Difference between revisions of "Journal:Experimental application of business process management technology to manage clinical pathways: A pediatric kidney transplantation follow-up case"
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===The context=== | ===The context=== | ||
The standard business process modeling notation (BPMN) has been already used at Bambino Gesù Children’s Hospital (Rome, Italy) for a previous project, whose objective was the optimization and planning of operating theatre activities.<ref name="BarbagalloOptim15">{{cite journal |title=Optimization and planning of operating theatre activities: An original definition of pathways and process modeling |journal=BMC Medical Informatics and Decision Making |author=Barbagallo, S.; Corradi, L.; de Ville de Goyet, J. et al. |volume=15 |issue=1 |pages=38 |year=2015 |doi=10.1186/s12911-015-0161-7 |pmid=25982033 |pmc=PMC4436841}}</ref> Bambino Gesù Children’s Hospital is the largest Italian pediatric hospital managing high-complexity cases of kidney transplantation. In the hospital, transplants are performed in children with more than eight kilograms body weight. All aspects of childcare are taken into account through an integrated and multidisciplinary approach, including psychological development.<ref name="TozziQuality12">{{cite journal |title=Quality of life in a cohort of patients diagnosed with renal failure in childhood and who received renal transplant |journal=Pediatric Transplantation |author=Tozzi, A.E.; Mazzotti, E.; Di Ciommo, V.M. et al. |volume=16 |issue=8 |pages=840–5 |year=2012 |doi=10.1111/j.1399-3046.2012.01774.x |pmid=22943602}}</ref> | The standard business process modeling notation (BPMN) has been already used at Bambino Gesù Children’s Hospital (Rome, Italy) for a previous project, whose objective was the optimization and planning of operating theatre activities.<ref name="BarbagalloOptim15">{{cite journal |title=Optimization and planning of operating theatre activities: An original definition of pathways and process modeling |journal=BMC Medical Informatics and Decision Making |author=Barbagallo, S.; Corradi, L.; de Ville de Goyet, J. et al. |volume=15 |issue=1 |pages=38 |year=2015 |doi=10.1186/s12911-015-0161-7 |pmid=25982033 |pmc=PMC4436841}}</ref> Bambino Gesù Children’s Hospital is the largest Italian pediatric [[hospital]] managing high-complexity cases of kidney transplantation. In the hospital, transplants are performed in children with more than eight kilograms body weight. All aspects of childcare are taken into account through an integrated and multidisciplinary approach, including psychological development.<ref name="TozziQuality12">{{cite journal |title=Quality of life in a cohort of patients diagnosed with renal failure in childhood and who received renal transplant |journal=Pediatric Transplantation |author=Tozzi, A.E.; Mazzotti, E.; Di Ciommo, V.M. et al. |volume=16 |issue=8 |pages=840–5 |year=2012 |doi=10.1111/j.1399-3046.2012.01774.x |pmid=22943602}}</ref> | ||
During each patient admission, either in the day hospital or in the ward, a member of the transplant team has to: | |||
* search the patient data in the hospital repository (personal data, medical reports, [[laboratory]] analysis results and follow-up plan) | |||
* select only clinical data relevant for decision-making, assisted by creating for instance special filters on the results | |||
* save the data in a shared document in specific folders of the file system, following an internal coding standard for classifying [[information]] | |||
This means that for each patient at each visit, the transplant coordinator has to check which exams have already been performed and what is still to be done, and create a specific program for each patient. A patient may miss an appointment for several reasons and, in this case, another appointment has to be planned and patient lists need to be rearranged. Moreover, results are currently stored in a database which does not allow direct downloading from the hospital system. | |||
To monitor the entire pathway of a single patient, the clinical team needs to navigate the clinical repository to access all the relevant data and copy them into a shared folder, including the specific documents for kidney transplantation. | |||
Coping with the variability of the process is therefore a matter of considerable manual file manipulation, with a difficult-to-manage and error-prone information sharing practice. Currently we have a list of tests (laboratory, instrumental, specialist visits) that must be performed every year at a specific time point according to international guidelines<ref name="CohenGeneral01">{{cite journal |title=General health management and long-term care of the renal transplant recipient |journal=American Journal of Kidney Diseases |author=Cohen, D.; Galbraith, C. |volume=38 |issue=6 Suppl. 6 |pages=S10–24 |year=2001 |doi=10.1053/ajkd.2001.28922 |pmid=11729002}}</ref><ref name="AdamsLong06">{{cite journal |title=Long-term patient survival: strategies to improve overall health |journal=American Journal of Kidney Diseases |author=Adams, P.L. |volume=47 |issue=4 Suppl. 2 |pages=S65–85 |year=2006 |doi=10.1053/j.ajkd.2005.12.043 |pmid=16567242}}</ref><ref name="HowardLong06">{{cite journal |title=Long-term posttransplantation care: The expanding role of community nephrologists |journal=American Journal of Kidney Diseases |author=Howard, A.D. |volume=47 |issue=4 Suppl. 2 |pages=S111–24 |year=2006 |doi=10.1053/j.ajkd.2005.12.040 |pmid=16567237}}</ref><ref name="JosephsonMonitor11">{{cite journal |title=Monitoring and managing graft health in the kidney transplant recipient |journal=Clinical Journal of the American Society of Nephrology |author=Josephson, M.A. |volume=6 |issue=7 |pages=1774-80 |year=2011 |doi=10.2215/CJN.01230211 |pmid=21734093}}</ref><ref name="HariharanRecomm06">{{cite journal |title=Recommendations for outpatient monitoring of kidney transplant recipients |journal=American Journal of Kidney Diseases |author=Hariharan, S. |volume=47 |issue=4 Suppl. 2 |pages=S22–36 |year=2006 |doi=10.1053/j.ajkd.2005.12.046 |pmid=16567238}}</ref><ref name="KasiskeRecomm00">{{cite journal |title=Recommendations for the outpatient surveillance of renal transplant recipients |journal=Journal of the American Society of Nephrology |author=Kasiske, B.L.; Vazquez, M.A.; Harmon, W.E. et al. |volume=11 |issue=Suppl. 1 |pages=S1–86 |year=2000 |pmid=11044969}}</ref><ref name="HowardLong01">{{cite journal |title=Long-term management of the renal transplant recipient: Optimizing the relationship between the transplant center and the community nephrologist |journal=American Journal of Kidney Diseases |author=Howard, A.D. |volume=38 |issue=6 Suppl. 6 |pages=S51–7 |year=2001 |doi=10.1053/ajkd.2001.28926 |pmid=11729006}}</ref> Feeding the database is thus a time-consuming task for the transplant coordinator. | |||
