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An Analysis Pattern for Patient Treatment

1. Introduction

• A Patient Treatment Pattern describes the treatment or stay history of a patient in a hospital.

• The hospital may be a member of a medical consortium. • Each patient has a medical history which contains insurance information and a record of all treatments within the medical consortium.

• Each patient has a primary physician, an employee of the hospital.

• Upon admission the patient is created as new or information is updated from previous visit(s).

• A treatment history is created for each patient admitted and updated throughout the patient’s stay.

• Inpatients are assigned a room, nurse team and consulting doctors.

• The Patient Treatment Pattern is a composite pattern that includes three simpler patterns.• Patient Record • Consortium Assets • Asset Assignment.

• The component patterns have their own value and can be used independent of the composite pattern.

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2. Patient Record

2.1 IntentThis pattern describes the process of creating patient records for a stay or treatment in a hospital and managing the history of these records.

2.2 ContextA hospital or medical consortium that keeps records of patient treatments.

2.3 ProblemMaintaining accurate patient records is crucial for patient treatment.

2.4 Forces• Patients may receive treatment in separate hospitals of the medical consortium and we need to keep track of all treatments in all hospitals.• Patients receive treatment for various ailments in different areas of a hospital and we need to keep track of all treatments in all departments of a hospital.• Patients may receive treatment from various doctors and nurses of the hospital and we need to keep track of all treatments by all medical employees.

2.5 Solution• Create a unique stay or treatment history for every patient upon admission to the hospital.• The treatment histories are added to the patient medical histories.

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2. Patient Record

Inpatient

nameaddresspatient number

Patient

Outpatient

specialty

insurancetreatment history

MedicalHistory

1

TreatmentHistory

medicationsprocedures

*

Figure 1 Class Diagram for Patient Record

4Figure 3 Sequence diagram for admit a patient (not new)

<<actor>>anAdmissionsClerk:

<<actor>>aPatient:

:Patient

:MedicalHistory

:TreatmentHistory

provide information <<create>>

<<create>>

<<create>>

Figure 2 Sequence diagram for admit a new patient

2. Patient Record

<<actor>>anAdmissionsClerk:

<<actor>>aPatient: :Patient :MedicalHistory

:TreatmentHistory

provide information

<<create>>

open

open

5

entry:addTreatmentHistory()

Active

activate

completetreatmentHistory

do: closeMedicalHistory ( )do: closePatient ( )

Closed

do: setPatient Info( )

Created

(New) create

Figure 10 State Chart Diagram: Medical History

5. Patient Record

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Created

create begin stay

do:updateTreatmentlHistory()

Under Diagnosis

do:updateTreatmentHistory()do:updateMedications()

UnderTreatment

start treatment

Suspend

suspend treatment

return to treatment

Figure 11 State chart Diagram: Treatment(Stay) History

5. Patient Record

do: closeTreatmentHistory ( )

Discharged

complete treatment

discontinue treatment or death

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2. Patient Record

2.6 ConsequencesAdvantages:• Each treatment or stay history is summarized into one record. • Each stay history is added to a patient medical history.• Each medical history provides information about the patient for future treatments within the medical consortium.• Role based access control can be used to protect the privacy of a patient.

Disadvantages:• Policies about the size of a treatment history need to be established, if a patient receives treatment in too many departments by multiple doctors and nurses during one stay, it may need to be broken down into separate treatments.• The accuracy of patient records will depend upon the employees of the medical group.

2.7 Known Uses• Every hospital or clinic maintains records about their patients. • For example if a patient visits West Boca Medical Center for the third time there will be a record of previous visits.

2.8 Related Patterns• Collection Pattern

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3. Consortium Assets

3.1 IntentTo manage the hospitals, buildings and employees and equipment of a medical consortium.

3.2 ContextA medical consortium that has multiple hospitals with buildings and rooms, medical equipment and employees.

3.3 ProblemManagement of assets is crucial for efficient and professional service.

3.4 Forces• In a medical consortium if employees or employee information changes this information needs to be recorded.• All hospitals of a medical consortium consist of buildings with rooms and the information about availability and use of these assets must be recorded and kept up to date.• We need to keep track of the use, stock, transfer and information about all medical equipment used by any hospital within the medical consortium.

