f-HINe model

The section consists of several subsections, which are listed at the beginning by means of the following bulleted list:

• Introduction
• The elements of the f-HINe model
• Characteristics of a f-HINe diagram
• Examples

 

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Introduction

A diagnosis the diagnosis is the final outcome of medical reasoning, i.e. the act of classifying the patient's condition within a nosographic class (a 'disease'). refers to a single (acute, or new) disease condition. In case of patients affected by chronic multi-pathology conditions, also suffering from intercurrent acute pains, the clinical reasoning needs to develop over time to foresee and handle the evolution of their overall health status. This also means therefore the need of an analysis based on patients’ clinical history. A Health Issue Network (HIN) is a graphical model for describing over time a subject's health conditions or problems (Health Issue , HI), along with their evolutions , and how the latters have been influenced by the interactions between clinical problems. The graphical model is a diagram featuring nodes – representing the HIs – and directed edges – representing the evolutions from input HIs to output HIs. The edges are drawn via: (i) a solid line, when the HI evolves without altering its nature (a bronchitis "changes" into a pneumonia); (ii) a dashed line, in case an existing HI generates a new HI (a diabetic subject starts suffering from retinopathy, too). Evolutions and HIs are labeled, and both are associated with sheets to report information (not directly drawable in the diagram) related to the activities performed during the diagnostic–therapeutic process. The f-HINe model describes clinical histories: (i) already occurred, related to real patients. The original (anonymized) data are usually extracted from Electronic Health Records, and enriched with comments, references (internal, or towards external sources), etc.; or (ii) teacher-designed for didactic objectives.

 

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The elements of the f-HINe model

Health Issue	Evolution	Further elements
Class of clinical problem	Worsening	Static Branch Point
Diagnosis	Examining in–depth	Aggregation
Risk Factor	Cause	Swimlane
Diagnostic Hypothesis	Cycle	Level
Iatrogenic Problem	Co-morbidity	Time
Psicological and/or Social Issue	Complication	Sheet
Evidence	Co-presence	Characteristics of a f-HINe diagram
Report	Positive feedback
	Improvement
Symptom	Persistence
	Recurrence

The medical concepts on which the evolution of a Health Issue, along with the terminology used, are based, come from the ContSys standard, together with its social side–focused extension (Extended Contsys).

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Characteristics of a f-HINe diagram

Here following are the main constraints underlying a f-HINe diagram to correctly represent a clinical history:

• f-HINe can feature isolated HI nodes (i.e., neither entering nor exiting evolutions are present).
• a “minimum” f-HINe only features a single HI node.
• f-HINe can be unconnected, which means that it features several unrelated parts (one per each developing HI) and isolated HI nodes.
• f-HINe does not feature closed paths is a path formed by a sequence of HI nodes, joined by arcs (evolutions), all of which are distinct except for the start and end HI nodes, which coincide. , except for recurrencies.
• the static branch node (or point) is an intermediate node, and it is always connected to other HI nodes.
• one and one only evolution can stand between two different HI nodes.
• a maximum of one solid–line edge can exit from a HI node.
• several (or even zero) dashed–line edges can exit from a HI node.
• a HI node can be reached from a maximum of one (solid–line or dashed–line) edge.
• a persistence evolution only connects identical HI nodes.
• an evolutionary path starts with either one or more HI nodes and ends with either one or more HI nodes.

 

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Examples

Here following are some instances of two different typologies of exercises: