Supporting integrated care pathways with workflow technology

Modern healthcare has moved to a focus on providing patient centric care rather than disease centred care. This new approach is provided by a unique care team which is formed to treat a patient. At the start of the treatment, the care team decide on the treatment pathway for the patient. This is a series of treatment stages where at the end of each stage, the care team use the patient’s current condition to decide whether the treatment moves to the next stage, continues in the treatment stage, or moves to an unanticipated stage. The initial treatment pathway for each patient is based on the clinical guidelines in an Integrated Care Pathway (ICP) [1] modified to suit the patient state. This research mapped a patient ICP decided by the healthcare providers into a Workflow Management System (WFMS) [2]. The clinical guidelines reflect the patient-centric flow to create an IT system supporting the care team. In the initial stage of the research the IT development team at Velindre Hospital identified that team communication and care coordination were obstacles hindering the implementation of a patient-centric delivery model. This was investigated to determine the causes, which were identified as difficulty in accessing the medical information held in dispersed legacy systems. Moreover, a major constraint in the domain is the need to keep legacy systems in operation and so there is a need to investigate approaches to enhance their functionalities. These information systems cannot be changed across all healthcare organisations and their complete autonomy needs to be retained as they are in constant use at the sites. Using workflow technology, an independent application representing an ICP was implemented. This was used to construct an independent layer in the software architecture to interact with legacy Clinical Information Systems (CISs) and so evolve their offered functionalities to support the teams. This was used to build a Virtual Organisation (VO) [3, 4] around a patient which facilitates patient-centric care. Moreover, the VO virtually integrates the data from legacy systems and ensures its availability (as needed) at the different treatment stages along the care pathway. Implications of the proposal include: formalising the treatment process, filtering and gathering the patient’s information, ensuring care continuity, and pro-acting to change. Evaluation of the proposal involved three stages; First, usefulness evaluation by the healthcare providers representing the users; Second, setup evaluation by developers of CISs; and Finally, technical evaluation by the community of the technology. The evaluation proved; the healthcare providers’ need for an adaptive and a proactive system, the possibility of adopting the proposed system, and the novelty and innovation of the proposed approach. The research proposes a patient-centric system achieved by creating a version of an ICP in the system for each patient. It also provides focussed support for team communication and care coordination, by identifying the treatment stages and providing the care team requirements at each stage. It utilises the data within the legacy system to be proactive. Moreover, it makes these required data for the actions available from the running legacy system which is required for patient-centred care. In the future the worth could be extended by mapping other ICPs into the system. This work has been published in four full papers. It found acceptance in the health informatics community [5, 6, 7] as well as the BPM community [8, 9]. It is also the winner of the 2011 “Global Award of Excellence in Adaptive Case Management (ACM)” in “Medical and Healthcare” [10] of the Workflow Management Coalition (WFMC) [11].