A Review On Commonkads Computer Science Essay

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CommonKADS is a modelling tool employed to provide knowledge management systems solutions within the organization. The tool gathers important information within the organizational context and presents it in a logical pattern that allows for formulation of knowledge based solutions to identified problems (Schreiber, 1956, p28). These solutions are then incorporated into business processes with the objective of improving the over-all performance of the organization.

This report considers the abovementioned concepts and uses the CommonKADS tool in proposing for an improvement of a business process of the case understudy.

Formulation of the solution is based only on the data stated in the case given. Assumptions made on the organization's mission, vision and goals were derived from the scenarios described within the case as well.

The Emergency Medical Service (EMS)

The case understudy is the Emergency Medical System (EMS) of Netherlands. The EMS is a medical unit under the General & Social Sanitary Care (GSSC) section of the Municipal Medical & Sanitary Service (MMSS) (see Figure 1). It is responsible for receiving emergency calls from prospective patients and provides temporary medical assistance while transporting the patient to a permanent medical facility like a hospital. The unit's main objective is to be able to respond to patients requiring medical attention at the shortest possible time and to provide assistance either temporary and or permanent to reduce incidence of permanent injury or death. The realization of this objective is translated to organizational effectiveness and efficiency but should be operating within budgetary limits without sacrificing quality. This goal is used all throughout the organization and is the basic guidelines of the service delivery function.

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A description of the problems of EMS

The main problem is Triage knowledge currently available at the EMS is insufficient for proper triage of acute myocardial infarction particularly by telephone. In addition to this, Dispatchers often relay on heuristic knowledge.Dispatchers say they can "feel" when something is wrong. This vague notion of an emergency prevents the knowledge from being similar across the dispatchers. There is a strong need for protocols, both for dispatchers and for management.

Major gains in reducing the mortality from AMI will come from improvements during emergency management. However, several types of delays play a role: these are four types, triage delay as explained above, patient delay, GP delay and treatment delay.

Patient delay: the patient waits one hour on average before calling the GP. Reduction of this delay could be achieved by encouraging patients to ask for medical assistance earlier. Recognizing a cardiac problem is essential. The Netherlands Heart Foundation distributes educational material to citizens.

Unfortunately, psychological factors strongly reduce the effect of trying to improve self-assessment.

Additionally, most people are hesitant to contact a GP, especially outside "office hours", when they are not sure that something serious has occurred.

GP arrival delay: it takes about one and a half hour before the GP is with the patient and has made a judgement about the disease.

Treatment delay: if treatment is delayed until arrival at the hospital another 25 minutes is lost.

However, the treatment is only warranted if the patient is diagnosed to have AMI

The use of commonKADS methodology in this case assumes that the problems solution has already been determined. The proposed solution is to "eliminate the GP delay by allowing citizens to make a call directly to the EMS" and to "develop a knowledge deficit in the EMS".

Organization context & mission.

The identified problem with the corresponding organizational considerations as well as the possible solutions is described in the table below.

Table 1 - Worksheet OM-1

Organization Model

Problems and Opportunities OM-1

Problems and

Opportunities

Delays in responding to AMI emergency cases

Incorporate knowledge-based system to formulated solution

Organizational Context

Mission:

Provide effective and efficient emergency response service to the people

Operate within the budgetary requirement without sacrificing effectiveness and efficiency

Goal:

Send emergency response team in the shortest possible time

Provide fast hospital transport on critical cases which necessitates it

Streamline and strengthen coordination within the emergency service team

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Solutions

1. Reduce the delay by removing the GP in the process and allowing the patient to call directly to EMS

2. Coordinate with the Netherlands Heart Foundation and collaborate to develop a strastrategic plan on educational campaign for detecting early signs of AMI including the psychological aspects of the patient as well as stressing and locating available GPs within the area.

Alternative solution

1. Retain GP and still allow patient to call directly to EMS

2. Empower Gp and retrain GP on triage skills and absorb the Gp to feel part of EMS

3 .Merge both department of Ems ambulance and dispatch

4. Retrench all dispatch staff replace with expert paramedics, replace system manager have only one manager for entire EMS to reduce costs. Employ only multi skilled in triage and medicine paramedics.

Figure 1 - Municipal Medical & Sanitary Service (MMSS) Organization structure.

