Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

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. 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. 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. 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

Supporting physicians and patients through recommendation: Guidelines and beyond

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Healthcare Process Support: Achievements, Challenges, Current Research

Healthcare organizations are facing the challenge of delivering high-quality services to their patients at affordable costs. To tackle this challenge, the Medical Informatics community targets at formalisms for developing decision-support systems (DSSs) based on clinical guidelines. At the same time, business process management (BPM) enables IT support for healthcare processes, e.g., based on workflow technology. By integrating aspects from these two fields, promising perspectives for achieving better healthcare process support arise. The perspectives and limitations of IT support for healthcare processes provided the focus of three Workshops on Process-oriented Information Systems (ProHealth). These were held in conjunction with the International Conference on Business Process Management in 2007-2009. The ProHealth workshops provided a forum wherein challenges, paradigms, and tools for optimized process support in healthcare were debated. Following the success of these workshops, this special issue on process support in healthcare provides extended papers by research groups who contributed multiple times to the ProHealth workshop series. These works address issues pertaining to healthcare process modeling, process-aware healthcare information system, workflow management in healthcare, IT support for guideline implementation and medical decision support, flexibility in healthcare processes, process interoperability in healthcare and healthcare standards, clinical semantics of healthcare processes, healthcare process patterns, best practices for designing healthcare processes, and healthcare process validation, verification, and evaluation

Decentralised Clinical Guidelines Modelling with Lightweight Coordination Calculus

Background: Clinical protocols and guidelines have been considered as a major means to ensure that cost-effective services are provided at the point of care. Recently, the computerisation of clinical guidelines has attracted extensive research interest. Many languages and frameworks have been developed. Thus far, however,an enactment mechanism to facilitate decentralised guideline execution has been a largely neglected line of research. It is our contention that decentralisation is essential to maintain a high-performance system in pervasive health care scenarios. In this paper, we propose the use of Lightweight Coordination Calculus (LCC) as a feasible solution. LCC is a light-weight and executable process calculus that has been used successfully in multi-agent systems, peer-to-peer (p2p) computer networks, etc. In light of an envisaged pervasive health care scenario, LCC, which represents clinical protocols and guidelines as message-based interaction models, allows information exchange among software agents distributed across different departments and/or hospitals. Results: We outlined the syntax and semantics of LCC; proposed a list of refined criteria against which the appropriateness of candidate clinical guideline modelling languages are evaluated; and presented two LCC interaction models of real life clinical guidelines. Conclusions: We demonstrated that LCC is particularly useful in modelling clinical guidelines. It specifies the exact partition of a workflow of events or tasks that should be observed by multiple "players" as well as the interactions among these "players". LCC presents the strength of both process calculi and Horn clauses pair of which can provide a close resemblance of logic programming and the flexibility of practical implementation

Representing temporal patterns in computer-interpretable clinical Guidelines

Computer-interpretable Guidelines (CIGs) as machine-readable versions of clinical protocols have to provide appropriate constructs for the representation of different aspects of medical knowledge, namely administrative information, workflows of procedures, clinical constraints and temporal constraints. This work focuses on the latter, by aiming to develop a comprehensive representation of temporal constraints for machine readable formats of clinical protocols and provide a proper execution engine that deals with different time patterns and constraints placed on them. A model for the representation of time is presented for the CompGuide ontology in Ontology Web language (OWL) along with a comparison with the available formalisms in this field.This work is part-funded by ERDF - European Regional Development Fund through the COMPETE Programme (operational programme for competitiveness) and by National Funds through the FCT - Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project FCOMP-01-0124-FEDER-028980 and project Scope UID/CEC/00319/2013.The work of Tiago Oliveira is supported by a FCT grant with the reference SFRH/BD/85291/2012.info:eu-repo/semantics/publishedVersio

The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions : a review

Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each managing a separate condition, which often results in instructions that may interact with each other, such as conflicts in medication. Furthermore, the impetus to deliver customised care based on patient-specific information, results in the need to be able to offer guidelines in an integrated manner, identifying and managing their interactions. In recent years, CPGs have been formatted as computer-interpretable guidelines (CIGs). This enables developing CIG-driven clinical decision support systems (CDSSs), which allow the development of IT applications that contribute to the systematic and reliable management of multiple guidelines. This study focuses on understanding the use of CIG-based CDSSs, in order to manage care complexities of patients with multimorbidity. The literature between 2011 and 2017 is reviewed, which covers: (a) the challenges and barriers in the care of multimorbid patients, (b) the role of CIGs in CDSS augmented delivery of care, and (c) the approaches to alleviating care complexities of multimorbid patients. Generating integrated care plans, detecting and resolving adverse interactions between treatments and medications, dealing with temporal constraints in care steps, supporting patient-caregiver shared decision making and maintaining the continuity of care are some of the approaches that are enabled using a CIG-based CDSS