Is a new case-mix classification , GRE/NCC©, (Group Related Episodes by Need of Care Criteria), of ‘iso-therapeutic behaviour’, able to read the effectiveness and efficiency, in seven probems group or in 24 Solving Basic Models of clinical behaviour, after check the 100% of activity.

1. Can we overcome the current divorce
between professionals and managers
and find a common language able to
do health and management?.
NEW CASE-MIX CLASSIFICATION FOR PROFESSIONALS,
AND MANAGERS.
TWO IN ONE.
Ángel Ruiz Téllez. CYMAP
Fernando A. Alonso López. CS Dobra Cantabria

2. angelruiztellez@cymap.es
+00 34 637.53.23.59
Contact:
Ángel Ruiz Téllez
angelruiztellez@cymap.es
www.cymap.es
& Ángel Ruiz Téllez in Linkedin

3. angelruiztellez@cymap.es
+00 34 637.53.23.59
ISIS Manager© Project ( Measure of Professional Excellence = Effectiveness + Efficiency )
spreads out along :
• 6 Regional Spanish Health Services,
• 200 Primary Care Health Centres,
• 2000 Family Practice or Paediatrician
• 2 Million people

4. angelruiztellez@cymap.es
+00 34 637.53.23.59
ISIS Manager© Project On eight questions
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
2.-Do you know that the previous 7 groups are divided in other 24 Solving Basic Models SBM,
that represent the 24 models of therapeutic homogeneous professional behaviour?
3.-How could we interpret the retrospective information when into a ICPC Code can exists very
different clinical syndromes?
4.-How measure the Preventive Activity?
5.-Do you know that the relation between Activity and Costs is negative and not positive?.
6.- Do you know that the “Portfolio Services”, reach only the 10% of epidemiological reality?.
7.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?.
8.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a law
of quarters?

5. angelruiztellez@cymap.es
+00 34 637.53.23.59
ISIS Manager© Project ( Measure of Professional Excellence = Effectiveness + Efficiency )
Previous conditions
Useful to any health record software if are observed
next conditions:
•Systems with informatics health records,
•Working with, and around, the Episode of
Attention.
•Items of Activity (pharmacy, referrals, laboratory
values, diagnostic or therapeutic procedures, etc)
Episode of Attention related.

6. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION The chart shows the evaluation of the whole annual
A PROBLEMS OF COLLECTIVE ORIENTATION professional activity, distributed in such 7 groups, and,
B CONSUMTIVE OR DISABLING DISEASES every one showing the 3 types of Episodes. The blue
B1 SANITARY PROBLEM OF SOCIAL ORIGIN ones (the Solved) , in relation to the red ones (the Seen)
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION , and those ones with regard to the green ones (the
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES. Hoped)
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90% Whole annual professional activity
80% evaluated:
70%
60%
Hoped Ep
1. The “Seen Episodes” with regard to
50%
Seen Ep the “Hoped Episodes”
40%
Solved Ep
30%
20%
2. The “Solved Episodes” in relation to
10%
the “Seen Episodes”
0%
A B B1 C D E P

7. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION To solve the C Problems’ Group requires:
A PROBLEMS OF COLLECTIVE ORIENTATION • Our older members...
B CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70% • owners of a large range of experience
60% inuncertainty management
Hoped Ep
50%
Seen Ep
40% •Who can restrain, put a curb the
Solved Ep excessive patients’ requests in the:
30%
20% •“Non-Diseases”
10% •Low Severity Problems
0%
C
A B B1 C D E P

8. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION
A PROBLEMS OF COLLECTIVE ORIENTATION To solve the D Problems’ Group requires:
B CONSUMTIVE OR DISABLING DISEASES • Our modern Doctors...
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70%
60%
Hoped Ep
50%
Seen Ep
40%
30%
Solved Ep •With a lot of expertise, skills on
Diag-Therapeutic procedures:
20%
•Injuries, wounds,
10%
pyelonephritis.....
0%
D
A B B1 C D E P

9. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION
To solve the B&B1 Problems’ Group requires:
A PROBLEMS OF COLLECTIVE ORIENTATION
B CONSUMTIVE OR DISABLING DISEASES •Abilities to do a Family Therapeutic Orientation
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70%
60%
Hoped Ep
50%
Seen Ep
40%
Solved Ep
30%
20% •The known Community Medicine.
10%
0%
B B1
A B B1 C D E P

10. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION
A PROBLEMS OF COLLECTIVE ORIENTATION To solve the P Problems’ Group requires:
B CONSUMTIVE OR DISABLING DISEASES Vocation towards the
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
Effectiveness Prevention
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70%
60%
Hoped Ep
50%
Seen Ep
40%
Solved Ep
30%
20% •Avoiding the superfluous prevention.
10%
0%
P
A B B1 C D E P

11. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION
A PROBLEMS OF COLLECTIVE ORIENTATION To solve the E Problems’ Group requires:
B CONSUMTIVE OR DISABLING DISEASES •our best “open minded” doctor...
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70%
60%
Hoped Ep
50% •Able to manage, monitoring and
Seen Ep
40% coordinate Health Problems of
Solved Ep
30% low feasibility in PC, with:
20% •Hospital,
10% •Second level
0% •Social resources...
E
A B B1 C D E P

12. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION To solve the A Problems’ Group requires:
A PROBLEMS OF COLLECTIVE ORIENTATION •High competent professional
B CONSUMTIVE OR DISABLING DISEASES
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70%
60%
Hoped Ep •able to treat problems of collective
50%
Seen Ep
orientation, for their epidemiological,
40% economical o social significance, with the
Solved Ep
30% best effectiveness and efficiency like:
20% •transmissible diseases, Ischemic
10% heart diseases, mental illness, etc
0%
A
A B B1 C D E P

13. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION
A PROBLEMS OF COLLECTIVE ORIENTATION
B CONSUMTIVE OR DISABLING DISEASES All of seven groups define a
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
good generalist
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70%
60%
Hoped Ep
50%
Seen Ep And the professionals can check out
40%
30%
Solved Ep their profiles
20%
10%
0%
A B B1 C D E P

14. angelruiztellez@cymap.es
+00 34 637.53.23.59
1.-Do you know the existence of 7 Groups of Problems in Primary Care, that show the 7 qualities
of a good Family Practice?:
G.R.E./NCC© Group Related Episodes by Need of Care Criteria ©
G.R.E. DESCRIPTION
A PROBLEMS OF COLLECTIVE ORIENTATION
B CONSUMTIVE OR DISABLING DISEASES All of seven groups define a
B1 SANITARY PROBLEM OF SOCIAL ORIGIN
C HEALTH PROBLEMS THAT TEND TO AN SPONTANEOUS RESOLUTION
good generalist
D SPECIFIC PROBLEMS OF INDIVIDUAL HEALTH, DEPENDANT ON TECHNICAL ABILITIES.
E HEALTH PROBLEMS OF LOW FEASIBILITY, IN PRIMARY CARE
P HEALTH NEEDS WITH EFFECTIVE PREVENTION
100%
90%
80%
70%
60%
Hoped Ep
50%
Seen Ep And the professionals can check out
40%
30%
Solved Ep their profiles
20%
10%
0%
A B B1 C D E P

15. angelruiztellez@cymap.es
+00 34 637.53.23.59
2.-Do you know that the previous 7 groups are divided in other 24 Solving Basic Models SBM, that
represent the 24 models of therapeutic homogeneous professional behaviour?:
SBM DESCRIPTION
SBM© Solving Basic Models© A01 TRANSMISSIBLE DISEASES
A02 RISK HABITS
A03 RISK FACTORS
100% A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY
90% A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCE
80% B01 CONSUMTIVE DISEASES
70% B02 DISABLING ILLNESSES
B11 SANITARY PROBLEMS OF SOCIAL ORIGIN
60%
C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION
50% C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY
40% C03 ACUTE AND BANAL HEALTH PROBLEMS
30% SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A
C04
SHORT TERM
20%
SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND
10% C05
UNCERTAINTY IN A LONG TERM
0% D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR
A01
A02
A03
A04
A05
P01
P02
P03
B01
B02
B11
C01
C02
C03
C04
C05
E01
E02
E03
E04
D01
D02
D03
D04
D02
COMPLEXITY
SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE
Solved Ep Seen Ep Hoped Ep D03
COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
And, so, in an only chart, the professionals, quickly, can E01
SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN
PRIMARY CARE-PC
observe his o her profile, in the 24 SBM, understanding their E02 SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL
strength and weakness around each one of them. E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC &
E04
WITH SHARED CONTROL
Above those SBM we have the whole classification, in P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS
P02 PROMOTION OF HEALTHY LIFE STYLES
detail, with around 1.000 Modulated Episodes, each one P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
allocated[to one specific SBM.