A. Organizational Model

EMS receives about 400 calls a day, 85% to 90% of which are emergency cases that requires hospital transport. One type of call, which requires immediate response, comes from doctors, which have patients suffering from a heart related problem called acute myocardial infarction (AMI). However, a therapeutic intervention called coronary reperfusion is currently available but requires early introduction to AMI patients for it to be effective. Timing therefore is very critical which reduces patients' risk of injury or even death.

In response to AMI emergency calls, several factors come into play before a patient is transported to a hospital. Delays experienced by patients in deciding to contact a GP for assessment to the time elapsed until the GP has done a diagnosis, which warrants an emergency case and time consumed in transporting the patient to a hospital to initiate treatment. Thus, getting to the patient suffering from AMI in the least possible time poses a problem to the emergency unit. However, formulating solutions to address the time problem provides an opportunity to incorporate knowledge-based systems within the procedure.

B. Existing Business Process and Knowledge Assets

The focus area of the problem identified is the emergency management process of EMS. Conducting a detailed analysis on the different tasks within this process provides an understanding on the appropriate solution in response to the problem. Worksheet OM-2 (see table 2) describes the analysis done on the process.

Table 2 - Worksheet OM-2

Organization Model

Variant Aspects Worksheet OM-2

Structure

A detailed structure of the EMS is presented in Figure 2 with the corresponding departments where it belongs.

Process

The emergency management process involves 5 major tasks from the GP receiving the call from the patient until hospital transport. Figure 3 presents a high-level task level diagram.

People

External to the EMS, the GP plays a critical role in attending to patient's call

Managers of the GSSC and the MMSS ensures adherence of the organization to mission and goals

Managers of the EMS units supervise the entire operation

Nurse dispatcher in the Dispatch Center handles communication and coordination between emergency calls and the Ambulance Center

Paramedic carries out emergency medical care to patients transported

Driver is in-charge in the mobilization of the ambulance

System Manager handles the archiving function of the emergency services provided

Resources

Communication system to handle calls and coordinating task within the EMS and outside

IT support system and infrastructure performing emergency tasks as well as urgent reservations and other information support systems

Vehicle for hospital transport

Temporary &immediate medical care equipment

Knowledge

Different sets of knowledge assets which support the different personnel in performing the different tasks within the process are detailed in table 4.

Culture &Power

There exist within the organization certain formal informal relationships that may, in one way or another, affect how the personnel perform their tasks (refer to Figure 4). It should be noted that here is no existing social relationship that exists between the two units within EMS.

Figure 2 - Emergency Medical Service (EMS) Organization Chart within MMSS

Figure 3 - EMS Emergency Management Process

Figure 4 - Power Relationships within EMS

Table 3 - Worksheet OM-3

Organization Model

Process Breakdown Worksheet OM-3

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No.

Task

Performed By

Where?

Knowledge Asset

Knowledge

Intensive?

Significance

1

Diagnose Patient

GP

Patient's home

Medical background to warrant correct assessment of symptoms for AMI

Highly Intensive

Early diagnosis conducted increases the patient's recovery from AMI

1a

Call EMS

GP

Patient's home

-

-

Same as above

2

Receive Call

Nurse Dispatcher

EMS - Dispatch Center

IT support system operations

Medium

Early receipt of emergency call initiates faster dispatch to patient hospital transport

3

Coordinate Ambulance Service

Nurse Dispatcher

EMS - Dispatch Center

IT support system operations

Medium

Same as above

4

Dispatch Ambulance

Paramedic

EMS - Ambu-lance Service

Procedures on initial AMI medical assistance

Yes

Same as above

5

Transport Patient to Hospital

Driver

-

Geographic data of the area

Medium

Same as above

Table 4 - Worksheet OM-4

Organization Model

Process Breakdown Worksheet OM-4

Knowl-edge Asset

Pos-sessed by

Used In

Right Form?

Right Place?

Right Time?

Right Quality?

Medical background to warrant correct assessment of symptoms for AMI

GP

Patient diagnosis

(Task 1)

Yes

Yes

No (it takes some time before diagnosis is done)

Yes

IT support system operations

Nurse Dis- patcher

Coordina-tion with

Ambu- lance Service (Task 2&3)

No (too limited, can be im-proved)

No (can be accessed until the time ambulance is dispatched)

Yes

Yes

Procedures on initial AMI medical assistance

Para- medic

On patients during hospital transport

(Task 4)

No (un- availa-ble)

No (initial assistance needed during hospital transport)

No (Inter- vention given in hospital only, might be too late)

No (un-available)

Geographic data of the area

Driver

Hospital transport

(Task 5)

No (maps, cannot fasttrack hospital trans-port)

No (un-available)

No (un-available during emergency cases)

No (not in real-time)

C. Solution and Impact Analysis

Figure 3 illustrates the problem identified in OM-1 (Table 1) which shows that EMS's response to assist immediate medical assistance is entirely dependent on GP's diagnosis and subsequent call to EMS. Thus, the solution to take the GP out can increase the chances of initiating immediate medical intervention on emergency cases.

