How to make the analytical cognitive process more effective and rigorous in clinical reasoning. A model that goes far beyond the traditional time-lines of current clinical systems.
A network of health conditions (Health Issue NetworkHIN) is a graphical model for describing a person’s health conditions or problems (Health Issue, HI) throughout their life and their evolution over time, and how these have been influenced by interactions between clinical problems.
The graphical model, which is based on Petri nets, is a diagram composed of nodes representing the HIs, and directed arcs representing the evolution of the input node. The arcs are solid if the HI does not substantially change its nature (a bronchitis “changes” into pneumonia), while if a HI generates a new HI, the arc is dotted (in a diabetic subject a retinopathy). Evolutions and HIs are labeled and a card is associated with each of them.
The diagram describing the temporal evolution along the horizontal axis is divided into three lanes or levels: clinical, semiotic and pathophysiological.
The f-HINe model represents clinical stories referring to real patients (cases that have already occurred) generally extracted from medical records in anonymized form and enriched by comments, references, etc. The medical concepts underlying the evolution of a clinical problem and the related terminology used are taken from the standard ContSysalso extended to the social (Contsys extended).
The f-HINe model has been tested multiple times in various real use cases and with various users by:
- The Italian Society of Medical Pedagogy (SIPeM) – a special workshop was held during the IX SIPeM National Congress in Naples in 2018.
- PhD students and students of the University of Rome “Sapienza” – the f-HINe model is currently adopted in some courses within the Medicine and Surgery Degree Course since 2019.
- The researchers and professors of the University of Naples “Federico II” – the f-HINe model is being implemented in some courses within the CCdSS in Medicine and Surgery, Veterinary Medicine, Animal Production Technology.
The model is suitable for the representation of real cases and as a basis for the simulation Case Based Learning (CBL).
Using the QT multiplatform application framework and based on the DiagramScene example of the Qt Toolkit, the fHINscene software has been developed which manages clinical histories represented with the f-HINe model. The software has two main functions:
- Editor: supports teachers and students in drawing a new f-HINe diagram, and only teachers in verifying its correctness.
- Comparator: Helps teachers check the similarity of two f-HINe diagrams for educational purposes, making it easier to analyze all f-HINe diagrams drawn by students.
A third feature foreseen in the project, but still under development, concerns a work environment for the development and execution of exercises based on the f-HINe model.
The HIN project is promoted by the Research Institute on Population and Social Policies of the National Research Council, by Sapienza University, by the Italian Society of Medical Pedagogy and by the Federico II University of Naples and involves five researchers with a long history of eHealth : Fabrizio Consorti, Daniela Luzi, Fabrizio Pecoraro, Fabrizio Ricci and Oscar Tamburis.