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The main goal of each Healthcare Institution in a highly controlled & competitive environment, is to reduce operating costs while maintaining a consistently acceptable level of patient treatment. Reduce operating costs at all levels:

Cost of healthcare Professionals
According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product
>
Cost of lab equipment & consumables
Cost of pharmaceuticals / medical material
Cost of a treatment per Diagnosis related grouping (DRG)
Cost per type of medical intervention (e.g. specific medical operation)

On the other hand, an acceptable

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

level of patient treatment involves:

Evidence based medicine, accurate diagnosis and efficient treatment
On time admittance in the Hospital and healthcare treatment
Treatment with respect for the Patient- analysis of options
Reduction of risks during

lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

treatment (e.g. related to the use of medicine, biomedical equipment, blood transfusions)

Capture of medical history of the patient in order to support evidence based medicine

Moreover, goals of each Healthcare Institution are:

Reduction of medical errors an

here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe

d exposure of the patient to medical hazards (e.g. inappropriate levels of radiation)

Support medical research with patient & treatment data

Participate and support a larger Healthcare system, with the exchange of medical information on a patient, as well as stati

d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

Combination pro

tics on population morbidity & mortality.In Private Healthcare, the excellent Patient service is critical to Customer retention & loyalty and business growth. In order to achieve these goals, each modern Healthcare system aims to enhance its Organisational capabilit

ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc

y with the introduction of standard business processes, standard healthcare treatment based on standardized healthcare interventions. Medical information management is supported by the introduction of information systems aligned to the standardized processes as well as the introducti

easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi

on of classifications or codifications of certain information types like diseases (based on ICD), medical interventions, lab exams, biomedical equipment & consumables. Hospital information systems (HIS) are used to capture and process all information related to the administrative

nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically

as well as the medical aspects of a patient event. A patient record is created which stores all the patient history, structured per event. A datamart monitoring the inpatient and outpatient service could be based on data retrieved from the HIS database. In a dimensional model it wou

and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ

ld store the dimensions involved in the service: Patient, Date, Healthcare Unit and Department, exit DRG (diagnosis related grouping) group, Diagnosis (based on ICD), Medical intervention based on selected codification, pharmaceutical treatment, medical material used, and capture all

ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi

cost related facts in the fact table. The star schema captures information related to an inpatient event, which normally may last few days. In order to capture the whole lifecycle of the event, an accumulating snapshot fact table is used, as shown in the figure (check link below). Ba

ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a

sed on this star schema, a wide range of analytical tasks can be carried out. Analysis related to medical treatment of a specific event (indicatively):

Produce a medical history report on a patient
Produce stats on morbidity by restricting on specific ICD codes (e.g.

dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod

frequency of an ICD as a percentage of total events, ICD related to demographic info like age or educational level)

Analyse the relation of medical interventions to ICD & DRGs, by restricting on specific DRGs

Mortal events per ICD / DRG (this can be coded in a sp

cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin

ecific Exit_diagnosis value)Analysis related to cost incurred by a specific event (indicatively):

Analysis on the average length of stay (ALOS) per DRG as well as per Patient demographics.
Analysis on the medical material & consumables cost related to a

tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen

medical intervention

Analysis on the medical material & consumables cost related to an event of specific DRG

Analysis on the pharmaceutical cost related to an event of specific DRG

Delays in payment and collection levels

Department related ana

t?

As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel

ysis:

Number of treatment events / medical interventions per Department
comparison of same specialty Departments

The star schema could also capture the involvement and performance of medical Professionals. In addition it could capture many more facts related

ping new procedures for reviewing their safety, efficacy and quality.

Professional from academic institutions, pharmaceutical industries, health care indust

to the event like manhours spent by the Doctor in charge, by the other professionals involved. The datamart can be linked to the datamart of another Hospital or Healthcare system, if the two use conformed dimensions and facts. Standardized codifications (like ICD) aim at achieving t

y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products

his conformance, in order to be able to consolidate information at the regional, national and international level. Why develop the star schema, instead of querying directly the Hospital Information System database. For two important reasons:

The star schema model is easily un

.

As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de

derstandable by the Business Analyst

The analysis on the star schema is computationally more efficient (the symmetric structure’s simplicity allows for better query optimization)

Moreover the star schema incorporates enriched information at the dimensions as we

elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

Companies that provide selfless information through particip

ll as derived facts on the fact table (cost, duration). This additional information is produced and appended in the datamart staging area. Business intelligence infrastructures, like the one presented above can facilitate the analysis and continuous improvement in a Healthcare system

tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

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