=Paper=
{{Paper
|id=Vol-2711/paper26
|storemode=property
|title=Modeling the Decision Making Process on Civil Law Regulation of Contracts for the Provision of Therapeutic Services
|pdfUrl=https://ceur-ws.org/Vol-2711/paper26.pdf
|volume=Vol-2711
|authors=Tetiana Hovorushchenko,Alla Herts,Yelyzaveta Hnatchuk
|dblpUrl=https://dblp.org/rec/conf/icst2/HovorushchenkoH20
}}
==Modeling the Decision Making Process on Civil Law Regulation of Contracts for the Provision of Therapeutic Services==
https://ceur-ws.org/Vol-2711/paper26.pdf
Modeling the Decision Making Process on Civil Law
Regulation of Contracts for the Provision of Therapeutic
Services
Tetiana Hovorushchenko1[0000-0002-7942-1857], Alla Herts2[0000-0002-3310-3159],
Yelyzaveta Hnatchuk3[0000-0003-2989-3183]
1 Khmelnytskyi National University, Institutska str., 11, Khmelnytskyi, Ukraine
tat_yana@ukr.net, liza_veta@ukr.net
2 Ivan Franko National University of Lviv, Universytetska str., 1, Lviv, Ukraine
agerc@ukr.net
Abstract. Currently, there is a need in Ukraine to design and develop a decision
support system (DSS) on civil law regulation of Contracts for the Provision of Ther-
apeutic Services (regarding the correctness or incorrectness of the Contract struc-
ture). For designing such a DSS, it's necessary the modeling of the decision making
process on civil law regulation of Contracts for the Provision of Therapeutic Ser-
vices, which is the goal of this research. The paper first time proposes a set-
theoretical model, and a model of the ideal ontology of a Contract for the Provision
of Therapeutic Services based on the ideal structure of the Contract in terms of civil
law regulation. In addition, the modeling of the decision-making process on civil
law regulation of Contracts for the Provision of Therapeutic Services (regarding the
correctness or incorrectness of the Contract structure) was performed. The devel-
oped model of the decision-making process is a theoretical basis for the develop-
ment and design of DSS on civil law regulation of Contracts for the Provision of
Therapeutic Services.
Keywords: Contracts for the Provision of Therapeutic Services, Civil Law
Regulation, Ontology-Based Decision Support System, Set-Theoretical Model,
Model of Ontology, Model of Process of Decision Making, Correctness of the
Contract Structure.
1 Introduction
Today, medical technologies must meet 4 requirements: efficiency, safety, novelty and
economic benefits [1]. The modern therapist makes the decision, integrating several
medical specialties. This solution is a daily problem, especially when using innovative
medical technologies [2]. With the introduction of insurance medicine in Ukraine, every
therapist should know the standards of diagnosis and especially the standards of treat-
ment of therapeutic diseases, as failure to comply with the standards of treatment can
lead to complaints of patients, legal conflicts and compensation of considerable finan-
cial resources at the expense of the doctor.
Copyright © 2020 for this paper by its authors. Use permitted under Creative Commons
License Attribution 4.0 International (CC BY 4.0). ICST-2020
In view of the above, the issue of concluding a Contract for the Provision of Thera-
peutic Services needs increasing attention today. A Contract for the Provision of Ther-
apeutic Services can be defined as an arrangement whereby one party (provider) under-
takes, on the task of the other party (customer), with complying the health care legisla-
tion, to provide a service of a therapeutic nature, and the customer agrees to pay the
contractor the specified service unless otherwise specified by contract or law.
This service is to establish and treat the etiology, pathogenesis and clinical manifes-
tations of diseases of the internal organs, their diagnosis, prevention, and rehabilitation.
The parties to the agreement on the provision of therapeutic services may be health
care institutions; individuals carrying out private medical practice; patients - individu-
als.
Depending on the subject of Contract, the following types of Therapeutic Service
Contracts are currently being proposed: Contract for the provision of basic therapeutic
services (that will interrupt the course of the disease and promote healing); Contract on
the provision of special therapeutic services (which will prevent and eliminate the pos-
sible exacerbation of the underlying disease or the occurrence of relapses of concomi-
tant pathological processes, the manifestation of possible side effects of drugs on spe-
cial indications); Contract for the provision of additional therapeutic services (after
discharge of a patient from the hospital).