16. angelruiztellez@cymap.es
+00 34 637.53.23.59
3.-How could we interpret the retrospective information when into a ICPC Code can exists very
different clinical syndromes?.
Modulated Episodes©
ModEp DESCRIPTION SBM Creating different subgroups of
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 Episodes, allocated to one o more
UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY
R74.02
PROBLEMS (1-13 YEAR)
C01
ICPC , according to therapeutical
R74.03 UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY C04 orientation.
PROBLEMS (1-13 YEAR)
…….
Let’s see one example around the ICPC Code R74- UPPER
R74 RESPIRATORY INFECTION ACUTE
It isn’t the same a Cold in a breast-fed baby, or in a child
with Asthma or without. There are three different problems,
Modulation with the same code, with three Selection Criteria, and with
three Resolution Criteria, that need to be allocated in their
Engine respective SBM.
Because we analyse informatics records retrospectively, is
impossible discriminate and interpret the information
without doing groups of problems depend on the Selection
Criteria , what will allow us to state the Resolution Criteria to
SC1 SC2 SC3 analyze the Effectiveness.
So, you will be able to understand that was needed to
allocate each one to different Groups of SBM , and so,
Managers and Professionals will have a common language.
RC1 RC2 RC3

17. angelruiztellez@cymap.es
+00 34 637.53.23.59
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
Above those SBM we have the whole classification, in detail, with around 1.000 Modulated Episodes, each one allocated to one specific SBM.
Modulated Episodes© SBM DESCRIPTION
ModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASES
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS
UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORS
R74.02 C01
PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY
UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCE
R74.03 C04 B01 CONSUMTIVE DISEASES
PROBLEMS (1-13 YEAR)
B02 DISABLING ILLNESSES
……. B11 SANITARY PROBLEMS OF SOCIAL ORIGIN
C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION
C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY
R74 C03 ACUTE AND BANAL HEALTH PROBLEMS
SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A
C04
SHORT TERM
SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND
C05
Modulation UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
Engine D02
SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR
COMPLEXITY
SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE
D03
COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN
E01
SC1 SC2 SC3 E02
PRIMARY CARE-PC
SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL
E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC &
E04
WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS
P02 PROMOTION OF HEALTHY LIFE STYLES
RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
SC: Selection Criteria RC: Resolution Criteria

18. angelruiztellez@cymap.es
+00 34 637.53.23.59
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
Modulated Episodes© SBM DESCRIPTION
ModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASES
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS
UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORS
R74.02 C01
PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY
UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCE
R74.03 C04 B01 CONSUMTIVE DISEASES
PROBLEMS (1-13 YEAR)
B02 DISABLING ILLNESSES
……. B11 SANITARY PROBLEMS OF SOCIAL ORIGIN
C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION
C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY
R74 C03 ACUTE AND BANAL HEALTH PROBLEMS
SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A
C04
SHORT TERM
SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND
C05
Modulation UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
Engine D02
SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR
COMPLEXITY
SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE
D03
COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN
E01
SC1 SC2 SC3 E02
PRIMARY CARE-PC
SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL
E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC &
E04
WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS
P02 PROMOTION OF HEALTHY LIFE STYLES
RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
R74.01

19. angelruiztellez@cymap.es
+00 34 637.53.23.59
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
Modulated Episodes© SBM DESCRIPTION
ModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASES
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS
UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORS
R74.02 C01
PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY
UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCE
R74.03 C04 B01 CONSUMTIVE DISEASES
PROBLEMS (1-13 YEAR)
B02 DISABLING ILLNESSES
……. B11 SANITARY PROBLEMS OF SOCIAL ORIGIN
C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION
C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY
R74 C03 ACUTE AND BANAL HEALTH PROBLEMS
SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A
C04
SHORT TERM
SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND
C05
Modulation UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
Engine D02
SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR
COMPLEXITY
SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE
D03
COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN
E01
SC1 SC2 SC3 E02
PRIMARY CARE-PC
SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL
E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC &
E04
WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS
P02 PROMOTION OF HEALTHY LIFE STYLES
RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
R74.02

