Saturday, May 10, 2014

Scaling UDHC in your town: a sketchy business model and role of the 'Clinical Information communications manager' CICM

We are trying to implement the UDHC business model in our town and would like to learn more from your inputs on this brief and sketchy model (cash-flow and workflow) narrated below:

a) Clinical encounter fee from patient (100/-): Health professional sees patient in his clinic for a fee and asks his 'trained clinical information communications manager CICM or trained clinical health educator/entrepreneur' TCHE (more details on TCHE here: to prepare an online record in UDHC (which is more like an evolving case report of the patient with various bits and pieces of available information around the patient strewn coherently for meaningful use). This is done after obtaining informed consent from the patient from the form downloadable here:

b)) Fee division (figures in %): Physician 70/- and CICM (20/-) for the first and subsequent visits (10/- could go to the online as well as offline managers/developers of this entire workflow).

Workflow: Physician primarily writes on the prescription slips (as per common-current workflow with minimal change pressures for the physician) and this is promptly uploaded on the site (after patient de-identification) by the CICM who also types out a proper history of the patient in the narrative space on the web based record. See this illustrative example from our functioning website here:

The CICM here in the above linked record is our medicine office clerk who is trained to take a clinical history (using the Hindi language and her common sense). She has input the data (again in Hindi using English fonts) to the site along with the uploaded prescriptions that i wrote for the patient and in the same narrative space we have pasted the subsequent conversations around this patient in our online processing forum (tabula rasa) with multiple inputs from global experts.

We could further train the CICM (particularly if the candidate has a nursing or pharmacy background) to become a complete physician's assistant (also well trained in medical information processing aka clinical problem solving). You may ask what would distinguish a fully trained CICM from a very good primary care physician then? Well the CICM can nurture the information workflow but may not still be able to take the final decision and make the prescription orders. But yes if the same training was given to an MBBS s/he may become a very good primary care physician.

The other important workflow of the CICM would be to take all the phone calls from the patients for the physician and if indicated enter those conversations into the patient's web based record to keep the physician asynchronously in the loop.In fact this model can be fast tracked with more and more patient users being generated through a telephonic introduction to the physician's and CICM's practice, following which (if the patient is satisfied after the first phone call and a phone call generated web record) the patient could decide to come and meet the physician and CICM for the first face to face clinical encounter.

The success of the model (as in most health care delivery models) would be heavily dependent on the level of training and learning-sustenance achieved in both the actors (physician as well as TCHEs) and the UDHC website is perhaps in some ways functioning as a differently structured 'web based learning management tool' for these actors (as well as the patient) and the entire information that may rapidly accumulate in this open database can again be 'mined' to gain further insights in health-cognition. In future we can develop this into a sustainable 'home-care' model integrating pharma and nursing trained CICMs/TCHEs (but that is for later and currently we just need to focus on the information communication part and i am willing to pilot this here in our town if i can begin with a few trainees and if we have nursing or pharma trainees we could even fast track the home-care model).

Will be looking forward to keep learning from all of your thoughts and inputs on the above.

No comments: