Zen Clinicals: A Patient Care Pathways Solution (4 of 4)

A Clinical Care Pathways Workflow & Activity Orchestration


Clinical pathways are structured multidisciplinary care plans which address specific clinical scenarios and help to standardize and coordination of care.
The patient care pathways solutions have become an important clinical guidelines implementation tools in hospital settings. They have the ability to provide, not only a standardised care to the patients’ presenting same/ similar diagnosis, but also provide the ability to handle the variance from the defined care pathways for various specialties and diagnosis.
The care pathways also provides the ability to coordinate care of a patient across various user groups and user roles, like the group of nurses across shifts and across roles like doctors, nurses and administrative staff.
The Care Pathways aim to optimize the efficiency and quality of care
The care pathways solution that we propose to develop have the following features.

Clinical Data Repository

At the heart of our Patient Care Pathways solution is a clinical data repository that maintains a longitudinal patient care record. The Patient CDR is a data warehouse of the Patient’s clinical data that has been stored in the clinical data repository to enable data analysis across the patient episodes and visits.
The Clinical Data Repository provides the ability to organically analyse data from ‘similar’ patients across same or similar set of data points like diagnosis, test results and clinical studies.
The clinical data repository converts all the data captured in various connected systems to a analysable data point for the care pathways solution. The data captured in the external system
The clinical data repository is a the heart of the care pathways solution that contains information that has been stored in standardised format using the standard healthcare coding systems like ICD10, SNOMED CT, ICD10 PCS and others as applicable in the clinical scenario.
In-built into the Clinical Data Repository are latest big data analytics capabilities that are required to generate the statistical analysis of the adherence to the quality and efficincy of the Care Pathway.
The clinical data repository has the ability to generate, out of the box, all the analytical reports and predictive modelling required for todays’ clinicians to make the right decisions at the right time.
The Clinical Data Repository allows for the following features and functionalities that are relevant to the Care Pathways solution
  1. Allows for analysing historical outcomes from clinically similar patients, e.g. patients like me type of scenario matching
  2. Display the variance and outcomes for the patient specific pathway and across various patients

Care Pathways Designer

The Care Pathways designer is a visual tool that allows the user to define the workflow of activities based on a start condition. The Start Up condition for a Care Pathway could be a Code Red alarm for quarantine or it could be a set of questions that a care provider answers to based on the patient they are treating for, for instance, chest pain.
The Care pathways designer has at its core the following:
  1. Activities
  2. Activity Groups
  3. Users
  4. User Groups
  5. Workflow Designer
Care Pathways Designer Features:
  1. The care pathways designer is a tool that allows the care pathways design team to define the standardised care templates of activities that should be scheduled for a patient presenting a chief complaint or being treated for a chronic condition.
  2. The care pathways designer has a set of pre-defined activity categories. For example, Appointment Scheduling, Laboratory Orders, Radiology Orders, Pharmacy Orders and many more. Each of the activity categories are defined based on the corresponding activity that needs to be instantiated at the host system, such as an EHR or a HIMS Solution. The Patient Care Pathways solution allows the users to define these activity categories depending on the host system.
  3. The Care Pathways Designer tool allows the users to define the workflow for the care pathways. The tool allows the user to define rules and the activities (or activity groups) that will be instantiated depending on the condition of the rule.
  4. The Care Pathways designer tool also has the ability to define various outcomes and the activities that need to be performed to achieve those outcomes.

Rules Designer

The clinical pathways designer will have a rules designer that allows the users to select the various activities and activities groups to be the outcome and action targets for a clinical rule.
For instance, if the doctor selects a certain type of schedule H drugs to be ordered for a patient and the doctor does not have the authorization to order schedule H drugs, the order will be sent to the next level of authorization within the patient care team.
The rules can be included into the care pathways designer as workflow activities and decision criteria.

User & User Group based Task Lists

The system will have a user specific task list that will inform the user on the various activities that a user (nurse, doctor, admissions and billing users) needs to perform vis-a-vis a patient. The Task list will help the user to complete the tasks that have been generated based on the various active care pathways for the various patients.
The system also has the ability to share the generated tasks between a group of care providers. This allows for the nurses taking care of the patients across the various shifts to review the tasks that have been completed or not completed during an earlier shift.

Care Pathway Dashboard

The system will have a comprehensive Care Pathway Dashboard. The dashboard will display the following:
  1. The Care Pathway adherence Index displays the variance or conformance of a care pathway when applied to multiple patients.
  2. The Care Pathway patient adherence Index, this displays the effectiveness of a care plan when applied to a specific patient.
In both the above scenarios, the care plan adherence Index will display the deviations, the variances and adherence levels to the defined care plan. It will also list out the activities that were done in addition or in variance of a defined care plan.
In addition to the variance and conformance metrics the Care Pathway Dashboards will display to the users the following:
  1. The Patient Specific Care Pathway Activity Scheduler: Displays the day by day list of all the activities that have been defined (scheduled) in a care plan. It also has the ability to showcase the activities by a shift.
  2. Care Pathway timeline: Displays the care plan timeline and recorded variance and non-conformance detection
  3. Outcomes Recording: The Care Pathway solution also allows the users to record the outcomes for each of the planned activities and the Outcomes defined for the Care Pathway.

Care Pathway Push Notifications & Alerts Center

The Care Pathway Push Notifications and Alerts center is an important part of our solution. The Care Pathway push notification system identifies the most important and high priority tasks that need to be performed for each of the patients. The users are alerted about these high priority tasks on their associated mobile devices.
The Care Pathway Push Notifications have been designed to be non-obstrusive and presented in a way the user has configured these to be delivered to them. This is done to ensure there is no alert-fatigue generated based on our notifications and alerts center.
In addition to the Push Notification for tasks to be performed on a high priority, the Care Pathways solution also has the ability to provide alerts of outstanding or upcoming, completed or activities in variance of the defined Care Pathway to relevant team members.
Each alert and push notification will be configured with a level of priority (that can be assigned to the alert type or determined by the system) and depending on the Level of Priority of that alert and notification, the system will present the alert to the user.

Additional Resources & Standards Definitions:

  1. The care pathway models in the tool are based on the following industry standards:
    1. OMG Case Management Model and Notation (CMMN), and
    2. HL7 GELLO and
    3. vMR

Care Pathway Examples:

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