3.5 Solution• Maintain employee records with basic information and separate employees by their profession to add specific information, specialties and rights.• Each hospital is a separate asset of the consortium. Each building is an asset of the hospital. Each room is an asset of the building. This way all the information can be easily kept up to date.• Use the Stock Manager Pattern[Fer2000] to keep track of the medical equipment inventory and use.

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Consortiumnamemain location

Building

namelocation

*

Room

numbersize

*

Figure 4 Class Diagram for Consortium Assets

3. Consortium Assets

Hospitalnameaddress

*

1…*namess numberaddress

Employee

Nurse

specialty

Doctor

specialty

*works at

MedEquipStock

add()remove()

Inventory

MedEquipnamenumber

Locationnumberlocation

Distribution

localQuantity

Class Diagram for Stock Manager

*

1

quantity

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4. Asset Assignment

4.1 IntentTo assign doctors, nurses and rooms to a patient for treatment

4.2 ContextA hospital or medical consortium that assigns doctors, nurses and rooms to patients.

4.3 ProblemHow does the hospital keep track of which doctors, nurses and rooms are assigned to the patients.

Doctor

specialty

* 1assigned to primaryNurse

specialty

*

*assigned to

*

0...*assigned toconsultingInpatient

nameaddresspatient number

Patient

Outpatient

specialty

Room

numbersize

1assigned to1...2

Figure 5 Class Diagram for Asset Assignment

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<<actor>>anAdmissionsClerk:

<<actor>>aPatient:

:Patient

<<actor>>aDoctor:

:MedicalHistory

:TreatmentHistory

provide information<<create>>

<<create>>

<<create>>

assign

4. Asset Assignment

Figure 6 Sequence diagram for admit a new patient and assign doctor

<<actor>>anAdmissions clerk:

:Building :Doctor:Room

assign

assign

:Nurse

checkavailability

<<actor>>aDoctor:

assign

assign

Figure 7 Sequence diagram for admit an inpatient

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5. Patient Treatment

5.1 IntentThis pattern describes the process of admitting and treating a patient in a hospital.

5.2 ContextA medical facility that offers patient treatment.

5.3 ProblemTo provide patients with necessary services the combination of patient records, medical consortium assets and assignment of patients to these assets needs to be organized, maintained and and managed efficiently.

5.4 ForcesIn addition to the forces of component patterns we also have:• A patient may be moved or reassigned during a stay and we need to document the new assignment and location.• After the patient is discharged all assignments need to be released and the records updated.• Patients may discontinue treatment for various reasons and all information needs to be recorded.

5.5 SolutionThe combination of the previous patterns function together to manage patient treatment in a hospital.

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5. Patient Treatment

Figure 8 Class Diagram for Patient Treatment

1

*

assigned to primaryConsortium

namemain location

Building

namelocation

*

namess numberaddress

Employee

Nurse

specialty

Hospitalnameaddress

Room

numbersize

*

*

Doctor

specialty

*

1…*

works at

insurancetreatment history

MedicalHistory1

TreatmentHistory

medicationsprocedures

*

Inpatient

nameaddresspatient number

Patient

Outpatient

specialty

*

*

assigned to

*

0...*

assigned toconsulting

1...2

1assigned to

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5. patient treatment5.6 ConsequencesAdvantages:• All information about a patient’s stay is recorded and documented even if there are reassignments during that stay.• When a patient is discharged the treatment history is added to the medical history and all treatments within the medical consortium will be kept for future reference.• If a patient discontinues treatment for any reason this information will be on record.• Role based access control can be used to protect the privacy of a patient.

Disadvantages:• The accuracy of patient treatment, assignment and record updates are dependent upon the employees maintaining and recording information.• Employees need to follow procedure.

5.8 Related PatternsRepair Pattern – A patient enters a hospital for “repair”, assignment is made for the repair and a record is kept.

Future Work• Defining the Role Rights and adding authorization to the Patient Treatment Pattern.• Generalizing the pattern for other applications such as student, prison, or repair.

