Abstract
Objectives: Procedural interoperability in health care requires information support and monitoring of a common work practice. Our aim was to devise an information model for a complete annotation of actions in clinical pathways that allow use of multiple plans concomitantly as several partial processes underlie any composite clinical process.Materials and Methods: The development of the information model was based on the integration of a defined protocol for clinical interoperability in the care of patients with chronic obstructive pulmonary disease and an observational study protocol for cohort characterization at the group level. In the clinical process patient reported outcome measures were included.Results: The clinical protocol and the observation study protocol were developed on the clinical level and a single plan definition was developed by merging of the protocols. The information model and a common data model that had been developed for care pathways was successfully implemented and data for the medical records and the observational study could be extracted independently. The interprofessional process support improved the communication between the stakeholders (health care professionals, clinical scientists and providers).Discussion: We successfully merged the processes and had a functionally successful pilot demonstrating a seamless appearance for the health care professionals, while at the same time it was possible to generate data that could serve quality registries and clinical research. The adopted data model was initially tested and hereby published to the public domain.Conclusion: The use of a patient centered information model and data annotation focused on the care pathway simplifies the annotation of data for different purposes and supports sharing of knowledge along the patient care path.
Highlights
The delivery of patient-centered care in the context of increasing multimorbidity and medical complexity cannot be sustained by traditional healthcare systems [1]
A key issue that we addressed is the absence of a dominant standard for care plan derived data annotation that fully utilizes the semantic potential
We give an account for the results of a methodological development and the initial practical steps to share the efforts that are necessary to technically support the change of working patterns in health care from an iterative manual approach to a planned process approach. Such processes need to be developed in order to handle the societal pressure on the health care sector to be more person oriented [33], eliminate waste [5], and to have the ability to continuously report on the quality in terms of delivered patient value according to the principles of value based health care [21]
Summary
The delivery of patient-centered care in the context of increasing multimorbidity and medical complexity cannot be sustained by traditional healthcare systems [1]. Future general health services need support for complex processes that are continuous across boundaries between providers while at the same time involving the patient [2]. The flags and triggers necessary to identify who qualifies for which care plan and/or intervention, will not be reliable; potentially subjecting individual patients to care that is not beneficial or that may be harmful [5]. Health care without tools to support standard operating procedures will function without procedural interoperability and the collected data will not have consistent semantic underpinnings. Information systems that are not designed for information interoperability cannot support procedural interoperability nor generate data suitable for quality benchmarking or clinical research
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