However, the detailed task and knowledge analysis in OM-3 & OM-4 (Tables 3 and 4 respectively) indicates that GP diagnosis is a knowledge intensive activity and such asset is the basis for the critical decision of whether the patient's call qualifies as an emergency case or not. Taking out the GP in the process takes out the knowledge asset which currently is not available in the EMS. Additionally, allowing patients to call directly to the EMS will contribute to a significant increase in the number of calls received which may or may not be emergency cases. Triage of emergency cases is also not currently available in the EMS.

The abovementioned challenges can be addressed in three areas: 1) enhancing the organization's IT support system to include triage knowledge and dispatch scheduling; 2) collaboration with medical practitioners in hospitals to conduct knowledge transfer on the aspect of initial medical intervention for AMI cases; and 2) formulate protocols to standardize organizational response in receiving and serving emergency cases. These avenues for improvement are well within the organization's capacity to implement since it only utilizes existing resources.

D. Business Process and Knowledge Improvement

The analysis of complementary changes that are required such as the need for changes in workflow processes and agent capabilities, Business and Technical feasibility, advantages and disadvantages of the new changes is part of the new knowledge basis of the nfunctionc ans roles to herald new organisational change amid system improvement for efficiency.

It will entail to Streamline EMS by Merge the Two units of the EMS: the dispatch centre and the ambulance service. The dispatch centre and the ambulance service which are physically

Separated should be joined and thirdly department of information services of The Municipal Medical and Sanitary Service. Two types of functions should be integrated together for one team action into both support and emergency and should not be distinguished at the EMS so that they can be performed by multiskilled employees .Further integrartion of the three emergency-management functions: (i) communication &

coordination, (ii) emergency medical care, and (iii) the ambulance function together with the Support functions of archiving, evaluation, policy making, and supervision will mean a multiskilled staff performed at one point of action by one person at once .This is to avoid duplication of time and wastage of resources this will reduce the number of staff and increase the skills of few well trained paramedics

The staff at dispatch centre nurse dispatchers will be retrenched as they are redundant due to the new processes and there roles absorbed by multiskilled paramedics who solve the TRIAGE deficit at EMS while carrying out the communication & coordination function as one multiskill job by one person at a go. This will also reduce staff and costs at the ambulance service, now supervised by paramedic who is a peer to each ambulance paramedic, and the driver should be a trained paramedic to carries out emergency medical care as well. The paramedics should also be able to be good drivers who will responsible for the ambulance function and can be called upon in an emergency to assist in transport and delivery also… All the paramedics will integrate the roles of the system manager and be responsible for the archiving function. They will be incharge of both the dispatch centre and the ambulance service as a team responsible to team goals in carrying out evaluation, policy making and supervision functions.

Only the manager of the entire EMS service holds power over all the staff regardless of their roles since the skills of system manager and of the dispatchers will be integrated into multiskilled paramedics .The cases are assigned to several paramedics who inturn are in charge of drivers and an ambulance each. In addition, calls directly from citizens are received by paramedics who are trained in triage hence reducing chance of non-emergencies and heuristisc tendencies. The ambulance service should now hold power over the paramedic and the drivers. The manager of the General and Social Sanitary Service will remain as head of one EMS with streamlined integrated function of not both departments. We shall have eliminated the the dispatch centre and the dispatchers and replaced with senior paramedics in charge of handling medical emergencies and in this role coordinated and not controls peer paramedics who now formally perform the ambulance function, and be formally their supervisor. The ambulance personnel and dispatchers do will now socialize as both peers and as one team.information support system of the EMS, which uses IBM RISC/600/320 machines under UNIX, to run and it performs other tasks including

Emergency issues as well as finance and some medical statistics, will now be fully integrated and more usefull as it will now be used by the same staff that developed it the information services department of the Municipal Medical and Sanitary Service. The use of Graphical terminals that are not used now will be explored.

