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Wu J, Yuan CT, Moyal-Smith R, Wick EC, Rosen MA. Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care. J Am Med Inform Assoc 2024; 31:591-599. [PMID: 38078843 PMCID: PMC10873834 DOI: 10.1093/jamia/ocad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/30/2023] [Accepted: 11/25/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Enhanced recovery pathways (ERPs) are evidence-based approaches to improving perioperative surgical care. However, the role of electronic health records (EHRs) in their implementation is unclear. We examine how EHRs facilitate or hinder ERP implementation. MATERIALS AND METHODS We conducted interviews with informaticians and clinicians from US hospitals participating in an ERP implementation collaborative. We used inductive thematic analysis to analyze transcripts and categorized hospitals into 3 groups based on process measure adherence. High performers exhibited a minimum 80% adherence to 6 of 9 metrics, high improvers demonstrated significantly better adherence over 12 months, and strivers included all others. We mapped interrelationships between themes using causal loop diagrams. RESULTS We interviewed 168 participants from 8 hospitals and found 3 thematic clusters: (1) "EHR difficulties" with the technology itself and contextual factors related to (2) "EHR enablers," and (3) "EHR barriers" in ERP implementation. Although all hospitals experienced issues, high performers and improvers successfully integrated ERPs into EHRs through a dedicated multidisciplinary team with informatics expertise. Strivers, while enacting some fixes, were unable to overcome individual resistance to EHR-supported ERPs. DISCUSSION AND CONCLUSION We add to the literature describing the limitations of EHRs' technological capabilities to facilitate clinical workflows. We illustrate how organizational strategies around engaging motivated clinical teams with informatics training and resources, especially with dedicated technical support, moderate the extent of EHRs' support to ERP implementation, causing downstream effects for hospitals to transform technological challenges into care-improving opportunities. Early and consistent involvement of informatics expertise with frontline EHR clinician users benefited the efficiency and effectiveness of ERP implementation and sustainability.
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Affiliation(s)
- JunBo Wu
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Christina T Yuan
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Rachel Moyal-Smith
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Ariadne Labs: A Joint Center of the Harvard School of Public Health and Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA 02215, United States
| | - Elizabeth C Wick
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Michael A Rosen
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
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García-García JA, Carrero M, Escalona MJ, Lizcano D. Evaluation of clinical practice guideline-derived clinical decision support systems using a novel quality model. J Biomed Inform 2024; 149:104573. [PMID: 38081565 DOI: 10.1016/j.jbi.2023.104573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024]
Abstract
Over the last decade, clinical practice guidelines (CPGs) have become an important asset for daily life in healthcare organizations. Efficient management and digitization of CPGs help achieve organizational objectives and improve patient care and healthcare quality by reducing variability. However, digitizing CPGs is a difficult, complex task because they are usually expressed as text, and this often leads to the development of partial software solutions. At present, different research proposals and CPG-derived CDSS (clinical decision support system) do exist for managing CPG digitalization lifecycles (from modeling to deployment and execution), but they do not all provide full lifecycle support, making it more difficult to choose solutions or proposals that fully meet the needs of a healthcare organization. This paper proposes a method based on quality models to uniformly compare and evaluate technological tools, providing a rigorous method that uses qualitative and quantitative analysis of technological aspects. In addition, this paper also presents how this method has been instantiated to evaluate and compare CPG-derived CDSS by highlighting each phase of the CPG digitization lifecycle. Finally, discussion and analysis of currently available tools are presented, identifying gaps and limitations.
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Affiliation(s)
- Julián Alberto García-García
- ES3 Group (Engineering and Science for Software Systems group). Computer Languages and Systems Department. Escuela Técnica Superior de Ingeniería Informática., Avda. Reina Mercedes s/n. 41012 Seville, Spain.
| | - Manuel Carrero
- ES3 Group (Engineering and Science for Software Systems group). Computer Languages and Systems Department. Escuela Técnica Superior de Ingeniería Informática., Avda. Reina Mercedes s/n. 41012 Seville, Spain.
| | - María José Escalona
- ES3 Group (Engineering and Science for Software Systems group). Computer Languages and Systems Department. Escuela Técnica Superior de Ingeniería Informática., Avda. Reina Mercedes s/n. 41012 Seville, Spain.
| | - David Lizcano
- School of Computer Science, Madrid Open University, UDIMA., Campus Collado Villalba, Madrid, Spain.
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Wendel SK, Bookman K, Holmes M, Wiler JL. Successful Implementation of Workflow-Embedded Clinical Pathways During the COVID 19 Pandemic. Qual Manag Health Care 2023; 32:205-210. [PMID: 36913774 PMCID: PMC10289068 DOI: 10.1097/qmh.0000000000000408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Clinical pathways have been found effective for improving adherence to evidence-based guidelines, thus providing better patient outcomes. As coronavirus disease-2019 (COVID-19) clinical guidance changed rapidly and evolved, a large hospital system in Colorado established clinical pathways within the electronic health record to guide clinical practice and provide the most up-to-date information to frontline providers. METHODS On March 12, 2020, a system-wide multidisciplinary committee of specialists in emergency medicine, hospital medicine, surgery, intensive care, infectious disease, pharmacy, care management, virtual health, informatics, and primary care was recruited to develop clinical guidelines for COVID-19 patient care based on the limited available evidence and consensus. These guidelines were organized into novel noninterruptive digitally embedded pathways in the electronic health record (Epic Systems, Verona, Wisconsin) and made available to nurses and providers at all sites of care. Pathway utilization data were analyzed from March 14 to December 31, 2020. Retrospective pathway utilization was stratified by each care setting and compared with Colorado hospitalization rates. This project was designated as a quality improvement initiative. RESULTS Nine unique pathways were developed, including emergency medicine, ambulatory, inpatient, and surgical care guidelines. Pathway data were analyzed from March 14 to December 31, 2020, and showed that COVID-19 clinical pathways were used 21 099 times. Eighty-one percent of pathway utilization occurred in the emergency department setting, and 92.4% applied embedded testing recommendations. A total of 3474 distinct providers employed these pathways for patient care. CONCLUSIONS Noninterruptive digitally embedded clinical care pathways were broadly utilized during the early part of the COVID-19 pandemic in Colorado and influenced care across many care settings. This clinical guidance was most highly utilized in the emergency department setting. This shows an opportunity to leverage noninterruptive technology at the point of care to guide clinical decision-making and practice.
