Towards a View-Based Measure of Educational Flexibility for Complex Clinical Cases: A Combinatorial Approach

An f-HINe diagram represents real-world clinical histories, primarily of chronic patients with multiple pathologies, who therefore interact with multiple specialists. Therefore, considering the different specialties and the fact that a health problem in a clinical history may refer to multiple medical specialties, an f-HINe diagram presents different specialty swimlanes. Furthermore, the health problem can be organized according to different perspectives, creating logical-conceptual spaces or levels of analysis. The presence of swimlanes and levels allows for the generation of different views from a clinical case, extracted and anonymized from an electronic medical record (reference case). Another way to generate a view can be based on focusing attention on the clinical case over a period of time. The goal of this paper is not only to present the various ways of extracting a view from a clinical case but also to identify an indicator (the educational flexibility of a clinical history) for determining the number of views that can be extracted from a reference case. Indeed, the definition of flexibility has many similarities with the view-based search, as the view provides the guide for calculating this indicator. It is also rooted in the psychological and educational construct of flexibility. The value of flexibility depends on the type of view considered and how the specialty swimlanes, levels, analysis levels, and time intervals of analysis are combined. Since not all views are medically interesting, the indicator’s usefulness is to show all potentially extractable views and allow the clinician to choose the most useful and meaningful ones for their teaching and education objectives.