A generic model of clinical practice.
OBJECTIVE
Many shared-care projects feel the need for electronic patient-record (EPR) systems. In absence of practical experiences from paper record keeping, a theoretical model is the only reference for the design of these systems. In this article, we review existing models of individual clinical practice and integrate their useful elements. We then present a generic model of clinical practice that is applicable to both individual and collaborative clinical practice.


METHODS
We followed the principles of the conversation-for-action theory and the DEMO method. According to these principles, information can only be generated by a conversation between two actors. An actor is a role that can be played by one or more human subjects, so the model does not distinguish between inter-individual and intra-individual conversations.


RESULTS
Clinical practice has been divided into four actors: service provider, problem solver, coordinator, and worker. Each actor represents a level of clinical responsibility. Any information in the patient record is the result of a conversation between two of these actors. Connecting different conversations to one another can create a process view with meta-information about the rationale of clinical practice. Such process view can be implemented as an extension to the EPR.


CONCLUSIONS
The model has the potential to cover all professional activities, but needs to be further validated. The model can serve as a theoretical basis for the design of EPR-systems for shared care, but a successful EPR-system needs more than just a theoretical model.
Tange
H J
HJ
Department of Medical Informatics, Maastricht University, Maastricht. tange@mi.unimaas.nl
Dietz
J L G
JL
Hasman
A
A
de Vries Robbé
P F
PF
D003142:Communication; D003299:Cooperative Behavior; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D008501:Medical Records, Problem-Oriented; D017146:Models, Organizational; D009426:Netherlands; D010818:Practice Patterns, Physicians'