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Affiliation(s)
- Sarah K. Wendel
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
| | - Kelly Bookman
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
| | - Molly Holmes
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
| | - Jennifer L. Wiler
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
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Provider and Manager Perspectives on the Use of an Integrated Clinical Pathway for Community-Dwelling Older Adults: A Qualitative Case Study. Int J Integr Care 2022; 22:1. [PMID: 35087350 PMCID: PMC8782094 DOI: 10.5334/ijic.5965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs. Theory and Methods: A case study based on eleven semi-structured interviews and analysis of documents was carried out in an urban home care unit. The Normalization Process Theory was used for mixed thematic analysis. Results: While its capacity to store data and enhance interprofessional information exchange was appreciated by home care staff, the broad scope, and automated features of the ICP tool were often problematic. Concerns about increased provider workloads, disruption to provider-client relationships during clinical encounters, and difficulties engaging clients in decision-making were main obstacles in the use of the ICP. Conclusion: Given the importance of ICPs in advancing clinical integration, it is critical to continuously adjust their design to align with providers’ realities in order to optimize their potential in real life contexts.
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Masya L, Shepherd HL, Butow P, Geerligs L, Allison KC, Dolan C, Prest G, Shaw J. Impact of Individual, Organizational, and Technological Factors on the Implementation of an Online Portal to Support a Clinical Pathway Addressing Psycho-Oncology Care: Mixed Methods Study. JMIR Hum Factors 2021; 8:e26390. [PMID: 33851926 PMCID: PMC8082382 DOI: 10.2196/26390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/08/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Clinical pathways (CPs) can improve patient outcomes but can be complex to implement. Technologies, such as clinical decision support (CDS) tools, can facilitate their use, but require end-user testing in clinical settings. Objective This study applied the Technology Acceptance Model to evaluate the individual, organizational, and technological contexts impacting application of a portal to facilitate a CP for anxiety and depression (the ADAPT Portal) in a metropolitan cancer service. The ADAPT Portal triggers patient screening on patient reported outcomes, alerts staff to high scores, recommends evidence-based management, and triggers review and rescreening at set intervals. Methods Quantitative and qualitative data on portal activity, data accuracy, and health service staff perspectives were collected. Quantitative data were analyzed descriptively, and thematic analysis was applied to qualitative data. Results Overall, 15 (100% of those invited) health service staff agreed to be interviewed. During the pilot, 73 users (36 health service staff members and 37 patients) were registered on the ADAPT Portal. Of the 37 patients registered, 16 (43%) completed screening at least once, with seven screening positive and triaged appropriately. In total, 34 support requests were lodged, resulting in 17 portal enhancements (technical issues). Health service staff considered the ADAPT Portal easy to use and useful; however, some deemed it unnecessary or burdensome (individual issues), particularly in a busy cancer service (organizational issues). Conclusions User testing of a CDS to facilitate screening and assessment of anxiety and depression in cancer patients highlighted some technological issues in implementing the ADAPT CDS, resulting in 17 enhancements. Our results highlight the importance of obtaining health service staff feedback when piloting specialized CDS tools and addressing contextual factors when implementing them.
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Affiliation(s)
- Lindy Masya
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - Heather L Shepherd
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Liesbeth Geerligs
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Karen C Allison
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | | | - Gabrielle Prest
- Australian College of Nursing, Sydney, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
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The effectiveness of clinical pathway software in inpatient settings: A systematic review. Int J Med Inform 2020; 147:104374. [PMID: 33422761 DOI: 10.1016/j.ijmedinf.2020.104374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/05/2020] [Accepted: 12/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Various studies have assessed the effectiveness of clinical pathways (CPs) in inpatient settings and provided systematic evidence that they positively affect patient outcomes and efficiency of care, thus lowering costs. In recent years, CP implementation is often combined or extended with clinical pathway software (CPS). Until now, no systematic literature review appears to exist which synthesizes the evidence on the effectiveness of CPS in inpatient settings, in relation to the CPs they support. OBJECTIVES The purpose of this study was to systematically review evidence on (perceived) effectiveness of clinical pathway software (CPS) and investigate mechanisms explaining the effects of CPS implementation on outcomes. METHODS We searched MEDLINE via PubMed and Scopus, for English-language original articles. Articles were included if they examined the effectiveness and/or the perceived effectiveness of CPS in the inpatient setting. They were analyzed for evidence on structure, process and outcome effects, as well as for mechanisms explaining such effects in relation to contextual factors. RESULTS From 2904 articles, 12 studies met our inclusion criteria. The seven studies reporting on adherence provide conclusive evidence that CPSs can improve adherence. We also found conclusive evidence of improvement of process related measures regarding appropriate diagnostics, timeliness of care, and length of stay (LOS). Evidence on costs and outcomes is weak and/or less conclusive. This holds true both for patient outcomes (e.g. mortality/patient satisfaction) and caregiver outcomes (e.g. user satisfaction). The studies presented no direct evidence on mechanisms explaining how CPS relate to process and outcome improvements. CONCLUSIONS The primary effects of CPS to increase adherence may in turn positively impact other process indicators such as LOS, timeliness of care, and diagnostic effectiveness. Subsequent effects on costs, outcomes for patients, physicians and nurses remain inconclusive and call for further research. Further research should explicitly take context into account. The scarce and weak evidence-base relating CPS implementation to process and outcome effects needs development along the same lines.
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de la Fuente R, Fuentes R, Munoz-Gama J, Dagnino J, Sepúlveda M. Delphi Method to Achieve Clinical Consensus for a BPMN Representation of the Central Venous Access Placement for Training Purposes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113889. [PMID: 32486300 PMCID: PMC7312914 DOI: 10.3390/ijerph17113889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022]
Abstract
Proper teaching of the technical skills necessary to perform a medical procedure begins with its breakdown into its constituent steps. Currently available methodologies require substantial resources and their results may be biased. Therefore, it is difficult to generate the necessary breakdown capable of supporting a procedural curriculum. The aim of our work was to breakdown the steps required for ultrasound guided Central Venous Catheter (CVC) placement and represent this procedure graphically using the standard BPMN notation. Methods: We performed the first breakdown based on the activities defined in validated evaluation checklists, which were then graphically represented in BPMN. In order to establish clinical consensus, we used the Delphi method by conducting an online survey in which experts were asked to score the suitability of the proposed activities and eventually propose new activities. Results: Surveys were answered by 13 experts from three medical specialties and eight different institutions in two rounds. The final model included 28 activities proposed in the initial model and four new activities proposed by the experts; seven activities from the initial model were excluded. Conclusions: The proposed methodology proved to be simple and effective, generating a graphic representation to represent activities, decision points, and alternative paths. This approach is complementary to more classical representations for the development of a solid knowledge base that allows the standardization of medical procedures for teaching purposes.
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Affiliation(s)
- Rene de la Fuente
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
| | - Ricardo Fuentes
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
- Correspondence:
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (J.M.-G.); (M.S.)
| | - Jorge Dagnino
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (J.M.-G.); (M.S.)
