Industries

 
   

 

 
     
 
 
 

Business Patterns

  
 

The following is a high level view of business processes and their interactions for the type of industry you have selected.

This pattern only shows high level business functional areas such as sales. marketing, and corporate management. More detailed views show the business processes (BPs) within each business functional (BF) areas.

  • For a short tutorial on Business Process Patterns, Click here

  • To view BPs within each BF, click on the BF of interest

  • To view a more detailed BP level model, click on ‘More Detail’

    From the BP level model, you can also retrieve detailed Information Models (UML Patterns) for each BP. For a short tutorial on Information Models and UML, Click here

 
 

     

 
 

Enterprise Business Pattern (BF Level) 

  

 

 

Healthcare Administrative Services

The Provider to Patient relationship is rather straightforward; a person becomes sick or injured and seeks medical attention from a medical services provider. The complexity in the Provider/Patient/Payer Triad is realized through the introduction of a third party payer. The payer is most often a public or private form of health insurance carrier, who carries the risk that their client will, indeed, one day become a  sick or injured patient. There are many forms providers of third party health insurance; on the public side are programs like CHIPS (http://www.chipcoverspakids.com/), Medicare (http://www.medicare.gov/), and Medicaid, which state-by-state, so the AARP web site is offered as a sample of this program (http://www.aarphealthcare.com/products/premierhealth/Aetnahome.aspx). Private health insurance is even more crowded with many different Payers; eHealth Insurance offers a comparison web site (http://www.ehealthinsurance.com/health-insurance-companies) for more information. Private plans vary to satisfy client price-point levels, to comply with individual state criteria, and to cover both individual and group care plans. The combinations can be overwhelming for the health insurance layman to comprehend.

Healthcare Clinical Services

Clinical healthcare services cover everything from disease/injury diagnosis, to disease preventing interventions, to medical treatments whether life-style changes, drug prescriptions, or surgical procedures. In the particular case of Hypertension, the diagnosis is often delayed (in the case of those individuals who seek medical attention only there is an obvious problem), unable to be prevented (especially when the cause is linked to heredity), and treated in a variety of fashions. The following chart defines the stages of hypertension that are widely accepted in the medical community.

Classification

Systolic pressure

Diastolic pressure

mmHg

kPa (kN/m2)

mmHg

kPa (kN/m2)

Normal

90–119

12–15.9

60–79

8.0–10.5

Prehypertension

120–139

16.0–18.5

80–89

10.7–11.9

Stage 1

140–159

18.7–21.2

90–99

12.0–13.2

Stage 2

≥160

≥21.3

≥100

≥13.3

Isolated systolic
hypertension

≥140

≥18.7

<90

<12.0

Source: American Heart Association (2003).[8]

 

 

 

 

 

 

 

 

 

The three most common forms of hypertension have suggested treatments that are tailored on a case basis, but an attempt to chart the treatment options follows.

 

Risk Groups

Blood Pressure Stages (Systolic/Diastolic)

 

Prehypertension

(120-139/80-89)

Mild (Stage 1) Blood Pressure

(140-159/90-99)

Moderate to Severe (Stage 2) Blood Pressure

(Systolic pressure over 160 or diastolic pressure over 100)

Risk Group A

Have no risk factors for heart disease.

Lifestyle changes only. (Exercise and dietary program with regular monitoring.)

Year trial of lifestyle changes only. If blood pressure is not lower at 1 year, add drug treatments.

Lifestyle changes and medications.

Risk Group B

Have at least one risk factor for heart disease* (excluding diabetes) but have no target organ damage (such as in the kidneys, eyes, or heart, or existing heart disease).

Lifestyle changes only.

6-month trial of lifestyle changes only. If blood pressure is not lower at 6 months, add drug treatments.

Medications considered for patients with multiple risk factors.

Lifestyle changes and medications.

Risk Group C

Have diabetes with or without target organ damage and existing heart disease (with or without risk factors for heart disease).

Lifestyle changes and medications.

Lifestyle changes and medications.

Lifestyle changes and medications