Successfully implemented medical software and decision support systems can great-
ly increase the productivity of therapists [3].
Even more significant and important to support the work of therapists are multidis-
ciplinary medical DSSs, which are being developed at the intersection of the medical
and other subject areas – for example, the DSS for medical law, which would support
decision-making on concluding Contracts for the Provision of Therapeutic Services,
taking into account legislative grounds.
So today, the actual task is to develop an intelligent DSS for the civil law regula-
tion of Contracts for the Provision of Therapeutic Services.
2 Literature Review
The review and analysis of known decision support systems for the medical law
are represented on Figure 1.
This review has proven that none of these known DSS is intended to support deci-
sion-making on concluding Contracts for the Provision of Therapeutic Services, tak-
ing into account legislative grounds.
So today, it is necessary to develop an intelligent DSS for the civil law regulation
of Contracts for the Provision of Therapeutic Services. For that, the decision-making
process on civil law regulation of Contracts for the Provision of Therapeutic Services
should first be organized, which is the goal of this research. This paper is devoted to,
in particular, modeling the decision making process on civil law regulation of Con-
tracts for the Provision of Therapeutic Services.
Fig. 1. Review and analysis of known decision support systems for the medical law
3 Civil Law Regulation of Contracts for the Provision of
Therapeutic Services
Consider the structure of the Contracts for the provision of therapeutic services
required in terms of civil law regulation. An essential condition of a Contract for
the Provision of Therapeutic Services is the subject – medical service in therapy. The
subject of this Contract is the provision of therapeutic services consumed in the
carrying out therapeutic activities.
According to Part 3 of Art. 626 of the Civil Code of Ukraine [13], the Contract for
the Provision of Therapeutic Services is bilateral. Based on the subjective structure of
the Contract for the Provision of Therapeutic Services, these contracts in accordance
with Part 1 of Art. 633 of the Civil Code of Ukraine [13] are public.
These Contracts are payable unless otherwise provided by Contracts, by law, or do
not follow from the substance of the contracts. An important condition of contracts
for the provision of therapeutic services is the price for services and the procedure for
settlements. Therefore, the contract must specify the procedure for calculations. Issues
of payment under the contract of the parties decide in accordance with Art. 632, 903-
904 of the Civil Code of Ukraine [13].
Regarding the term, these Contracts may be concluded for a term that, as a matter
of fact, depends objectively on the capabilities of a particular type of therapeutic
service, as well as on the desired result to be achieved.
The text of the Contract for the Provision of Therapeutic Services should include
the section "General Terms" and "Main Part". The General Terms section consists of
the following clauses: subject of the Contract; theoretical principles of work; practical
tools; limits of competence of the practitioner; duties, rights and responsibilities of the
doctor (medical institution); duties, rights and responsibilities of the client; price of
services and procedure of payments; timing and schedule of services; possible
manifestations of concomitant and incidental adverse effects of exposure to
therapeutic services; other conditions.
The Main Part section of the Contract may include the following units:
Unit І “Diagnostic Search” consists of the next clauses: patient's complaints,
identifying individual signs (symptoms) of the disease based on complaints, medical
history, patient's life history, objective survey data, general clinical and laboratory-
instrumental research methods. The basic condition of this stage is compliance with
the systematic and complete examination of the patient.
Unit ІІ “Making the Diagnosis”. There are the previous (syndromic) diagnosis,
after the first examination; the clinical diagnosis, after additional examination and
observation of the patient; the final diagnosis.