20. angelruiztellez@cymap.es
+00 34 637.53.23.59
3.-The Modulated Episodes ( ± 1000, each one allocated to one specific SBM )
Modulated Episodes© SBM DESCRIPTION
ModEp DESCRIPTION SBM A01 TRANSMISSIBLE DISEASES
R74.01 UPPER RESPIRATORY INFECTION ACUTE (<1 YEAR) D01 A02 RISK HABITS
UPPER RESPIRATORY INFECTION ACUTE WITHOUT RESPIRATORY A03 RISK FACTORS
R74.02 C01
PROBLEMS (1-13 YEAR) A04 HEALTH PROBLEMS OF HIGH MORBIDITY OR MORTALITY
UPPER RESPIRATORY INFECTION ACUTE WITH RESPIRATORY A05 HEALTH PROBLEMS OF HIGH SOCIOECONOMIC INFLUENCE
R74.03 C04
PROBLEMS (1-13 YEAR) B01 CONSUMTIVE DISEASES
……. B02 DISABLING ILLNESSES
B11 SANITARY PROBLEMS OF SOCIAL ORIGIN
C01 SPECIFIC SYNDROMES THAT TEND TO AN NATURAL RESOLUTION
C02 CHRONIC SYMPTOM/COMPLAINT OF LOW RISK OR LOW UNCERTAINTY
R74 C03 ACUTE AND BANAL HEALTH PROBLEMS
SYMPTOM/COMPLAINT OF POTENTIAL RISK AND UNCERTAINTY IN A
C04
SHORT TERM
SYMPTOM/COMPLAINT OF HIGHER POTENTIAL RISK AND
C05
Modulation UNCERTAINTY IN A LONG TERM
D01 SPECIFIC PROBLEMS WITH MODERATE SEVERITY/COMPLEXITY
Engine D02
SPECIFIC PROBLEMS WITH MODERATE SEVERITY AND MINOR
COMPLEXITY
SPECIFIC PROBLEMS WITH MINOR SEVERITY AND MODERATE
D03
COMPLEXITY
D04 SPECIFIC PROBLEMS WITH MINOR SEVERITY AND COMPLEXITY
SPECIALIZED PROBLEMS OF LOW THERAPEUTIC FEASIBILITY-LTF IN
E01
SC1 SC2 SC3 E02
PRIMARY CARE-PC
SPECIALIZED PROBLEMS LTF-PC WITH SHARED CONTROL
E03 SPECIALIZED PROBLEMS LTF-PC DIAGNOSED IN PC
SPECIALIZED PROBLEMS LTF-PC THAT CAN BE DIAGNOSED IN PC &
E04
WITH SHARED CONTROL
P01 SANITARY EDUCATION ABOUT HEALTH DOUBTS
P02 PROMOTION OF HEALTHY LIFE STYLES
RC1 RC2 RC3 P03 SCREENING AND SECONDARY PREVENTION OF PREVALENT DISEASES
R74.03

21. angelruiztellez@cymap.es
+00 34 637.53.23.59
Solving the classification of Prevention : The Modulated Episodes
Modulated Episodes©
G.R.E./NCC©
 G.R.E./NCC©
 SBM
 SubSBM
 Mod Episode

22. angelruiztellez@cymap.es
+00 34 637.53.23.59
4.-Do you know that the “Portfolio Services”, reach only the 10% of epidemiological reality?.
Activity •Which will be our excellent professionals?
100
90
80
70
As excellent as •When we control the 10% of the direction
60
invisible Doctors of the ship....?
50
Activity
40
?
30
20 Roof “Portfolio Services”
10
0
Doctor A Doctor B Doctor C Doctor D
We need to measure the Ship adrift
100% Activity & Manageable
Costs

23. angelruiztellez@cymap.es
+00 34 637.53.23.59
5.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?.
100 SR = Seen / Hoped = 60/100 = 0.6
Hoped Episodes
Supply Rate = SEEN Episodes / HOPED Episodes
60 ER = Solved / Seen = 40/60 = 0.66
Seen Episodes
Effectiveness Rate = SOLVED Episodes / SEEN Episodes
40 SPR = Solved / Hoped = 40/100 = 0.4
Solved Social Profitability Rate = SOLVED Episodes / HOPED Episodes
Episodes
SPR = SR x ER = 0.6 x 0.66 = 0.4
€R = SPR / €osts
The Supply isn’t a whole number.
Efficiency Rate

