Care Pathways

This document discusses care pathways and particularly technologies with the potential to support their development and deployment within the Connecting for Health programme of the NHS in England.

Tim Benson

Abies Ltd
93 Milespit Hill
Mill Hill Village
London, NW7 2RS, UK

2005

Commissioned by the NHS National Programme for IT (NPfIT), England (now Connecting for Health). Published on OpenClinical with permission from the NHS.

Management Summary

"Care pathways are one of the core elements of the NPfIT [now Connecting for Health - Ed.] and are needed to support the vision of consistent and personalised care, by providing patient information and evidence-based knowledge wherever and whenever it is needed, giving benefits to patients, clinicians and managers. Electronic care pathways provide a means of supporting the practice of evidence-based medicine across all disciplines, but their introduction may involve significant changes to existing processes and needs to take account of local factors.

"The terms used in discussing care pathways are defined. These terms include Guidance, Clinical Protocol and Care Pathway, as well as prefixes (uni-disciplinary, multi-disciplinary, cross-specialty and cross-sector) and suffixes (template, in use and ended).

"A care pathway in use is logically part of an identified patient record, while a care pathway template is not linked to any individual patient - it is general clinical knowledge. Care pathways and their components may be located either inside or outside an individual patient record. This implies two logical repositories – patient care record and knowledge library. User interfaces provide views into these repositories.

"This report reviews a number of tools, which have been proposed to facilitate the development of electronic care pathways. These are: PROforma, the Map of Medicine, BPMN and the HL7 Version 3 Clinical Statement Pattern.

"PROforma is a guideline specification language, developed by Cancer Research UK (CRUK), which specifies each decision in terms of any number of candidate options and the arguments for and against each candidate. Each candidate is evaluated in terms of the available evidence for and against it. Decisions are contained within plans, which may also specify actions to be done and enquiries, which obtain evidence. PROforma is a declarative language, focussing on what is or is not known about the patient, as opposed to procedural languages that focus on the sequence in which tasks are carried out. In this way PROforma reflects clinical practice. PROforma has been developed over the past 12 years and an impressive body of published evidence has been accumulated, which demonstrates its practical value. PROforma is a platform-independent language, which at present has two platform-specific implementations (InferMed’s Arezzo and CRUK’s Tallis).

"The Map of Medicine is an online clinical knowledge browser that provides desktop access to a wide range of specialist clinical information and evidence-based practice. The Map of Medicine is platformindependent and can be localised to meet local needs.

"BPMN (Business Process Modelling Notation) is a new standard for business process modelling. It is now part of the OMG (Object Management Group). It provides facilities for documenting events, such as triggers, and for decomposing processes into sub-processes and tasks.

"The HL7 Version 3 Clinical Statement Pattern is the model used for all clinical messages, including the exchange of patient records, in the NPfIT. Preliminary analysis suggests a fit between the needs of care pathways and the HL7 Clinical Statement Pattern, but this has not been demonstrated in practice and requires further work to identify issues and document recommendations. The use of these tools is illustrated using two simple examples: GP referrals for possible colo-rectal cancer, and the triple assessment process for breast cancer diagnosis."

E: tim.bensonabies.co.uk

   Complete paper [note: 2463KB]    Abies Ltd., London    Connecting for Health (formerly the National Programme for IT (NPfIT))    PROforma and Tallis technology [OC]    InferMed Ltd. and Arezzo technology [OC]    Map of Medicine [OC]    Care pathways [OC]