1. 1 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.

2. 2 2. Patient Record 2.1 Intent This 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 Context A hospital or medical consortium that keeps records of patient treatments. 2.3 Problem Maintaining 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.

3. 3 2. Patient Record Inpatient name address patient number Patient Outpatient specialty insurance treatment history MedicalHistory 1 TreatmentHistory medications procedures * Figure 1 Class Diagram for Patient Record

4. 4 Figure 3 Sequence diagram for admit a patient (not new) > anAdmissionsClerk: > aPatient: :Patient :MedicalHistory :TreatmentHistory provide information > Figure 2 Sequence diagram for admit a new patient 2. Patient Record > anAdmissionsClerk: > aPatient: :Patient :MedicalHistory :TreatmentHistory provide information > open

5. 5 entry:addTreatmentHistory() Active activate complete treatmentHistory do: closeMedicalHistory ( ) do: closePatient ( ) Closed do: setPatient Info( ) Created (New) create Figure 10 State Chart Diagram: Medical History 5. Patient Record

6. 6 Created createbegin 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

7. 7 2. Patient Record 2.6 Consequences Advantages: 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

8. 8 3. Consortium Assets 3.1 Intent To manage the hospitals, buildings and employees and equipment of a medical consortium. 3.2 Context A medical consortium that has multiple hospitals with buildings and rooms, medical equipment and employees. 3.3 Problem Management 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.

9. 9 Consortium name main location Building name location * Room number size * Figure 4 Class Diagram for Consortium Assets 3. Consortium Assets Hospital name address * 1… * name ss number address Employee Nurse specialty Doctor specialty * works at MedEquipStock add() remove() Inventory MedEquip name number Location number location Distribution localQuantity Class Diagram for Stock Manager * 1 quantity

10. 10 4. Asset Assignment 4.1 Intent To assign doctors, nurses and rooms to a patient for treatment 4.2 Context A hospital or medical consortium that assigns doctors, nurses and rooms to patients. 4.3 Problem How does the hospital keep track of which doctors, nurses and rooms are assigned to the patients. Doctor specialty * 1 assigned to primary Nurse specialty * * assigned to * 0...* assigned to consulting Inpatient name address patient number Patient Outpatient specialty Room number size 1 assigned to 1...2 Figure 5 Class Diagram for Asset Assignment

11. 11 > anAdmissionsClerk: > aPatient: :Patient > aDoctor: :MedicalHistory :TreatmentHistory provide information > assign 4. Asset Assignment Figure 6 Sequence diagram for admit a new patient and assign doctor > anAdmissions clerk: :Building:Doctor:Room assign :Nurse check availability > aDoctor: assign Figure 7 Sequence diagram for admit an inpatient

12. 12 5. Patient Treatment 5.1 Intent This pattern describes the process of admitting and treating a patient in a hospital. 5.2 Context A medical facility that offers patient treatment. 5.3 Problem To 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 Forces In 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 Solution The combination of the previous patterns function together to manage patient treatment in a hospital.

13. 13 5. Patient Treatment Figure 8 Class Diagram for Patient Treatment 1 * assigned to primary Consortium name main location Building name location * name ss number address Employee Nurse specialty Hospital name address Room number size * * Doctor specialty * 1… * works at insurance treatment history MedicalHistory 1 TreatmentHistory medications procedures * Inpatient name address patient number Patient Outpatient specialty * * assigned to * 0...* assigned to consulting 1...2 1 assigned to

14. 14 5. patient treatment 5.6 Consequences Advantages: 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 Patterns Repair 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.

15. 15 insurance treatment history MedicalHistory 1 TreatmentHistory medications procedures Inpatient name patient number Patient Outpatient specialty * create update Right create update * name ss number address Employee Nurse specialty Consortium name main location * Hospital name address * update Right update Right create *. AdmissionsClerk 1 * 1 Class Diagram for Patient Treatment with Authorization Right create 1 * 1 * > Doctor specialty

16. 16 - newPatient - openPatient - patientNumber - patientInformation - treatmentHistory - medicalHistory - inpatient - outpatient - insurance - treatmentHistory MedicalHistory 1 TreatmentHistory - 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 AdmitPatientViewAdmitPatientController Admit a Patient New Patient Create Treatment History Medical History + handleEvent( ) + update( ) +admit_patient() Open Patient Patient Number: Patient Information: OutpatientInpatient. AdmissionsClerk 1 admit_patient Right Patient Treatment Admit a Patient with Authorization

17. 17 + 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 to consulting assigned to. AdmissionsClerk 1 Right admit_inpatient Patient Treatment Admit an Inpatient with Authorization

18. 18 + 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 to consulting assigned to Treatment HistoryMedical History Right discharge_patient. AdministrativeClerk 1 * Right discharge_patient Patient Treatment Discharge a Patient with Authorization * 1. Doctor 1

19. 19 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 19 th 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”