For the past ten years, CK Computer Consultants has designed, developed, evaluated and supported DOS-based health care management software for physician offices, clinics, occupational health services and various other hospital departments.

In the process of developing and then installing the Teamwork Occupational Management System in very different types of beta sites around the country, Jerry Kogan, the PI, designed and implemented protocol types designed to provide timely warnings and feedback to users, and data scanning and review procedures, which output E-Mail to appropriate case managers listing all instances which do not match care standards.

Users were given the option of setting up protocols based on the purpose of the visit and the patient's employer. These could include care instructions, and also automatically update the visit examination screen with a set of required examinations.

Diagnostic related protocols originally set up to include anticipated lengths of disability for various physical labor categories. These were expanded to allow a definition of an extensive treatment plan, with entry of a recommended schedule of required and optional treatments, medications, specialist referrals, work status changes, and physical performance goals.

A Case Review Process was developed to allow users to scan the database for cases in need of immediate followup based on a variety of criteria including:

• time since last review, last job status change, original entry in system;
• Missing followup information from specialists patient was referred to;
• requested or prescribed treatments that need approvals from guarantors or insurers; treatments that do not match those listed in a diagnostic related protocol;
• outdated job restrictions; extended disability time periods.

Have a first hand understanding of the different ways that medical data can be structured, and the problems that we may be encountering in trying to define Health Care Events in terms of changing data.