Task

BUSINESS FEASIBILITY

To adress the above business engineering using common KADS knowledge management-modelling tool, will means a complete re-engineering of the sytsms at EMS.it is feasible provided the costing is reduced by employing less workers who are more skilled hence more efficient and effective. Business Feasibility goal will be achieved by reduces the staff numbers by making them multi skilled .Ensure removing the drivers and nurses from the EMS. Retrench dispatch manager and his function skills are integrate d in the work of the ambulance manager. The Ems must integrate the service process as well as the staff then we empower the GP and integrate them to EMS service. To involve the GP Empower the GP with the EMS function .this will integrate the dispatch manager to ambulance function and drivers be controlled by paramedic involved also in triage. Driver should have skills of a paramedic. Dispatcher should be a paramedic skilled and ambulance manager should have dispatcher skills so that reduces the heuristic

TECHNICAL FEASIBILITY

The new processes and work flows are technically eassyto implement since the IT department will now integrate all functions including both electronic as well as manual queing and prioritization scheduling and will no longer be the only way to determines outcpmes but juts one among many other Ems support functions done by professionals with professionalism.

Tasks within the EMS (Figure 3) can be improved by providing an enhanced IT Support System. Features to support triage, which triggers a dispatch schedule in emergency cases, can be embedded into the system. Patient's whereabouts can also be graphically triangulated and captured to provide fast mobilization. This information can then be forwarded to the Ambulance Service with corresponding prioritization.

The effective use of the enhanced IT support system of personnel performing task 2 (Figure 3) can improve the negative impact of the identified solution. Furthermore, efficiency and effectiveness exhibited in performing task 2 can affect the preceding task, which is the ambulance dispatch function. Thus, only task 2 will be given a detailed task analysis, which is shown in Table 5. Furthermore, 2 knowledge items are explored in relation to task 2 execution and its dependent tasks (tasks 4 and 5). The IT support system and procedures on initial AMI medical assistance is reviewed in detail in Table 6. The personnel in the Dispatch Center and Ambulance Service are the agents considered in detail in Table 7.

Table 5 - Worksheet TM-1

Task Model

Task Analysis Worksheet TM-1

Task

Receive Call (Task 2 see Figure 3)

Organization

The task is performed in the emergency management process of EMS and is carried out in the Dispatch Center of said organization.

Goal and Value

This task significantly affects the response time of the EMS to emergency case through an accurate and complete assessment of patient's call. The objective of this task is to be able to evaluate if received calls from prospective patient warrants an emergency case.

Dependency Flow

Input task: GP and or Patients call or both.

Output task: Ambulance dispatch, transport to hospital

Please see Figure 5 for diagram of the process flow.

Objects Handled

Input Objects: response of patient and or GP to baseline questions related to experienced condition, patient name and location

Output Objects: paramedic as well as case assessment, or both on the dispatch schedule

Internal Objects: paramedic or expert at EMS or triage questionnaire or both

Timing and Control

This task is executed for every call received by the EMS. Triage of emergency cases is executed by the Dispatcher/paramedic through the aid of the support system and or expert knowledge. Details of the call are logged into the emergency and paramedic's expert opinion is sought as well as the assessment database either of which may or may not trigger a dispatch schedule. The dispatch schedule is the basis for the dispatch or non-dispatch of the ambulance service (see Figure 5)

Agents

Nurse Dispatcher, IT support system/paramedic/medical expert/GP

Knowledge and Competence

The Nurse Dispatcher/paramedic/Gp/medical expert at EMS should be able to navigate the IT support system, which will provide full support in the execution of this task. Furthermore, the Nurse Dispatcher/paramedic/Gp/medical expert should also possess intensive knowledge on established symptoms of most or common medical conditions.

Resources

Computed salaries of staff time (Nurse Dispatcher/paramedic/GP/medical expert) receiving calls for a 24hr service available 7 times a week 6 month development time of IT staff to enhance the IT support system integrating the features illustrated in Figure 5

Quality and Performance

The following key performance indicators can be used to gauge quality of task execution:

Average time to take calls with appropriate assessment

Total number of dispatch that results to hospital transport

Percentage of morbidity and mortality rates within the cases received

Figure 5 - Receive Call Detailed Task Flow

Table 6 - Worksheet TM-2 for the IT Support System

Task Model

Knowledge Item Worksheet TM-2

Name

Possessed By

Used In

Domain

IT Support System

Nurse Dispatcher

Receive Call (cf. Task 2 in Figure 3)

IT operations

Nature of Knowledge

Bottleneck/ to be improved?