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Cho M, Kim K, Lim J, Baek H, Kim S, Hwang H, Song M, Yoo S. Developing data-driven clinical pathways using electronic health records: The cases of total laparoscopic hysterectomy and rotator cuff tears. Int J Med Inform 2019; 133:104015. [PMID: 31683142 DOI: 10.1016/j.ijmedinf.2019.104015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/26/2019] [Accepted: 10/15/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE A clinical pathway is one of the tools used to support clinical decision making that provides a standardized care process in a specific context. The objective of this research was to develop a method for building data-driven clinical pathways using electronic health record data. MATERIALS AND METHODS We proposed a matching rate-based clinical pathway mining algorithm that produces the optimal set of clinical orders for each clinical stage by employing matching rates. To validate the approach, we utilized two different datasets of deidentified inpatient records directly related to total laparoscopic hysterectomy (TLH) and rotator cuff tears (RCTs) from a hospital in South Korea. The derived data-driven clinical pathways were evaluated with knowledge-based models by health professionals using a delta analysis. RESULTS Two different data-driven clinical pathways, i.e., TLH and RCTs, were produced by applying the matching rate-based clinical pathway mining algorithm. We identified that there were significant differences in clinical orders between the data-driven and knowledge-based models. Additionally, the data-driven clinical pathways based on our algorithm outperformed the models by clinical experts, with average matching rates of 82.02% and 79.66%, respectively. CONCLUSION The proposed algorithm will be helpful for supporting clinical decisions and directly applicable in medical practices.
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Affiliation(s)
- Minsu Cho
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jungeun Lim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Hyunyoung Baek
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seok Kim
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hee Hwang
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Minseok Song
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, South Korea.
| | - Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Huang S, Kuo ML, Yu HM, Huang CH, Shieh WY, Hsu WH, Huang YP, Kuo FC, Lee MS. Clinical information and guidance shared via a patient infotainment system can reduce hospital stay and maintain 2 medical quality for total knee arthroplasty: A single-blinded quasi-randomised controlled trial. Int J Nurs Stud 2019; 104:103440. [PMID: 32105971 DOI: 10.1016/j.ijnurstu.2019.103440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The demand for total knee arthroplasty is increasing worldwide. Optimising results and meeting patients' expectations are more challenging than before, because the length of hospitalisation has markedly reduced and the standard care processes have been accelerated. We incorporated an interactive patient infotainment system into the standard clinical pathway for total knee arthroplasty in the hope of improving patients' length of stay. OBJECTIVES To analyse whether incorporation of an interactive infotainment system reduced the length of stay and improved the quality of medical care (in terms of number of medical orders and emergency room returns). DESIGN A prospective, quasi-randomised controlled trial. PARTICIPANTS AND SETTING Data of 86 patients hospitalised for a unilateral total knee arthroplasty at a medical centre in Taiwan were analysed. METHODS From January 2017 to July 2017, 86 patients who underwent unilateral total knee arthroplasty and were cared for under a standard clinical pathway were included. The study group (41 patients) had access to electronic programs and video demonstrations related to health literacy, physical therapy, home care and precautions following total knee arthroplasty via a patient infotainment system, while the control group (45 patients) did not. Hospital course, quality indices, in-hospital medical costs, returns to the emergency room and readmission at 30 or 90 days were analysed and compared between the two groups of patients. RESULTS The study group had a shorter length of stay (4.4 vs. 4.8 days, mean differences [MD] = -0.37, 95% CI -0.71 to -0.03, p = 0.026) and fewer medical orders (109 vs 111 orders, MD = -1.86, 95% confidence intervals (CI) -3.58 to -0.15, p = 0.047) as compared with the control group. The incidences of emergency room return and readmission to the hospital at 30 or 90 days were comparable between the two groups. No difference in the total medical cost was found between the two groups, with only the cost of laboratory tests in the study group being significantly lower than that in the control group ($144 vs. $163, MD = -21.7, 95% CI -41.0 to -2.25, p = 0.007). CONCLUSIONS The incorporation of a patient infotainment system into the standard clinical pathway for total knee arthroplasty can efficiently reduce the length of hospital stay and maintain the quality of medical care. Further studies on improvement of patient medical literacy with the help of the infotainment system would be of interest in order to improve clinical practice and patient satisfaction. REGISTRATION NUMBER NCT03788798 TWEETABLE ABSTRACT: A patient infotainment system can reduce hospital stay and maintain medical quality for total knee arthroplasty.
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Affiliation(s)
- Shan Huang
- Division of Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Nursing, Fooyin University, Kaohsiung, Taiwan.
| | - Mei-Ling Kuo
- Division of Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Hsin-Ming Yu
- Department of Management Information System, Chang Gung Medical Foundation, Taoyuan, Taiwan.
| | - Chiu-Hui Huang
- Division of Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Wann-Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan.
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan.
| | - Yo-Ping Huang
- Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan.
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Mel S Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Bandong AN, Mackey M, Leaver A, Ingram R, Sterling M, Ritchie C, Kelly J, Rebbeck T. An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation. JMIR Form Res 2019; 3:e12216. [PMID: 31452515 PMCID: PMC6732967 DOI: 10.2196/12216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background Whiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management. Objective The study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process. Methods This study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice. Results The development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures. Conclusions A robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators.
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Affiliation(s)
- Aila Nica Bandong
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Department of Physical Therapy, College of Allied Medical Professions, The University of the Philippines, Manila, Philippines
| | - Martin Mackey
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Andrew Leaver
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Rodney Ingram
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
| | - Carrie Ritchie
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
| | - Joan Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Trudy Rebbeck
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Kolling Institute, John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, Australia
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Laleci Erturkmen GB, Yuksel M, Sarigul B, Arvanitis TN, Lindman P, Chen R, Zhao L, Sadou E, Bouaud J, Traore L, Teoman A, Lim Choi Keung SN, Despotou G, de Manuel E, Verdoy D, de Blas A, Gonzalez N, Lilja M, von Tottleben M, Beach M, Marguerie C, Klein GO, Kalra D. A Collaborative Platform for Management of Chronic Diseases via Guideline-Driven Individualized Care Plans. Comput Struct Biotechnol J 2019; 17:869-885. [PMID: 31333814 PMCID: PMC6614507 DOI: 10.1016/j.csbj.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/18/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians.