Effective treatment requires proper diagnosis based on a systematic examination
of the patient, analysis of anamnesis, complaints and objective signs of the disease
(revealed during the physical examination, as well as using routine laboratory and
instrumental methods). Identified signs (symptoms) of the disease should be
combined by the therapist into syndromes (a set of symptoms having common
pathogenesis), on the basis of which a final conclusion can be drawn about a possible
disease. If it is impossible to draw a clear conclusion about the disease, differential
diagnosis of several similar diseases should be performed with additional laboratory
and instrumental studies. In some difficult to diagnose clinical cases, trial treatment is
prescribed, which provides the so-called "diagnosis ex juvantibus" (diagnosis based
on evaluation of the conducted treatment results). Therefore, a syndromic diagnosis is
first established, and the final step in this process is the formulation of a clinical
diagnosis, which should include the following components:
1. the name of the disease;
2. stage of pathological process;
3. clinical form and manifestations of the disease;
4. functional state of individual organs and systems;
5. diagnosis of complications;
6. diagnosis of comorbidities.
Unit ІІІ “Purpose of Treatment”. At this stage, the verification of the veracity of
the diagnostic search is performed by the appointment of adequate treatment, which
should include: optimal physical, diet and hygiene regimens; medication,
physiotherapy facilities and/or surgical methods; spa offers.
4 Modeling the Decision Making Process on Civil Law
Regulation of Contracts for the Provision of Therapeutic
Services
In [4, 14], the authors have argued that information of the subject area, including the
area of medical law, is advisable to submit as ontologies that allow for systematic and
rapid analysis of this information. The paper [4] presents the concept of the decision-
making process in the field of legal regulation of surrogate motherhood. A similar
approach can be used for decision making process on civil law regulation of Contracts
for the Provision of Therapeutic Services.
For decision making on civil law regulation of Contracts for the Provision of
Therapeutic Services, an ideal ontology is needed, which will represent the necessary
(ideal) structure (sections, units, clauses) of the Contract for the Provision of
Therapeutic Services in terms of civil law regulation. For each case, the conclusion of a
Contract for the Provision of Therapeutic Services will require a real ontology, which
will contain the real structure of the real contract. Comparison of the real ontology with
the ideal ontology makes it possible to determine the presence of the necessary points in
the real Contract for the Provision of Therapeutic Services and to decide accordingly on
the correctness or incorrectness of the structure of this Contract.
Let is the set of missing clauses in the Contract for the Provision of
Therapeutic Services:
AP = Ideal_onto logy\(Idea l_ontology Real_ontol ogy) (1)
At the requirement of the interviewed experts in the field of medical law, consid-
ering the obligation to guarantee by such a contract of the safety of services in therapy
for the patient, for the conclusion of the contract for the provision of therapeutic ser-
vices, it is mandatory to perform all the above points. Therefore, taking into account
the theory described in [12], the criterion of the correctness of the structure of the
Contract for the Provision of Therapeutic Services has the form:
• if AP = , then structure of the Contract for the Provision of Therapeutic Services
is correct;
• if AP , then structure of the Contract for the Provision of Therapeutic Services
is incorrect.
For the filling of an ideal ontology, set-theoretical and ontological models are
required. In addition, given the presented criterion of the correctness of the structure
of the Contract for the Provision of Therapeutic Services, it is necessary to develop a
model of the decision making process on civil law regulation of Contracts for the
Provision of Therapeutic Services.
Considering the above requirements to the structure of the Contract for the
Provision of Therapeutic Services, we will present this Contract in the following
formalized form:
CPTS = GTC , MPC , (2)
where – General Terms of Contract, – Main Part of Contract.
General Terms section consists of a number of clauses and can be presented in the
following set-theoretical form:
GTC = { sc , tpw , pt , lcp , drrd , drrc , pspp , tss , pmaeets , oc }, (3)
where – subject of the Contract, – theoretical principles of work, – practi-
cal tools, – limits of competence of the practitioner, – duties, rights and
responsibilities of the doctor (medical institution), – duties, rights and responsi-
bilities of the client, – price of services and procedure of payments, – timing
and schedule of services, – possible manifestations of concomitant and
incidental adverse effects of exposure to therapeutic services, – other conditions.
Main Part section consists of 3 units and can be represented as a cortege:
MPC = DS , MD , PT , (4)
where – Diagnostic Search, – Making the Diagnosis, – Purpose of Treatment.
