Step-Guided Clinical Workflow Fulfilment Measure for Clinical Guidelines

Abstract

Health-care quality control is a challenge that medical services and their information systems will deal with in the following years. Clinical Practice Guidelines are a structured set of recommendations for physicians to solve a medical problem. The correct fulfilment of a guideline seems to be a good indicator of health-care quality. However, the guideline fulfilment checking is an open clinical problem that requires collaborative efforts. In this sense, clinical workflows have demonstrated to be an effective approach to partially model a clinical guideline. Moreover, some efforts have been done in consistency checking and debugging management in order to obtain a correct description of the clinical processes. However, the clinical practice not always strictly fulfils clinical workflows, since patients require personalised care and unexpected situations occur. Therefore, in order to obtain a workflow fulfilment degree, it seems reasonable to compare a posteriori the evolution of the patient records and the clinical workflow, providing a flexible fulfilment measure. In this work we present a general framework to classify and study the development of these measures, and we propose a workflow fulfilment function, illustrating its suitability in the clinical domain by an example of a real medical problem.