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Affiliation(s)
| | - Mustafa Yuksel
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | - Bunyamin Sarigul
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | | | | | - Rong Chen
- Cambio Healthcare Systems, Sweden
- Health Informatics Center, Karolinska Institutet, Sweden
| | - Lei Zhao
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Eric Sadou
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | - Jacques Bouaud
- AP-HP, Delegation for Clinical Research and Innovation, Paris, France
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | - Lamine Traore
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | - Alper Teoman
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | | | - George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | | | | | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Malte von Tottleben
- empirica Gesellschaft fÜr Kommunikations- und Technologieforschung mbH, Bonn, Germany
| | | | | | - Gunnar O. Klein
- Örebro University School of Business, Informatics, Örebro, Sweden
| | - Dipak Kalra
- European Institute for Innovation through Health Data, Belgium
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12
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Sanei-Moghaddam A, Goughnour S, Edwards R, Comerci J, Kelley J, Donnellan N, Linkov F, Mansuria S. Hysterectomy Pathway as the Global Engine of Practice Change: Implications for Value in Care. Cent Asian J Glob Health 2017; 6:299. [PMID: 29138742 DOI: 10.5195/cajgh.2017.299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction In 2012, University of Pittsburgh Medical Center (UPMC) introduced a hysterectomy clinical pathway to reduce the number of total abdominal hysterectomies performed for benign gynecological indications. This study focused on exploring physician and patient factors impacting the utilization of hysterectomy clinical pathways. Methods An online survey with 24 questions was implemented to explore physicians' attitudes and perceived barriers toward implementing the pathway. A survey consisting of 27 questions was developed for patients to determine the utility of a pathway-based educational tool for making surgery decisions and to measure satisfaction with the information provided. Descriptive statistics were used to describe survey results, while thematic analysis was performed on verbal feedback submitted by respondents. Results Physician respondents found the clinical pathway to be practical, beneficial to patients, and up-to-date with the latest evidence-based literature. Key barriers to the use of the pathway that were identified by physicians included perceived waste of time, inappropriateness for some of the patient groups, improper incentive structure, and excessive bureaucracy surrounding the process. Overall, patient respondents were satisfied with the tool and found it to be helpful with the decision-making process of choosing a hysterectomy route. Conclusions Physicians and patients found the developed tools to be practical and beneficial. Findings of this study will help to use pathways as a unifying framework to shape future care of patients needing hysterectomy and add value to their care.
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Affiliation(s)
- Amin Sanei-Moghaddam
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences
| | - Sharon Goughnour
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences
| | - Robert Edwards
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital
| | - John Comerci
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital
| | - Joseph Kelley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital
| | - Nicole Donnellan
- Divisions of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital
| | - Faina Linkov
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences
| | - Suketu Mansuria
- Divisions of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital
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13
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Aakre CA, Kitson JE, Li M, Herasevich V. Iterative User Interface Design for Automated Sequential Organ Failure Assessment Score Calculator in Sepsis Detection. JMIR Hum Factors 2017; 4:e14. [PMID: 28526675 PMCID: PMC5454218 DOI: 10.2196/humanfactors.7567] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 12/29/2022] Open
Abstract
Background The new sepsis definition has increased the need for frequent sequential organ failure assessment (SOFA) score recalculation and the clerical burden of information retrieval makes this score ideal for automated calculation. Objective The aim of this study was to (1) estimate the clerical workload of manual SOFA score calculation through a time-motion analysis and (2) describe a user-centered design process for an electronic medical record (EMR) integrated, automated SOFA score calculator with subsequent usability evaluation study. Methods First, we performed a time-motion analysis by recording time-to-task-completion for the manual calculation of 35 baseline and 35 current SOFA scores by 14 internal medicine residents over a 2-month period. Next, we used an agile development process to create a user interface for a previously developed automated SOFA score calculator. The final user interface usability was evaluated by clinician end users with the Computer Systems Usability Questionnaire. Results The overall mean (standard deviation, SD) time-to-complete manual SOFA score calculation time was 61.6 s (33). Among the 24% (12/50) usability survey respondents, our user-centered user interface design process resulted in >75% favorability of survey items in the domains of system usability, information quality, and interface quality. Conclusions Early stakeholder engagement in our agile design process resulted in a user interface for an automated SOFA score calculator that reduced clinician workload and met clinicians’ needs at the point of care. Emerging interoperable platforms may facilitate dissemination of similarly useful clinical score calculators and decision support algorithms as “apps.” A user-centered design process and usability evaluation should be considered during creation of these tools.
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Affiliation(s)
- Christopher Ansel Aakre
- Mayo Clinic, Department of Medicine, Division of General Internal Medicine, Rochester, MN, United States
| | - Jaben E Kitson
- Mayo Clinic, Department of Information Technology, Rochester, MN, United States
| | - Man Li
- Mayo Clinic, Department of Information Technology, Rochester, MN, United States
| | - Vitaly Herasevich
- Mayo Clinic, Multidisciplinary Epidemiology and Translation Research in Intensive Care (METRIC), Rochester, MN, United States.,Mayo Clinic, Department of Anesthesia and Perioperative Medicine, Rochester, MN, United States
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Abstract
Leaders in health-system pharmacy are challenged to maintain the highest quality pharmacy service at the lowest cost. Clinical pathways are evidence-based road maps that assist in reducing variations in clinical practice. Integration of clinical pathways within the electronic health record further helps to facilitate evidence-based practice. This article reviews the evolution of the clinical pathways, describes their clinical and economic impact, and identifies ways pharmacy directors can successfully implement these pathways into their institutions. Pharmacy directors can utilize their skills in this area or task clinical pharmacists to serve as members of the clinical pathway development team to further enhance patient-centered pharmacy services.
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Fernandez-Llatas C, Lizondo A, Monton E, Benedi JM, Traver V. Process Mining Methodology for Health Process Tracking Using Real-Time Indoor Location Systems. SENSORS (BASEL, SWITZERLAND) 2015; 15:29821-40. [PMID: 26633395 PMCID: PMC4721690 DOI: 10.3390/s151229769] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 11/18/2022]
Abstract
The definition of efficient and accurate health processes in hospitals is crucial for ensuring an adequate quality of service. Knowing and improving the behavior of the surgical processes in a hospital can improve the number of patients that can be operated on using the same resources. However, the measure of this process is usually made in an obtrusive way, forcing nurses to get information and time data, affecting the proper process and generating inaccurate data due to human errors during the stressful journey of health staff in the operating theater. The use of indoor location systems can take time information about the process in an unobtrusive way, freeing nurses, allowing them to engage in purely welfare work. However, it is necessary to present these data in a understandable way for health professionals, who cannot deal with large amounts of historical localization log data. The use of process mining techniques can deal with this problem, offering an easily understandable view of the process. In this paper, we present a tool and a process mining-based methodology that, using indoor location systems, enables health staff not only to represent the process, but to know precise information about the deployment of the process in an unobtrusive and transparent way. We have successfully tested this tool in a real surgical area with 3613 patients during February, March and April of 2015.
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Affiliation(s)
- Carlos Fernandez-Llatas
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera S/N, Valencia 46022, Spain.
- Unidad Mixta de Reingeniería de Procesos Sociosanitarios (eRPSS), Instituto de Investigación Sanitaria del Hospital Universitario y Politecnico La Fe, Bulevar Sur S/N, Valencia 46026, Spain.
| | - Aroa Lizondo
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera S/N, Valencia 46022, Spain.
| | - Eduardo Monton
- My Sphera S.L. Ronda Auguste y Louis Lumiere 23, Nave 13, Parque Tecnologico, Paterna 46980, Spain.
| | - Jose-Miguel Benedi
- Pattern Recognition and Human Language Technology (PRHTL), Universitat Politecnica de Valencia, Camino de Vera S/N, Valencia 46022, Spain.
| | - Vicente Traver
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera S/N, Valencia 46022, Spain.