24. angelruiztellez@cymap.es
+00 34 637.53.23.59
5.-Do you know that there are 14.000 Episodes Hoped, in a standard patient panel?.
100 SR = Seen / Hoped = 60/100 = 0.6
Hoped Episodes
Supply Rate = SEEN Episodes / HOPED Episodes
60 ER = Solved / Seen = 40/60 = 0.66
Seen Episodes
Effectiveness Rate = SOLVED Episodes / SEEN Episodes
40 SPR = Solved / Hoped = 40/100 = 0.4
Solved Social Profitability Rate = SOLVED Episodes / HOPED Episodes
Episodes
SPR = SR x ER = 0.6 x 0.66 = 0.4
The Supply isn’t a whole number, but a Rate of
Seen Needs / Hoped Needs.
Our model allows us to measure the rest of the €R = SPR / €osts
Rates:
•Effectiveness Efficiency Rate
•Social Profitability
•Efficiency
creating an environment of quality that provoke one
positive bias

25. angelruiztellez@cymap.es
+00 34 637.53.23.59
6.-Do you know that the relation between Activity and Costs is negative and not positive?.
Activity
Real Linear Regression
•There is a proportion of professionals that More x Less
make more activity by less costs and vice
versa.
•They are our excellent and transparent
professionals.
Less x More
•Our invisible professionals.
Professionals
Costs

26. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
Let’s compare the
B: difference of
weighed
Activity
professional
activity and costs,
against these both
C: average values,
sited in the middle
of the chart, ... C D
D: - Costs +

27. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

28. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: AExcellent B
&
Invisible
B: Activity
C:
C D
D: - Costs +

29. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

30. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

31. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A Logical B
&
Warriors
B: Activity
C:
C D
D: - Costs +

32. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

33. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

34. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
Prudent
C: &
C Calm D
D: - Costs +

35. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

36. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

37. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C: Generous
C D
D: - Costs +

38. angelruiztellez@cymap.es
+00 34 637.53.23.59
8.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
Activity Costs
+
A: A B
B: Activity
C:
C D
D: - Costs +

39. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
+
A B
Activity
C D
- Costs +

40. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
+
A B
•That is possible because the upper
ones have a bigger clinical applied
competence, perhaps because they
know a little bit more medicine. Activity
C D
- Costs +

41. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
+
A B
•That is possible because the upper
ones have a bigger clinical applied
competence, perhaps because they
know a little bit more medicine. Activity
And the upper left ones, moreover,
have a bigger organizational
competence.
C D
- Costs +

42. angelruiztellez@cymap.es
+00 34 637.53.23.59
7.-Would you know that we would find 4 areas of professional behaviour, in, more or less, a
rule, a law of quarters?
X Diagram Téllez-Alonso Each dot, an annual professional data
+
A 350% B
•That is possible because the upper better
ones have a bigger clinical applied Cost-Effectiveness
competence, perhaps because they
know a little bit more medicine.
with regards to
Activity the rest
And the upper left ones, moreover,
have a bigger organizational
competence.
C D
- Costs +

43. angelruiztellez@cymap.es
+00 34 637.53.23.59
Summarizing, what can ISIS Manager© Project do?:
Can create an environment of Excellence ( Effectiveness +
Efficiency ) across the “peer-review”, with controlled bias
towards more activity by less costs.
Activity
The first stage is to have a “Valuable Information
System”, according a Valuable, too, Worthy and
A B
Challenging Goal of Reference,
“To Solve the bigger number of Epidemiological Needs Model trend
with the best Effectiveness and Efficiency”
The second stage is to avoid the mistrust, after reading the
information data:
•Standardizing Data (weighed social, population, C D
epidemiological conditions of each Doctor patients’ Panel)
•Guaranteeing the ‘Quality Data’ across a method of Costs
certification of the Records Reliability ( ISIS Manager©
use 100 steps control along the ‘data chain’, included the
Certification in ICPC Professional Codification).

44. angelruiztellez@cymap.es
+00 34 637.53.23.59
CONCLUSIONS:
•The “peer-review” is the one of most powerful methods of professional
motivation, but must observe , fulfil, the next conditions:
•Must evaluate 100% activity and 100% manageable costs.
•Must evaluate the Effectiveness
•To avoid the mistrust around the professional comparison, the data
must be standardized and certificated in Records Reliability.
•The Information System have to create an environment with
controlled bias, controlled slant towards the “more activity by less
costs”.
• A classification like our GRE/NCC© allows, quickly,
• to the professionals:
•To Know his professional profile and
•To learn around their strength and weakness
•To the Managers:
•To know the reality and act consequently.