The Friendly Health Issue Network to Support Computer-Assisted Education for Clinical Reasoning in Multimorbidity Patients

Abstract

Clinical reasoning in multimorbidity conditions asks for the ability to anticipate the possible evolutions of the overall health state of a patient and to identify the interactions among the concurrent health issues and their treatments. The HIN (Health Issue Network) approach, as Petri Nets-based formal language, is introduced as capable of providing a novel perspective to facilitate the acquisition of such competencies, graphically representing the network among a set of health issues (HIs) that affect a person throughout their life, and describing how HIs evolve over time. The need to provide a more immediate user-oriented interface has led to the development of f-HIN (friendly HIN), a lighter version based on the same mathematical properties as HIN, from which stems in turn the f-HINe (friendly HIN extracted) model, used to represent networks related to either real patients’ clinical experiences extracted from electronic health records, or from teacher-designed realistic clinical histories. Such models have also been designed to be embedded in a software learning environment that allows drawing a f-HIN diagram, checking for its format correctness, as well as designing clinical exercises for the learners, including their computer-assisted assessment. The present paper aims at introducing and discussing the f-HIN/f-HINe models and their educational use. It also introduces the main features of the software learning environment it was built upon, pointing out its importance to: (i) help medical teachers in designing and representing the context of a learning outcome; and (ii) handle the complex history of a multimorbidity patient, to be conveyed in Case-Based Learning (CBL) exercises.

Education of clinical reasoning in patients with multimorbidity: a scoping review and perspectives for technology-enhanced learning

“…A quite different approach was adopted by Jack et al ( 2018) with the SHERPA method (Sharing Evidence Routine for a Person-Centred Plan for Action), who designed and tested a three-step process (share, link, and plan), to sketch out on paper the representation of the situation of a multimorbid patient and the related plan of management. The same idea of graphical representation of a complex clinical situation underlay the proposal of Jayasinghe ( 2016) and Pecoraro et al (2021). While the former is a developed kind of concept map, the latter is a formal approach with computational properties, based on Petri nets.…”

“…It could be awareness of the living condition of an old, multimorbid patient, of organizational issues and the availability of resources in the local healthcare system, or of the sequencing and time management of activities. A more robust proposal comes from Pecoraro et al (2021). Their research group developed a syntax of evolutions of the health-related problems over time of the health issues of a patient (Ricci et al, 2022), such as "worsening, " "improving, " "complication, " "recurrence, " "examining in-depth" (i.e., moving from the occurrence of symptoms and signs to a diagnosis), "persistence, " and "cycle" (i.e., an alternance of acute and sub-acute or asymptomatic phases of a disease).…”