- Unidad Mixta de Reingeniería de Procesos Sociosanitarios (eRPSS), Instituto de Investigación Sanitaria del Hospital Universitario y Politecnico La Fe, Bulevar Sur S/N, Valencia 46026, Spain.
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16
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Huang Z, Dong W, Ji L, Yin L, Duan H. On local anomaly detection and analysis for clinical pathways. Artif Intell Med 2015; 65:167-77. [PMID: 26375885 DOI: 10.1016/j.artmed.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 07/02/2015] [Accepted: 09/02/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Anomaly detection, as an imperative task for clinical pathway (CP) analysis and improvement, can provide useful and actionable knowledge of interest to clinical experts to be potentially exploited. Existing studies mainly focused on the detection of global anomalous inpatient traces of CPs using the similarity measures in a structured manner, which brings order in the chaos of CPs, may decline the accuracy of similarity measure between inpatient traces, and may distort the efficiency of anomaly detection. In addition, local anomalies that exist in some subsegments of events or behaviors in inpatient traces are easily overlooked by existing approaches since they are designed for detecting global or large anomalies. METHOD In this study, we employ a probabilistic topic model to discover underlying treatment patterns, and assume any significant unexplainable deviations from the normal behaviors surmised by the derived patterns are strongly correlated with anomalous behaviours. In this way, we can figure out the detailed local abnormal behaviors and the associations between these anomalies such that diagnostic information on local anomalies can be provided. RESULTS The proposed approach is evaluated via a clinical data-set, including 2954 unstable angina patient traces and 483,349 clinical events, extracted from a Chinese hospital. Using the proposed method, local anomalies are detected from the log. In addition, the identified associations between the detected local anomalies are derived from the log, which lead to clinical concern on the reason resulting in these anomalies in CPs. The correctness of the proposed approach has been evaluated by three experience cardiologists of the hospital. For four types of local anomalies (i.e., unexpected events, early events, delay events, and absent events), the proposed approach achieves 94%, 71% 77%, and 93.2% in terms of recall. This is quite remarkable as we do not use a prior knowledge. CONCLUSION Substantial experimental results show that the proposed approach can effectively detect local anomalies in CPs, and also provide diagnostic information on the detected anomalies in an informative manner.
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Affiliation(s)
- Zhengxing Huang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqing Building 510, Zheda Road 38#, 310008 Hangzhou, Zhejiang, China.
| | - Wei Dong
- Department of Cardiology, Chinese PLA General Hospital, Fuxing Road 28#, 100853 Beijing, China
| | - Lei Ji
- IT Department, Chinese PLA General Hospital, Fuxing Road 28#, 100853 Beijing, China
| | - Liangying Yin
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqing Building 510, Zheda Road 38#, 310008 Hangzhou, Zhejiang, China
| | - Huilong Duan
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqing Building 510, Zheda Road 38#, 310008 Hangzhou, Zhejiang, China
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17
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Yoo S, Cho M, Kim S, Kim E, Park SM, Kim K, Hwang H, Song M. Conformance Analysis of Clinical Pathway Using Electronic Health Record Data. Healthc Inform Res 2015; 21:161-6. [PMID: 26279952 PMCID: PMC4532840 DOI: 10.4258/hir.2015.21.3.161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 01/22/2023] Open
Abstract
Objectives The objective of this study was to confirm the conformance rate of the actual usage of the clinical pathway (CP) using Electronic Health Record (EHR) log data in a tertiary general university hospital to improve the CP by reflecting real-world care processes. Methods We analyzed the application and matching rates of clinicians' orders with predefined CP order sets based on data from 164 inpatients who received appendectomies out of all patients who were hospitalized from August 2013 to June 2014. We collected EHR log data on patient information, medication orders, operation performed, diagnosis, transfer, and CP order sets. The data were statistically analyzed. Results The average value of the actual application rate of the prescribed CP order ranged from 0.75 to 0.89. The application rate decreased when the order date was factored in along with the order code and type. Among CP pre-operation, intra-operation, post-operation, routine, and discharge orders, orders pertaining to operations had higher application rates than other types of orders. Routine orders and discharge orders had lower application rates. Conclusions This analysis of the application and matching rates of CP orders suggests that it is possible to improve these rates by updating the existing CP order sets for routine discharge orders to reflect data-driven evidence. This study shows that it is possible to improve the application and matching rates of the CP using EHR log data. However, further research should be performed to analyze the effects of these rates on care outcomes.
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Affiliation(s)
- Sooyoung Yoo
- Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Minsu Cho
- School of Technology Management, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Seok Kim
- Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunhye Kim
- Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Min Park
- Management Innovation Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Hwang
- Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Minseok Song
- School of Technology Management, Ulsan National Institute of Science and Technology, Ulsan, Korea
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18
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Huang Z, Juarez JM, Dong W, Ji L, Duan H. Predictive Monitoring of Local Anomalies in Clinical Treatment Processes. Artif Intell Med 2015. [DOI: 10.1007/978-3-319-19551-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Huang Z, Dong W, Bath P, Ji L, Duan H. On mining latent treatment patterns from electronic medical records. Data Min Knowl Discov 2014. [DOI: 10.1007/s10618-014-0381-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Huang Z, Dong W, Ji L, Gan C, Lu X, Duan H. Discovery of clinical pathway patterns from event logs using probabilistic topic models. J Biomed Inform 2013; 47:39-57. [PMID: 24076435 DOI: 10.1016/j.jbi.2013.09.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/05/2013] [Accepted: 09/07/2013] [Indexed: 11/30/2022]
Abstract
Discovery of clinical pathway (CP) patterns has experienced increased attention over the years due to its importance for revealing the structure, semantics and dynamics of CPs, and to its usefulness for providing clinicians with explicit knowledge which can be directly used to guide treatment activities of individual patients. Generally, discovery of CP patterns is a challenging task as treatment behaviors in CPs often have a large variability depending on factors such as time, location and patient individual. Based on the assumption that CP patterns can be derived from clinical event logs which usually record various treatment activities in CP executions, this study proposes a novel approach to CP pattern discovery by modeling CPs using mixtures of an extension to the Latent Dirichlet Allocation family that jointly models various treatment activities and their occurring time stamps in CPs. Clinical case studies are performed to evaluate the proposed approach via real-world data sets recording typical treatment behaviors in patient careflow. The obtained results demonstrate the suitability of the proposed approach for CP pattern discovery, and indicate the promise in research efforts related to CP analysis and optimization.