Unit I “Diagnostic search” should contain a number of clauses that can be
formalized in the following set-theoretical form:
DS = {pc,iisd,m h,plh,osd, gclimr}, (5)
where – patient's complaints, – identifying individual signs (symptoms) of the
disease based on complaints, – medical history, – patient's life history, –
objective survey data, – general clinical and laboratory-instrumental methods
of research.
Unit II “Making the Diagnosis” also should contain a number of clauses that can
be formalized in the following set-theoretical form:
MD = {pd , cd , fd}, (6)
where – previous (syndromic) diagnosis, – clinical diagnosis, – final diag-
nosis. Clinical diagnosis consists of many clauses:
cd = {nd , spp , cfmd , fsios , dc , dcb}, (7)
where – name of the disease, – stage of pathological process, – clinical
form and manifestations of the disease, – functional state of individual organs
and systems, – diagnosis of complications, – diagnosis of comorbidities.
Unit III “Purpose of Treatment” involves formulating and prescribing adequate
treatment, which consists of the following clauses:
PT = {phdhr , mphtfsm , spao}, (8)
where – optimal physical, diet and hygiene regimens; – medication,
physiotherapy facilities and/or surgical methods; – spa offers.
Then the model of the Contract for the Provision of Therapeutic Services with the
ideal structure in terms of civil law regulation has the following form:
CPTS = < {sc, tpw, pt, lcp, drrd, drrc, pspp, tss, pmaeets,oc},
{pc, iisd, mh, plh, osd, gclimr},{pd, {nd, spp, cfmd, fsios,dc, dcb}, fd}, (9)
{phdhr, mphtfsm, spao} > .
Considering formalized form of the Contract for the Provision of Therapeutic
Services with the ideal structure in terms of civil law regulation (equation (9)) and
relations between concepts “influences_the_decision”, model of the ideal ontology of
the Contract for the Provision of Therapeutic Services, can be represented in the form:
IO_CPTS = {CPTS," influences_the_decision" } =
= {{sc, tpw, pt, lcp, drrd, drrc, pspp, tss, pmaeets,oc},{pc, iisd, mh, plh, osd, gclimr},
(10)
{pd, {nd, spp, cfmd, fsios,dc, dcb}, fd},{pd, {nd, spp, cfmd, fsios, dc, dcb}, fd},
{phdhr, mphtfsm, spao}," influences_the_decision" }.
Taking into account the developed criterion for the correctness of the structure of
the Contract for the Provision of Therapeutic Services and the model of the ideal
ontology of the Contract for the Provision of Therapeutic Services, let conduct
modeling the process of decision making on civil law regulation of Contracts for the
Provision of Therapeutic Services.
If is the set of missing clauses in the Contract for the Provision of Therapeutic
Services, then:
AP = IO_CPTS \ (IO_CPTS RO_CPTS), (11)
where – model of real ontology, which contains the real structure of the real
Contract for the Provision of Therapeutic Services.
The production rule for deciding on the correctness or incorrectness of the struc-
ture of the Contract for the Provision of Therapeutic Services is:
if AP = ,
then" structure of Contract is correct" , (12)
else" structure of Contract is incorrect"
The developed models are used to systematize the information obtained from the
Contract for the Provision of Therapeutic Services and bring it to a general (unified)
form in accordance with the civil law of Ukraine, so it is advisable to develop such
models in static set-theoretical form.
The developed set-theoretical models are the basis for modeling the process of
decision making on civil law regulation of Contracts for the Provision of Therapeutic
Services.
The process of decision making on civil law regulation of Contracts for the
Provision of Therapeutic Services (regarding the correctness or incorrectness of the
Contract structure) is presented on Figure 2.
Contract for the
Provision of
Therapeutic Services
Comparing
Real ontology Ideal ontology
AP – set of missing
clauses in the Contract
for the Provision of
Therapeutic Services
no yes
AP =
Structure of Contract for Structure of Contract for
the Provision of the Provision of
Therapeutic Services is Therapeutic Services is
incorrect correct
Visualized Signing the Contract
information about
the absent clauses
of the Contract
Revision of the
Contract
Fig. 2. Process of decision making on civil law regulation of Contracts for the Provision of
Therapeutic Services (regarding the correctness or incorrectness of the Contract structure)
The proposed process of decision making on civil law regulation of Contracts for the
Provision of Therapeutic Services is an iterative process based on the comparison.
