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.