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Affiliation(s)
- Zhengxing Huang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqing Building 510, Zheda Road 38#, Hangzhou, Zhejiang 310008, China
| | - Wei Dong
- Department of Cardiology, Chinese PLA General Hospital, China
| | - Lei Ji
- IT Department, Chinese PLA General Hospital, China
| | - Chenxi Gan
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqing Building 510, Zheda Road 38#, Hangzhou, Zhejiang 310008, China
| | - Xudong Lu
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqing Building 510, Zheda Road 38#, Hangzhou, Zhejiang 310008, China
| | - Huilong Duan
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqing Building 510, Zheda Road 38#, Hangzhou, Zhejiang 310008, China.
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21
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Du G, Jiang Z, Yao Y, Diao X. Clinical Pathways Scheduling Using Hybrid Genetic Algorithm. J Med Syst 2013; 37:9945. [DOI: 10.1007/s10916-013-9945-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/25/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Gang Du
- Business School, East China Normal University, 500 Dong Chuan Road, Shanghai, 200241, China,
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22
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Creating personalised clinical pathways by semantic interoperability with electronic health records. Artif Intell Med 2013; 58:81-9. [PMID: 23466439 DOI: 10.1016/j.artmed.2013.02.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is a growing realisation that clinical pathways (CPs) are vital for improving the treatment quality of healthcare organisations. However, treatment personalisation is one of the main challenges when implementing CPs, and the inadequate dynamic adaptability restricts the practicality of CPs. The purpose of this study is to improve the practicality of CPs using semantic interoperability between knowledge-based CPs and semantic electronic health records (EHRs). METHODS Simple protocol and resource description framework query language is used to gather patient information from semantic EHRs. The gathered patient information is entered into the CP ontology represented by web ontology language. Then, after reasoning over rules described by semantic web rule language in the Jena semantic framework, we adjust the standardised CPs to meet different patients' practical needs. RESULTS A CP for acute appendicitis is used as an example to illustrate how to achieve CP customisation based on the semantic interoperability between knowledge-based CPs and semantic EHRs. A personalised care plan is generated by comprehensively analysing the patient's personal allergy history and past medical history, which are stored in semantic EHRs. Additionally, by monitoring the patient's clinical information, an exception is recorded and handled during CP execution. According to execution results of the actual example, the solutions we present are shown to be technically feasible. CONCLUSION This study contributes towards improving the clinical personalised practicality of standardised CPs. In addition, this study establishes the foundation for future work on the research and development of an independent CP system.
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Huang Z, Lu X, Duan H. Latent Treatment Pattern Discovery for Clinical Processes. J Med Syst 2013; 37:9915. [DOI: 10.1007/s10916-012-9915-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 12/29/2012] [Indexed: 11/29/2022]
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Huang Z, Lu X, Duan H, Fan W. Summarizing clinical pathways from event logs. J Biomed Inform 2012; 46:111-27. [PMID: 23085455 DOI: 10.1016/j.jbi.2012.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 10/04/2012] [Accepted: 10/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Clinical pathway analysis, as a pivotal issue in ensuring specialized, standardized, normalized and sophisticated therapy procedures, is receiving increasing attention in the field of medical informatics. Research in clinical pathway analysis has so far mostly focused on looking at aggregated data seen from an external perspective, and only provide very limited insight into the pathways. In some recent work, process mining techniques have been studied in discovering clinical pathway models from data. While it is interesting, discovered models may provide too much detail to give a comprehensive summary of the pathway. Moreover, the number of patterns discovered can be large. Alternatively, this article presents a new approach to build a concise and comprehensive summary that describes the entire structure of a clinical pathway, while revealing essential/critical medical behaviors in specific time intervals over the whole time period of the pathway. METHODS The presented approach summarizes a clinical pathway from the collected clinical event log, which regularly records all kinds of patient therapy and treatment activities in clinical workflow by various hospital information systems. The proposed approach formally defines the clinical pathway summarization problem as an optimization problem that can be solved in polynomial time by using a dynamic-programming algorithm. More specifically, given an input event log, the presented approach summarizes the pathway by segmenting the observed time period of the pathway into continuous and overlapping time intervals, and discovering frequent medical behavior patterns in each specific time interval from the log. RESULTS The proposed approach is evaluated via real-world data-sets, which are extracted from Zhejiang Huzhou Central hospital of China with regard to four specific diseases, i.e., bronchial lung cancer, colon cancer, gastric cancer, and cerebral infarction, in two years (2007.08-2009.09). Although the medical behaviors contained in these logs are very diverse and heterogeneous, experimental results indicates that the presented approach is feasible to construct condensed clinical pathway summaries in polynomial time from the collected logs, and have a linear scalability against the increasing size of the logs. CONCLUSION Experiments on real data-sets illustrate that the presented approach is efficient and discovers high-quality results: the observed time period of a clinical pathway is correctly segmented into a set of continuous and overlapping time intervals, in which essential/critical medical behaviors are well discovered from the event log to form the backbone of a clinical pathway. The experimental results indicate that the generated clinical pathway summary not only reveals the global structure of a pathway, but also provides a thorough understanding of the way in which actual medical behaviors are practiced in specific time intervals, which might be essential from the perspectives of clinical pathway analysis and improvement.
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Affiliation(s)
- Zhengxing Huang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang 310008, China.
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25
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Yang X, Han R, Guo Y, Bradley J, Cox B, Dickinson R, Kitney R. Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA. BMC Bioinformatics 2012; 13 Suppl 14:S4. [PMID: 23095226 PMCID: PMC3439723 DOI: 10.1186/1471-2105-13-s14-s4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Hospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways. Method Given this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed. Results A typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation. Conclusions ICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting hospitals to effectively manage time and resources in clinical pathway.
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Affiliation(s)
- Xian Yang
- Department of Computing, Imperial College London, London, SW7 2AZ, UK
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Lu X, Huang Z, Duan H. Supporting adaptive clinical treatment processes through recommendations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 107:413-424. [PMID: 21255860 DOI: 10.1016/j.cmpb.2010.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/06/2010] [Accepted: 12/06/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Efficient clinical treatment processes is considered a key factor of medical quality control. Current IT solutions are far away from this perspective since they typically have difficulty supporting the variances occurring in clinical practices, and providing adequate flexible support of clinical processes. METHODS This paper proposes a hybrid approach based on rough set theory and case-based reasoning to allow physicians to rapidly adjust patients' treatment processes to changes of patients' clinical states. In detail, the proposed approach recommends appropriate treatment plans in clinical process execution by adopting a similarity measure to select appropriate clinical treatment plans executed on patients who presented similar features to the current one. Such clinical treatment plans are then applied to suggest which actions to perform next in clinical treatment process execution. RESULTS As a motivating scenario, this study performs the experiments of type 2 diabetes patient's treatment process. The results show that the proposed approach is feasible to recommend suitable clinical treatment plans in clinical process execution, which makes adaptive clinical treatment processes possible.
