Modeling the healthcare assistance process for comorbidity patients compliant with prEN12967

The increment of life expectancy in our society, and the consequent population ageing, anticipate that the health sector must face the challenges associated with a growing population group of elderly patients with numerous disorders, generally chronic. In this work we introduce a framework to support the communication and information management tasks involved in a coordinated care of this kind of patients. This framework has been developed in the European context, it is compliant with CEN's prEN12967, and follows ITU-T's ODP methodology, that facilitates its integration in any system following this standard.