A novel framework for standardizing and digitizing clinical pathways in healthcare information systems

Abstract

Most healthcare institutions are reorganizing their healthcare delivery systems based on Clinical Pathways (CPs). CPs are medical management plans designed to standardize medical activities, reduce cost, optimize resource usage, and improve quality of service. However, most CPs are still paper-based and not fully integrated with Health Information Systems (HISs). More CP automation research is therefore required to fully benefit from the practical potentials of CPs. The common theme of current research in this field is to connect CPs with Electronic Medical Record (EMR) systems. Such view positions EMRs at the centre of HISs. A major long-term objective of this research is the placement of CP systems at the centre of HISs, because within CPs lies the very heart of medical planning, treatment and impressions, including healthcare quality and cost factors. An important contribution to the realization of this objective is to develop an international CP-specific digital coding system, and to fully standardize and digitize CPs based on the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) medical terminology system. This makes CPs digitally visible and machine-readable. In addition, to achieve semantic interoperability of CPs, we propose a CP knowledge representation using ontology engineering and HL7 standard. Our proposed framework makes CP systems smoothly linkable across various HISs. To show the feasibility and potential of the proposed framework, we developed a prototype Clinical Pathway Management System (CPMS) based on CPs currently in use at hospitals. The results show that CPs can be fully standardized and digitized using SNOMED CT terms and codes, and the CPMS can work as an independent healthcare system, performing novel CP-related functions including useful decision-support tasks. Furthermore, CP data were captured without loss, which contributes to reducing missing patient data and improving the results of data mining algorithms in healthcare. Standardized CPs can also be easily compared for auditing and quality management. The proposed framework is promising, and contributes toward solving major challenges related to CP standardization, digitization, independence, and proper inclusion in today’s modern computerized hospitals.