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Affiliation(s)
- Xudong Lu
- College of Biomedical Engineering and Instrument Science of Zhejiang University, The Key Laboratory of Biomedical Engineering, Ministry of Education, China
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Huang Z, Lu X, Duan H. On mining clinical pathway patterns from medical behaviors. Artif Intell Med 2012; 56:35-50. [PMID: 22809825 DOI: 10.1016/j.artmed.2012.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 05/21/2012] [Accepted: 06/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Clinical pathway analysis, as a pivotal issue in ensuring specialized, standardized, normalized and sophisticated therapy procedures, is receiving increasing attention in the field of medical informatics. Clinical pathway pattern mining is one of the most important components of clinical pathway analysis and aims to discover which medical behaviors are essential/critical for clinical pathways, and also where temporal orders of these medical behaviors are quantified with numerical bounds. Even though existing clinical pathway pattern mining techniques can tell us which medical behaviors are frequently performed and in which order, they seldom precisely provide quantified temporal order information of critical medical behaviors in clinical pathways. METHODS This study adopts process mining to analyze clinical pathways. The key contribution of the paper is to develop a new process mining approach to find a set of clinical pathway patterns given a specific clinical workflow log and minimum support threshold. The proposed approach not only discovers which critical medical behaviors are performed and in which order, but also provides comprehensive knowledge about quantified temporal orders of medical behaviors in clinical pathways. RESULTS The proposed approach is evaluated via real-world data-sets, which are extracted from Zhejiang Huzhou Central hospital of China with regard to six specific diseases, i.e., bronchial lung cancer, gastric cancer, cerebral hemorrhage, breast cancer, infarction, and colon cancer, in two years (2007.08-2009.09). As compared to the general sequence pattern mining algorithm, the proposed approach consumes less processing time, generates quite a smaller number of clinical pathway patterns, and has a linear scalability in terms of execution time against the increasing size of data sets. CONCLUSION The experimental results indicate the applicability of the proposed approach, based on which it is possible to discover clinical pathway patterns that can cover most frequent medical behaviors that are most regularly encountered in clinical practice. Therefore, it holds significant promise in research efforts related to the analysis of clinical pathways.
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Affiliation(s)
- Zhengxing Huang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhou Yiqin building 510, Zheda road 38#, Hangzhou, 310008 Zhejiang, China
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Yamamoto K, Yamanaka K, Hatano E, Sumi E, Ishii T, Taura K, Iguchi K, Teramukai S, Yokode M, Uemoto S, Fukushima M. An eClinical trial system for cancer that integrates with clinical pathways and electronic medical records. Clin Trials 2012; 9:408-17. [PMID: 22605791 DOI: 10.1177/1740774512445912] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Various information technologies currently are used to improve the efficiency of clinical trials. However, electronic medical records (EMRs) are not yet linked to the electronic data capture (EDC) system. Therefore, the data must be extracted from medical records and transcribed to the EDC system. Clinical pathways are planned process patterns that are used in routine clinical practice and are easily applicable to the medical care and evaluation defined in a trial protocol. However, few clinical pathways are intended to increase the efficiency of clinical trials. PURPOSE Our purpose is to describe the design and development of a new clinical trial process model that enables the primary use of EMRs in clinical trials by integrating clinical pathways and EMRs. METHODS We designed a new clinical trial model that uses EMR data directly in clinical trials and developed a system to follow this model. We applied the system to an investigator-initiated clinical trial and examined whether all data were extracted correctly. At the protocol development stage, our model measures endpoints based on clinical pathways with the same diagnosis. Next, medical record descriptions and the format of the statistical data are defined. According to these observations, screens for entry of data, which are used both in clinical practice and for study, are prepared into EMRs with an EMR template, and screens are prepared for data checks on our EMR retrieval system (ERS). In an actual trial, patients are registered and randomly assigned to a protocol treatment. The protocol treatment is executed according to clinical pathways, and the data are recorded to EMRs using EMR templates. The data are checked by a local data manager using reports created by the ERS. After edit checks and corrections, the data are extracted by the ERS, archived in portable document format (PDF) with an electronic signature, and transferred in comma-separated values (CSV) format to a coordinating centre. At the coordinating centre, the data are checked, integrated, and made available for a statistical analysis. RESULTS We verified that the data could be extracted correctly and found no unexpected problems. LIMITATION To execute clinical trials in our system, the EMR template and efficient ERSs are required. Additionally, to execute multi-institutional clinical trials, it is necessary to create templates appropriate for EMRs at all participating sites and for the coordinating centre to validate local templates and procedures. CONCLUSION We proposed and pilot tested a new eClinical trial model. Because our model is integrated with routine documentation of clinical practice and clinical trials, redundant data entries were avoided and the burden on the investigator was minimised. The reengineering of the clinical trial process would facilitate the establishment of evidence in the future.
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Affiliation(s)
- Keiichi Yamamoto
- Department of Clinical Trial Design and Management, Translational Research Centre, Kyoto University Hospital, Kyoto, Japan.
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Gooch P, Roudsari A. Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems. J Am Med Inform Assoc 2011; 18:738-48. [PMID: 21724740 PMCID: PMC3197986 DOI: 10.1136/amiajnl-2010-000033] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 05/27/2011] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. METHODS A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation 'challenge' themes. RESULTS One hundred and eight relevant studies were selected for review. Twenty-five underlying 'challenge' themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. DISCUSSION AND CONCLUSION We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings.
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Affiliation(s)
- Phil Gooch
- Centre for Health Informatics, School of Informatics, City University London, London, UK.
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Lyng K, Pedersen B. Participatory design for computerization of clinical practice guidelines. J Biomed Inform 2011; 44:909-18. [DOI: 10.1016/j.jbi.2011.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 05/03/2011] [Accepted: 05/15/2011] [Indexed: 01/22/2023]
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Kerr D. Commentaries. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Kerr
- School of Health Sciences, University of Ulster, Newtonabbey, County Antrim, Northern Ireland
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Huang Z, Lu X, Duan H. Using recommendation to support adaptive clinical pathways. J Med Syst 2011; 36:1849-60. [PMID: 21207121 DOI: 10.1007/s10916-010-9644-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 12/19/2010] [Indexed: 11/28/2022]
Abstract
Clinical pathways are among the main tools used to manage the quality in health-care concerning the standardization of care processes. This paper deals with a recommendation service to support adaptive clinical pathways. The proposed approach can guide physicians in clinical pathways by providing recommendations on possible next steps based on the measurement of the target patient status and medical knowledge from completed clinical cases. The efficiency and usability of the proposed method is validated by experiments referring to a real data set extracted from Electronic Patient Records. The experimental results indicate that the recommendation service can provide its users with advice rationales that remain consistent even when patient status has changed. This makes adaptive clinical pathways possible.
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Affiliation(s)
- Zhengxing Huang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, People's Republic of China.