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insurancetreatment history

MedicalHistory1 TreatmentHistory

medicationsprocedures

Inpatient

namepatient number

Patient

Outpatient

specialty

*

createupdate

Right

createupdate

*

namess numberaddress

Employee

Nurse

specialty

Consortium

namemain location

*

Hospital

nameaddress

*

updateRight

update

Right

create

* <<role>.AdmissionsClerk

1

*

1

Class Diagram for Patient Treatmentwith Authorization

Right

create

1

*

1

*

<<role>>

Doctor

specialty

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- newPatient- openPatient- patientNumber- patientInformation- treatmentHistory- medicalHistory- inpatient- outpatient

- insurance- treatmentHistory

MedicalHistory

1TreatmentHistory

- medications- procedures

*

Inpatient

- name- address- patient number

Patient

Outpatient

- specialty

*

+ create(patient info)+ update(patient info)+ close( )

+ open ( )+ create( )+ update ( )+ close ( )

+ create ( )+ update ( )+ close ( )

Model

Observer

AdmitPatientView AdmitPatientController

Admit a Patient

New Patient

CreateTreatment History

Medical History

+ handleEvent( )

+ update( )+admit_patient()

Open PatientPatient Number:

Patient Information:

OutpatientInpatient

<<role>.AdmissionsClerk

1

admit_patient

Right

Patient TreatmentAdmit a Patient with Authorization

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+ create(patient info)+ update(patient info)+ close( )

- insurance- treatmentHistory

MedicalHistory

TreatmentHistory

- medications- procedures

*

Inpatient

- name- address- patient number

Patient

+ open ( )+ create( )+ update ( )+ close ( )

+ create ( )+ update ( )+ close ( )

Model

Observer

AdmitInpatientView AdmitInpatientController

Admit an Inpatient

Room Patient Number

Patient Information

Hospital- name- address

+ addDepartment+ addBuilding ( )

Building

- name- location

*

+ activateRoom ( )+ deleteRoom ( )

Room

- number- size

+ assign ( )+ remove ( )

assigned to

Nurse

- specialty

Doctor

- specialty

0…*

+ assign ( )+ remove ( )

+ assign ( )+ remove ( )

Nurse Team

Consulting Doctor

*

- patientNumber- patientInfo- room- nurseTeam-consultingDoctor

+ update ( )admit_inpatient

+ handleEvent ( )

*1…2

1

assigned toconsulting

assigned to

<<role>.AdmissionsClerk

1

Right

admit_inpatient

Patient TreatmentAdmit an Inpatient with Authorization

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+ create(patient info)+ update(patient info)+ close( )

- insurance- treatmentHistory

MedicalHistory

TreatmentHistory

- medications- procedures

*

Inpatient

- name- address- patient number

Patient

+ open ( )+ create( )+ update ( )+ close ( )

+ create ( )+ update ( )+ close ( )

Model

Observer

DischargePatientView DischargePatientController

Discharge a Patient

Room Patient Number

Patient Information

Room

- number- size

+ assign ( )+ remove ( )

assigned to

Nurse

- specialty

Doctor

- specialty

0…*

+ assign ( )+ remove ( )

+ assign ( )+ remove ( )

Nurse Team

Consulting Doctor

- patientNumber- patientInfo- room- nurseTeam-consultingDoctor

+ update ( )

+ handleEvent ( )

*

1…2

1

assigned toconsulting

assigned to

Treatment History Medical History

Right

discharge_patient

<<role>.AdministrativeClerk 1

*

Right

discharge_patient

Patient TreatmentDischarge a Patient with Authorization

*

1 <<role>.Doctor

1

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References

E.B. Fernandez, X. Yuan, “An Analysis pattern for Course Management”

[Fer2000]E.B. Fernandez, “Stock Manager: An Analysis Pattern for Inventories”,Procs, of PLoP 2000.

E.B. Fernandez and X. Yuan, “Semantic Analysis Patterns”, Procs. of the 19th Int, Conf on Conceptual Modeling (ER2000),183-195.

E.B Fernandez, X. Yuan, and S. Brey, “An Analysis Pattern for Order and Shipment of a Product”, Procs. of PLoP 2000.

E.B. Fernandez, “Layers and non-functional patterns”

E.B. Fernandez and R. Pan, “A Pattern Language for security models”, Procs, of PLoP 2001.

E.B. Fernandez and J.C. Hawkins, “Determining Role Rights from Use Cases”

E.B. Fernandez, M. Larrondo-Petrie, N. Seliya, N. Delessy and A.Herzberg, “A Pattern Language for Firewalls”