5 Experiment, Results and Discussions
Let consider the functioning of the developed model of the process of decision mak-
ing on civil law regulation of Contracts for the Provision of Therapeutic Services
(concerning the correctness or incorrectness of the Contract structure). The analysis of
the real Contract for the Provision of Therapeutic Services, ready to be signed by the
parties, using the developed model of the decision making process on civil law regu-
lation of Сontracts for the Provision of Therapeutic Services, showed that the set
AP = { pt, iisd, pd, phdhr} . So, there are no clauses “practical tools”, “identifying indi-
vidual signs (symptoms) of the disease based on complaints”, “previous (syndromic) di-
agnosis”, “optimal physical, diet and hygiene regimens” in the prepared contract. The
signatories were informed that “Structure of Contract for the Provision of Therapeutic
Services is incorrect” with providing the information about the absent clauses of the
Contract, and were invited to revise the Contract. The Contract was revised; the Con-
tract was re-analyzed using the developed model, which resulted in the set AP = ,
thus concluding “Structure of the Contract for the Provision of Therapeutic Services
is correct” followed by singling the Contract.
The developed set-theoretical model, model of the ideal ontology of the Contract for
the Provision of Therapeutic Services, model of the process of decision making on
civil law regulation of Contracts for the Provision of Therapeutic Services (concern-
ing the correctness or incorrectness of the Contract structure) provided the possibility
to perform a fast check of the Contracts for the Provision of Therapeutic Services
concerning the correctness or incorrectness of the Contract structure in terms of civil
law regulation. Such check allows making automatically, without human participation,
unmistakable (in terms of civil law regulation) decisions about the
correctness/incorrectness of the structure of the Contract, the possibility/impossibility of
concluding (signing) the Contract, and significantly improves the effectiveness of the
therapist work and insurance medicine, as well as can protect both patients and doctors.
The described example proved the workability and effectiveness of the developed
model of the process of decision making on civil law regulation of Contracts (concern-
ing the correctness or incorrectness of the Contract structure).
6 Conclusions
Currently, there is a need in Ukraine to design and develop a decision support system
on civil law regulation of Contracts for the Provision of Therapeutic Services (regard-
ing the correctness or incorrectness of the Contract structure), which can significantly
improve the effectiveness of the therapist work and insurance medicine, as well as can
protect both patients and doctors.
The set-theoretical model, and the model of the ideal ontology of the Contract for
the Provision of Therapeutic Services based on the ideal structure of the Contract
from the point of view of civil law regulation, has been developed. These models
make it possible the modeling the process of decision making on civil law regulation
of Contracts for the Provision of Therapeutic Services (regarding the correctness or
incorrectness of the Contract structure).
The model of the process of decision making on civil law regulation of Contracts
for the Provision of Therapeutic Services (concerning the correctness or incorrectness
of the Contract structure) is first time developed. This model is based on a compara-
tive analysis of ontologies. The developed model reflects the features of decision
making regarding the correctness or incorrectness of the Contract structure. Such a
model is the theoretical basis for the development of methods and design of DSS on
civil law regulation of Contracts for the Provision of Therapeutic Services (regarding
the correctness or incorrectness of the Contract structure).
The perspective directions of future authors’ work are: the development of the
modeled ideal ontology, the development of the decision-making method and evalua-
tion of its effectiveness, and realization of the ontology-based decision support system
(as a part of intelligent information technology) on civil law regulation of Contracts
for the Provision of Therapeutic Services (regarding the correctness or incorrectness
of the Contract structure) on the basis of the proposed model of process of decision
making on civil law regulation of Contracts for the Provision of Therapeutic Services.
Successfully implementation of the proposed decision support systems can greatly
increase the productivity of therapists by support decision-making on concluding Con-
tracts for the Provision of Therapeutic Services, taking into account legislative grounds.
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