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Schuld J, Schäfer T, Nickel S, Jacob P, Schilling MK, Richter S. Impact of IT-supported clinical pathways on medical staff satisfaction. A prospective longitudinal cohort study. Int J Med Inform 2010; 80:151-6. [PMID: 21115391 DOI: 10.1016/j.ijmedinf.2010.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 10/08/2010] [Accepted: 10/09/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Clinical pathways (CPs) have been evaluated with regard to process optimization, economic effects, quality of care, patient satisfaction and staff satisfaction. IT- (information technology) supported CPs, integrated within the HIS (hospital information system), have been implemented in our department in 2004 for the first time world-wide. Herein, we describe the effect of this new concept on medical staff satisfaction. METHODS A prospective anonymous and voluntary survey with standardized questionnaires was performed annually from 2006 until 2009 evaluating staff satisfaction concerning CPs. Questions comprised satisfaction with the software, staff's attitude towards CPs and the impact of CPs on work-related processes. RESULTS Within the observation period the term "clinical pathways" became more common among doctors and nurses. Knowledge of the aims of CPs increased significantly in nursing staff (43.4-74.5%), whereas doctor's knowledge was on a constant high level. Standardization, process facilitation and cost effectiveness were the most claimed goals of CPs. Comprehensibility of the single steps within CPs was on a constant high level over the observation period. Generally, graphical layout and usability of CPs ranged on a very high satisfaction level. Acceptability of IT-supported CPs is independent from staffs computer knowledge. CONCLUSIONS Staff satisfaction with IT-supported CPs needs to take into account the job characteristics of the different professional groups. IT-supported CPs are leading to a high staff satisfaction, the aims of CPs are widely understood by medical employees. IT-supported CPs may ameliorate staff satisfaction and thereby enhance workflow efficiencies.
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Affiliation(s)
- Jochen Schuld
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University Hospital of the Saarland, 66421 Homburg/Saar, Germany
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Alexandrou DA, Skitsas IE, Mentzas GN. A holistic environment for the design and execution of self-adaptive clinical pathways. ACTA ACUST UNITED AC 2010; 15:108-18. [PMID: 20876028 DOI: 10.1109/titb.2010.2074205] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
One of the main challenges to be confronted by modern health care, so as to increase treatment quality, is the personalization of treatment. The treatment personalization requires the continuous reconfiguration and adaptation of the selected treatment schemes according to the "current" clinical status of each patient and "current" circumstances inside a health care organization that change rapidly, as well as the updated medical knowledge. In this paper, we present an innovative software environment that provides an integrated IT solution concerning the adaptation of health care processes (clinical pathways) during execution time. The software comprises a health care process execution engine assisted by a semantic infrastructure for reconfiguring the clinical pathways. During the execution of clinical pathways, the system reasons over the rules and reconfigures the next steps of the treatment. A graphical designer interface is implemented for the definition of the rule-set for the clinical pathways adaptation in a user-friendly way.
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Evans-Lacko S, Jarrett M, McCrone P, Thornicroft G. Facilitators and barriers to implementing clinical care pathways. BMC Health Serv Res 2010; 10:182. [PMID: 20584273 PMCID: PMC2912894 DOI: 10.1186/1472-6963-10-182] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 06/28/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The promotion of care pathways in the recent Governmental health policy reports of Lord Darzi is likely to increase efforts to promote the use of care pathways in the NHS. Evidence on the process of pathway implementation, however, is sparse and variations in how organisations go about the implementation process are likely to be large. This paper summarises what is known about factors which help or hinder clinicians in adopting and putting care pathways into practice, and which consequently promote or hinder the implementation of scientific evidence in clinical practice. DISCUSSION Care pathways can provide patients with clear expectations of their care, provide a means of measuring patient's progress, promote teamwork on a multi-disciplinary team, facilitate the use of guidelines, and may act as a basis for a payment system. In order to achieve adequate implementation, however, facilitators and barriers must be considered, planned for, and incorporated directly into the pathway with full engagement among clinical and management staff. Barriers and/or facilitators may be present at each stage of development, implementation and evaluation; and, barriers at any stage can impede successful implementation. Important considerations to be made are ensuring the inclusion of all types of staff, plans for evaluating and incorporating continuous improvements, allowing for organisational adaptations and promoting the use of multifaceted interventions. SUMMARY Although there is a dearth of information regarding the successful implementation of care pathways, evidence is available which may be applied when implementing a care pathway. Multifaceted interventions which incorporate all staff and facilitate organisational adaptations must be seriously considered and incorporated alongside care pathways in a continuous manner. In order to better understand the mechanism upon which care pathways are effective, however, more research specifically addressing conditions under which providers become engaged in using care pathways is needed.
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Affiliation(s)
- Sara Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Manuela Jarrett
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Paul McCrone
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Wakamiya S, Yamauchi K. What are the standard functions of electronic clinical pathways? Int J Med Inform 2009; 78:543-50. [PMID: 19345608 DOI: 10.1016/j.ijmedinf.2009.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 08/11/2008] [Accepted: 03/04/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The present study was performed to determine the standard functions of electronic clinical pathways (eCP) embedded in electronic medical records with regard to demand definition. METHODS The standard functions of eCP were decided by the required functions determined from interviews with hospital staff, those derived from the implementation of paper-based clinical pathways (CPs), and additional functions generated through the shift from a paper-based to an electronic system. Moreover, the proposed standard functions and those of eCP embedded in electronic medical records for large hospitals were compared by interviews with five vendors. RESULTS Seventeen functions were deemed necessary for eCP, and these were classified into six categories: displaying, recording, ordering, editing, variance, and statistics. Although most of these functions are already included in eCP products, their implementations differ between products. CONCLUSIONS We propose 17 standard functions required for eCP embedded in electronic medical records. The functions for editing patient checklists, checking the occurrence of variance, and statistics are especially important and should be implemented as standard functions. This study will aid in the future development of eCP embedded in electronic medical records.
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Affiliation(s)
- Shunji Wakamiya
- Department of Ophthalmology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan.
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Computer-based execution of clinical guidelines: a review. Int J Med Inform 2008; 77:787-808. [PMID: 18639485 DOI: 10.1016/j.ijmedinf.2008.05.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 05/28/2008] [Accepted: 05/29/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE Clinical guidelines are useful tools to standardize and improve health care. The automation of the guideline execution process is a basic step towards its widespread use in medical centres. This paper presents an analysis and a comparison of eight systems that allow the enactment of clinical guidelines in a (semi) automatic fashion. METHODS This paper presents a review of the literature (2000-2007) collected from medical databases as well as international conferences in the medical informatics area. RESULTS Eight systems containing a guideline execution engine were selected. The language used to represent the guidelines as well as the architecture of these systems were compared. Different aspects have been assessed for each system, such as the integration with external elements or the coordination mechanisms used in the execution of clinical guidelines. Security and terminology issues complement the above study. CONCLUSIONS Although these systems could be beneficial for clinicians and patients, it is an ongoing research area, and they are not yet fully implemented and integrated into existing careflow management systems and hence used in daily practice in health care institutions.
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