SITUATIONAL MODEL OF A MEDICAL BUSINESS PROCESS

Abstract

The subject of the research is medical business processes. The aim of the work is to develop a situational approach to modeling a generalized medical business process. Achieving this goal makes it possible to provide a specified level of medical services within the existing resource constraints of the medical business process. To achieve the goal, the following tasks are solved: structuring medical business processes considering the differences in treatment in the clinic, care, and the full process of patient treatment; development of a situational model of the medical business process. The structuring of medical business processes has been carried out. It is shown that such processes consist of a clinical pathway, care pathway, and disease treatment pathway. The clinical pathway is implemented within a single medical institution. The care pathway defines a comprehensive description of the sequence of care and treatment. The complete disease treatment pathway integrates various healthcare institutions. The treatment pathway includes the clinical pathway and care pathway as subprocesses. A situational model of a generalized medical business process is proposed, consisting of a sequence of situations. Each situation involves a choice considering resource, financial, and temporal constraints, and the subsequent execution of a sequence of actions of the medical business process. The model, in accordance with the presented structuring of medical business processes, at the top level of representation contains phases of primary medical care, outpatient treatment, clinical pathway, and discharge and rehabilitation. The model creates conditions for choosing an individualized treatment process considering the patient's needs and temporal and resource constraints. The typical sequence of actions of the medical business process is determined at the level of a set of situations, and the choice of alternatives is made within the situation. The sequence of situations sets the general standard of care or treatment, and individualization is performed within individual situations, taking into account the patient's needs and financial constraints.