Designing Patient-Oriented Healthcare Services as a System of Systems

Chronic diseases are on the rise, increasing in number and complexity. Consequently, the needs of patients with chronic diseases are increasing and becoming more complex and multi-faceted; they require addressing not only the physical body, but also behavioral, emotional, and spiritual health. The current healthcare delivery system organically developed to address acute conditions, primarily injury and infection during the mid-19th century, a time when the body was viewed as a machine. This led to the organization of the healthcare delivery system by organ systems into specialties and departments. However, the healthcare delivery system today needs to provide healthcare services that span multiple systems to provide the care patients need. Such care requires services from multiple specialties (e.g., podiatry and endocrinology for diabetes, primary care and psychiatry for behavioral health, and palliative care MDs and chaplains & social workers for end-of-life care) that each effectively functions as its own system. There are currently several limitations and difficulties in designing patient-oriented healthcare services utilizing a system of systems framework. First, clinical models describe the service with a focus on resources. Second, the description tends to be at a high-level of abstraction, leaving the details to the implementer. Finally, the patient is generally modeled as an operand non-participatory agent, being pushed and pulled through the system. This paper describes the use of engineering and systems principles to design patient-oriented healthcare services that provide detail and quantification that classic services do not model. In doing so, these designed system of system models incorporate the detail, data quantification and implementation level information to allow for the success of the clinical aspect of the model to be achieved. This paper presents a medical based description of a system of systems and the engineered system based description of an integrated patient-oriented service.