Formal, rigorous

X

X

Empirical, quantitative

X

Heuristic, rules of thumb

X

Highly specialized,

Domain-specific

X

Experience-based

Action based

X

Incomplete

X

Uncertain, may be incorrect

Quickly changing

Hard to verify

Tacit, hard to transfer

Form of Knowledge

Mind

Paper

Electronic

X

Action Skill

Other

Availability of Knowledge

Limitations in time

Limitations in space

Limitations in access

X

Limitations in quality

X

Limitations in form

X

Table 6 - Worksheet TM-2 for the Procedures on Initial AMI Medical Assistance

Task Model

Knowledge Item Worksheet TM-2

Name

Possessed By

Used In

Domain

Procedure on Initial AMI Medical Assistance

Paramedic

Ambulance Dispatch (cf. Task 4 in Figure 3)

Medical field

Nature of Knowledge

Bottleneck/ to be improved?

Formal, rigorous

X

X

Empirical, quantitative

X

X

Heuristic, rules of thumb

Highly specialized,

Domain-specific

X

X

Experience-based

X

X

Action based

X

X

Incomplete

X

Uncertain, may be incorrect

Quickly changing

Hard to verify

Tacit, hard to transfer

X

X

Form of Knowledge

Mind

X

X

Paper

Electronic

Action Skill

X

X

Other

Availability of Knowledge

Limitations in time

Limitations in space

Limitations in access

X

X

Limitations in quality

X

X

Limitations in form

X

X

Table 7 - Worksheet AM-1 for Nurse Dispatcher Agent

Agent Model

Agent Worksheet AM-1

Name

Nurse Dispatcher

Organization

Personnel under the Dispatch Center unit of the EMS

Involved In

Receiving patient calls and coordinating emergency calls (Task 2 and 3 see Figure 3)

Communicates With

Patients, Paramedic

Knowledge

Assessment and determination of emergency calls supported by the IT Support System

Other Competencies

Additional skill to be developed is the agent's listening ability and assessment of patient's responses to standardize questions related to patient's condition.

Responsibilities and Constraints

To receive calls from prospective patients and accurately capture conditions into the IT Support System

To be able to provide accurate assessment data and forward it calls to the Ambulance Service that warrants hospital transport.

Table 7 - Worksheet AM-1 for Paramedic Agent

Agent Model

Agent Worksheet AM-1

Name

Paramedic

Organization

Personnel under the Ambulance Service within EMS

Involved In

Ambulance dispatch (Task 4 see Figure 3)

Communicates With

Nurse Dispatcher, Driver, Patient

Knowledge

Procedures for initial AMI medical assistance, medical background

Other Competencies

Appropriately assess condition of patient on-site vis-à-vis information forwarded by the Dispatch team.

Responsibilities and Constraints

Provide immediate action to direct Driver to dispatch ambulance to patient's location and initiate medical procedures to patient during hospital transport. The possible constraint identified can be on the possible misinformation of the patient's condition forwarded by the Dispatch team

Conclusion

Knowledge-based solutions to improve business processes can be achieved through a detailed study of the current state of organizations. The organizational review is better understood by the use of tools like the CommonKADS.

This report presented an application of the CommonKADS methodology and provided an in depth analysis of the processes involved in the EMS case. The tools employed showed that adopting the solution in response to the time element problem has considerable impact in the organization and requires some improvements in the different tasks affected. Furthermore, a detailed analysis of the improvements to be incorporated within the emergency management service is also reflected using the CommonKADS methodology. Furthermore, the applied solution and the corresponding improvements made were ensured that it supports the organization's mission and goals within the established budgetary limits.

List of Figures and Tables

A. Figures

Figure 1 - Municipal Medical & Sanitary Service (MMSS) Organization Structure

Figure 2 - Emergency Medical Service (EMS) Organization Structure within MMSS

Figure 3 - EMS Emergency Management Process

Figure 4 - EMS Power Relationships within EMS

Figure 5 - Received Call Detailed Task Flow

B. Tables

Table 1 - Worksheet OM-1

Table 2 - Worksheet OM-2

Table 3 - Worksheet OM-3

Table 4 - Worksheet OM-4

Table 5 - Worksheet TM-1

Table 6 - Worksheet TM-2 for IT Support System and Procedures for Initial AMI Medical Assistance

Table 7 - Worksheet AM-1 for Nurse Dispatcher and Paramedic