This is a synthesis of the trends developed at the Future Research Lab on the “Evolution of Healthcare in the US” led by Peter Belohlavek. They are based on the global healthcare trends in developed countries that have been developed.
The objective of this research was to find the trends that underlie the healthcare business in the US.
The development of the future scenario that arose was based on the changes introduced in medical regulations and on the possibilities opened by the use of new technologies.
The 10-year trends can be synthesized in:
- The trend towards expansive healthcare organizations
- The trend towards patient centered management
- The trend towards adaptive information technology solutions
- The trend towards using semantic objects to segment
Two structural changes happened in the United States:
- The transparency of the use of electronic medical records established a new starting point for medical practice.
- The concept of the Accountable Care Organizations and its analogical multiplication in medical practice introduced the concept of profiting from healthcare improvements.
This triggered the need of adaptiveness for healthcare organizations.
New technologies that made structural adaptiveness possible:
- Adaptive Information Technology
- Semantic objects to manage adaptiveness
- The discovery of the human drivers of attitudes
- Double dialectical logic to manage adaptiveness
The integration of the structural changes and the now available technologies is predictable based on the understanding of the power of the archetype of the US.
If you are interested in learning about the unicist future research technologies that are used to develop future scenarios we recommend you to access:
These Trends are a Back to Hippocrates in the XXI Century
Back to Hippocrates means going back to the natural role of medicine.
In the XXI century it implies the use of an object driven organization model integrating processes with objects in order to ensure results and optimize the use of energy.
The Value Adding Approach is basically driven by the development of a model based on the use of the rules of Patient Centered Management.
The operational objective is to maximize the value added to patients considered as clients.
It is a backward-chaining-thinking approach beginning with the value being added and ending with the process and objects that are needed.
The process is centered on patient orientation, added value assurance and result assurance.
1) The Next Step in Healthcare:
Expansive Healthcare Organization (EHO)
Expansive healthcare organizations are an upgrade of the two major trends in medical practice: vocation driven and profession driven.
EHO are organizations that expand the size of their community in order to increase the level of wellbeing of their members. Their activity is naturally patient centered in terms of their focus on health.
The patient centered management requires the integration of results assurance, patient orientation and added value assurance in order to sustain the focus on health.
The maximal strategy is focused on the generation of value measured in terms of health. Having a structural medical practice allows dealing with health, going beyond the necessary specialties that are needed to cure patients.
Patients’ prevention is the catalyst of the expansive healthcare organization, which allows expanding the boundaries of the community of patients. This implies influencing actively their community in order to foster prevention.
The minimum strategy is focused on the healthcare business which is materialized in having the necessary disease centered medical practice and the medical prevention.
Medical prevention is the entropy inhibitor to sustain the community and avoid its entropy.
The segmentation of expansive healthcare organizations defines the way they manage the patient centered attitude.
1) Physicians driven
2) Therapeutics driven
3) Health driven
4) Community driven
Physicians driven Organizations
This segment is focused on ensuring the patient orientation through a structural physician organization. Their core is the organization of the role of physicians.
Therapeutics driven Organizations
This segment is focused on providing excellence in therapeutics in order to ensure patient orientation. Their core is the organization of the role of specialists.
Health driven Organizations
This segment is focused on providing healthcare solutions for patients based on a holistic approach to health. The core is the role of health oriented physicians.
Community driven Organizations
This segment is focused on being able to deal with the different segments that integrate the community to provide health. The core is the adaptiveness of the organization to adapt to the segments.
2) The Next Step in Healthcare:
Patient Centered Management (PCM)
Patient Centered Management is an organizational meta-model that allows empowering the work processes in healthcare institutions. It is homologous to Client Centered Management that is the natural model to guide work processes in businesses that was developed in the eighties.
On the one hand, PCM works as a conceptual action guide to design work processes and, on the other hand, it is the main catalyst for continuous improvement, change management and innovation management.
The purpose of the model is to assure results, its action is driven by patient orientation and there is a quality assurance that sustains the value added.
PCM as a Meta-model
Meta-models need to be materialized in a system. As such we are not talking only about the hardware and software but also about the peopleware.
Meta-models become meaningful when they are materialized in operational rules that have to be followed in a meaningful way.
The PCM generates four different segments of medical organizations:
- Artisanal Organizations
- Professional Organizations
- Technological Organizations
- Patient Centered Organizations
Artisanal organizations are driven by the individual capacity of their members. The added value is assured by the use of metrics and administrative EHR.
The core of their functionality lays on the capacity to integrate adequately chosen members. The activity is focused on curing processes based on the knowledge and reliability of each participant.
They are based on the individual capacity of doctors and their capacity to cure the problem of the patient.
Professional organizations are based on the fulfillment of roles that are based on the knowledge and authority of their participants.
Their strategy is defensive, based on ensuring the delivery of the necessary palliatives to cover the patients’ needs while the curing process is being implemented. They need to use adaptive EHR to monitor the curing processes.
They are based on the knowledge of the doctors and their capacity to use it. These organizations are knowledge centered and naturally tend towards evidence based medicine.
Technological organizations are based on the use of hard technologies to deliver the medical services. They tend to use the technological innovations to catalyze the professional role of their members.
They are usually dominant in the community based on the objective technology they use. They naturally integrate curing and palliating processes as a unit. They need to use adaptive systems to monitor their solutions.
They are based on having the most effective technologies to deal with the problems patients have.
Patient Centered Organization
Patient centered organizations are driven by their need to provide solutions for the community. They are innovation, efficacy and reliability driven.
Patient centered organizations base their strategy on their innovation capacity and on the influence they can exert on the environment.
They are health driven which allows them to build large patient communities with healthier members. Patient centered organizations need to use administrative EMR to sustain the efficacy of their doctors.
Integrated organizations include aspects of the different organizations to generate a natural environment for medical practices considering their specialties.
They are based on the professional roles of its members and an object driven organization model using medical objects, business objects and personal role objects to mange the adaptive processes of medical practice.
3) The Next Step in Healthcare: Adaptive IT Solutions
Adaptive IT solutions are systems that have been designed to interact with the external and internal environment. Nowadays, there are multiple programming solutions available to sustain the unicist adaptive architecture. The solutions include aspect objects architecture with unicist logical inferences to manage adaptiveness.
The integration of the unicist logical approach and the resulting business objects included in the business processes within an adaptive IT environment allows driving business processes to the next level.
To be able to organize by objects it is necessary to use both adaptive and administrative systems to organize the work processes. This widened the possibilities of hospitals to expand the boundaries of their activities within an environment of assured quality.
The level of adaptiveness varies according to the needs of the system. Adaptiveness is based on the medical, therapeutics and disease segmentation.
There are four levels of adaptiveness that can be managed:
1) Analogical drivers
This level is based on the recognition of the significant behavioral patterns of the segments of patients.
2) Rules based drivers
This level is based on the use of analogical patterns and the logical rules defined by the fundamentals that influence the processes.
3) Empirical drivers
This level is based on the previous level and the integration of mathematical models to infer behavior based on the observable aspects of the fundamentals of the processes.
4) Objects based drivers
This level is based on the previous level plus the use of medical objects that work as interdependent drivers to influence the attitude of patients. The feedback is defined by the results produced by these objects.
The IT Structure of the PCM
The integrator of the Patient Centered Management Model is given by the EMR/EHR/EPR system.
- Administrative EHR driven processes to allow monitoring the disease of the patient
- Adaptive EHR driven processes to allow monitoring the solutions provided by the doctors
- Adaptive EMR driven processes integrated with adaptive and administrative EHR to ensure the synchronicity of the solutions provided
- Administrative EMR driven processes integrated with EHR and EPR to focus on the health of the patient
4) The Next Step in Healthcare:
Semantic Objects to Segment
Semantic objects are linguistics communications, in written or verbal format, that have the power to install meaningful knowledge in the long term memory of an individual.
Semantic objects are “adaptive systems” based on messages that use figurative communication to build meaningful knowledge. These objects have a concept, an added value and a quality assurance in order to achieve their objective.
In order to build semantic objects it is necessary to manage the unicist ontogenetic map of messages and figurative communication. They require no knowledge in order to be used. Users only need to know what they produce and how to manage their output.
Semantic objects are extremely segmented because they are driven by the use of language that segments based on its implicit reasoning pattern and its ethical mask (see ontology of languages).
Semantic objects are the natural complementation for any communication that deals with human activity where results need to be achieved.
Types of Semantic Objects
- Informative Objects
- Value Adding Objects
- Conflict Management Objects
- Complement Building Objects
The Structure of the Types of Semantic Objects:
1) Informative Objects
These objects are used to approach the semantic memory of individuals. They need to include a message based on news that people are expecting and their figurative language needs to be sustained by graspable analogies.
2) Value Adding Objects
These objects are used to approach the procedural memory of individuals. They need to include a message based on a meaningful interpretation of the reality an individual is facing and their figurative language needs to be sustained by meaningful metaphors.
3) Conflict Management Objects
These objects are used to approach the episodic memory of individuals. They need to be based on a mind opening figurative communication and include a message that has to be based on objective information.
4) Complementation Building Objects
These objects are used to approach the long term memory of individuals in its oneness. It is a structural approach that needs to include the different aspects individual consider when making a decision. They need to be based on a homology driven figurative communication and include a message that opens and expands the possibilities of the individual.
The next step in healthcare organizations implies the integration of vocation driven attitudes, which are focused on health, with professionalism driven attitudes, which are focused on business.
It implies that the scorecard of measurement of medical practice will include the measurement of health and not only the activities that happen within the medical organizations
This will imply a structural change in the judiciary system dealing with malpractice problems. This change has already begun.
Adaptiveness is the name of the next step and the use of adaptive IT solutions, predicting interfaces and segmented communication are the way to sustain this new step.
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