6

Yes

Yes

Yes

Yes

Medical Care Preparation

Paramedic

Task 4

Yes

Yes

Yes

Yes

Assistance for patient’s getting on ambulance

Paramedic

Task 5

Yes

Yes

Yes

Yes

Emergent medical care techniques

Paramedic

Task 7

Yes

Yes

Yes

No, proper treatment for AMI patient on ambulance may not be available



3 Impact and Improvement Study

3.1    TM-1: Task Analysis

Task 2, Emergency Assessment, has been recognised as of high knowledge intensiveness and high significance. This task plays a critical role in the business processes of the organisation. The following table will describe this particular task’s different aspects:

Task Model

Task Analysis Worksheet TM-1

Task

Task 2: Emergency Assessment

Organisation

Dispatch Centre

Goal and Value

This task aims to determine the degree of emergency of the reported incident and prepare relevant medical treatment resources for the patient. This task is important as it can avoid delay of treatment for high-degree emergent illness.

Dependency and Flow

Input tasks: A call from GP comes in

Output tasks: dispatching ambulance and sending useful information to paramedic

Objects handled

Input Object: In-coming call

Output Object: Information package for Ambulance Service

Internal Object: Emergency confirmation

Timing and Control

Frequency: 400 per day

Duration: 3.6 minutes

Control: Ambulance Service will only take further action when they receive the information package from Dispatch Centre.

Constraint: the task has to be performed based on dispatcher’s heuristic triage knowledge; the decision has to be made within a short time.

Agents

Dispatcher

Knowledge & Competence

Online call system operation, call answering techniques, triage, internal Communication skills

Resources

Time, online call system, internal communication system

Quality and Performance

Proper response to the reported patients according to the correct judgement of their illness and degree of emergency



3.2    TM-2: Knowledge Item Description

To perform Task 2 well, Dispatchers have to use some specific knowledge, and such knowledge can actually be broken down into different knowledge items. The author has identifies these items and display them in the following table. Furthermore, those recognised as bottlenecks have been labelled, which will be beneficial for solution development.

Task Model

Knowledge Item Worksheet TM-2

Name

Triage

Process by

Dispatcher

Used in

Task 2. Assessing Emergency

Domain

Nursing, Medical

Nature of the Knowledge

Bottleneck/To be improved?

Formal, rigorous

X

Empirical, quantitative

X

X

Heuristic, rules of thumb

X

Highly specialised, domain-specific

Experience-based

X

Action-based

Incomplete

X

Uncertain, may be incorrect

Quickly changing

Hard to verify

Tacit, hard to transfer

X

X

Form of the knowledge

Bottleneck/to be improved?

Mind

X

X

Paper

Electronic

X

Action skill

X

Other

Availability of knowledge

Bottleneck/to be improved?

Limitations in time

X

Limitations in space

Limitations in access

X

X

Limitations in quality

X

X

Limitations in form

X



3.3    AM-1: Agent Specification

Dispatcher is the only agent who performs Task 2. Here we are to describe this position.

Agent Model

Agent Worksheet AM-1

Name

Dispatcher

Organisation

Informally controlling Ambulance personnel, under the supervision of Manager of Dispatch Centre

Involved in

Task 1, 2 and 3

Communicates with

Paramedics

Knowledge

Online call system operation, call answering techniques, triage, internal communication skills

Other Competences

Perform nursing service to patient

Responsibilities and Constraints

Dispatchers is responsible for collecting accurate information about callers’ detail and patients’ situation, making correct decisions in terms of emergency confirmation, ambulance resources allocation, information package for emergent medical treatment preparation.

Dispatcher has limitation in triage of some illness (e.g., AMI).

4   Conclusion

EMS’s organisation models show that its two subparts work closely to provide their service, where Ambulance Service’s action depends on the decision made by Dispatch Centre. And such decisions are based on the information about the patients that the Dispatcher collects via the emergent call system. Emergency Assessment seems to be critical in EMS’s business processes as it requires the dispatchers have sufficient triage knowledge so that they can perform the task properly and successfully. The role of Dispatcher has several responsibilities that directly relate the quality of the service. However, dispatchers’ limitations in triage knowledge access and quality have affected the organisation’s fulfilling their mission. As a result, the knowledge carried by dispatchers should be the focus for future study in terms of the solution to EMS’s problem.

5   References

Schreiber, G, Akkermans, H, Anjewierden, A, De Hoog, R, Shadbolt, N, Van de Velde, W and Wielinga, B 2000, ‘The task and its organizational context’, Knowledge Engineering and Management : the CommonKADS Methodology, MIT Press, Cambridge, pp25-67.


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