==References== | ==References== | ||
Revision as of 22:42, 13 November 2017
| Full article title | Experimental application of business process management technology to manage clinical pathways: A pediatric kidney transplantation follow-up case |
|---|---|
| Journal | BMC Medical Informatics and Decision Making |
| Author(s) | Andellini, Martina; Riesgo, Sandra Fernandez; Morolli, Federica; Ritrovato, Matteo; Cosoli, Piero; Petruzzellis, Silverio; Rosso, Nicola |
| Author affiliation(s) | Bambino Gesù Children’s Hospital, Openwork Srl |
| Primary contact | Email: martina dot andellini at opbg dot net |
| Year published | 2017 |
| Volume and issue | 17 (1) |
| Page(s) | 151 |
| DOI | 10.1186/s12911-017-0546-x |
| ISSN | 1472-6947 |
| Distribution license | Creative Commons Attribution 4.0 International |
| Website | https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-017-0546-x |
| Download | https://bmcmedinformdecismak.biomedcentral.com/track/pdf/10.1186/s12911-017-0546-x (PDF) |
 |
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Abstract
Background: To test the application of business process management (BPM) technology to manage clinical pathways, using a pediatric kidney transplantation as case study, and to identify the benefits obtained from using this technology.
Methods: Using a business process management platform, we implemented a specific application to manage the clinical pathway of pediatric patients, and we monitored the activities of the coordinator in charge of case management during a six-month period (from June 2015 to November 2015) using two methodologies: the traditional procedure and the one under study.
Results: The application helped physicians and nurses to optimize the amount of time and resources devoted to management purposes. In particular, time reduction was close to 60%. In addition, the reduction of data duplication, the integration of event management, and the efficient collection of data improved the quality of the service.
Conclusions: The use of business process management technology, usually related to well-defined processes with high management costs, is an established procedure in multiple environments; its use in healthcare, however, is innovative. The use of already accepted clinical pathways is known to improve outcomes. The combination of these two techniques, well established in their respective areas of application, could represent a revolution in clinical pathway management. The study has demonstrated that the use of this technology in a clinical environment, using a proper architecture, and identifying a well-defined process leads to real benefits in terms of resource optimization and quality improvement.
Keywords: clinical pathway, kidney transplantation, pediatrics, case management, business process management
Background
During recent years, two of the most important goals in healthcare have been the optimization of resources and the improvement of efficiency and quality.
These objectives have become vital in view of the limited ability of health organizations to adopt information technology (IT) due to the complexity of these organizations and their fragmented internal structures. In other words, healthcare institutions have been managed individually using ad hoc solutions. The critical elements in healthcare management are variability due to different availability of healthcare services, scarce use of medical evidence, and the phenomena of professional uncertainty. This has led to a slow evolution in healthcare management and optimization because new methodologies, technologies, and practices have not been implemented in healthcare environments at the same rate as in other sectors.[1] This aspect is critical because the main objective of health care services is to reduce cost without reducing the quality of patient care. To reach the best cost-quality ratio, healthcare management has to reach the same level as other services in terms of efficiency; to do this we will need to follow the same path as other sectors, not hesitating to implement new and available technologies and methodologies.
One such methodology developed in and established internationally since the 1980s is the implementation of clinical pathways to guide evidence-based healthcare.[2] Clinical pathways are clinical management tools used to manage the quality of health care through the standardization of care processes. Clinical pathways are an evidence-based response to specific health care problems and provide physicians and nurses with a pre-established care plan, devised according to international standards and developed by specialists in the field. The application of these standards helps professionals offer patients the best possible care plan, without needing to devise an individual care plan for each patient, thus avoiding human error and saving time for both physicians and patients.[3]
The management of these care plans is often a complex task, as the pathway integrates several guidelines, with different tests that have to be performed at specific time points. A clinical pathway timeline defines the expected plan of treatments for a group of patients with a particular diagnosis or undergoing a particular clinical procedure. It outlines a time-specified plan of treatment, recommending tests and therapies based upon a combination of clinical practice consensus and evidence from the scientific literature, thus leading to an improvement in the quality of clinical outcomes.[3] When the pathway is applied to a large set of patients, management becomes a time-consuming activity. It has been shown that their implementation reduces the variability in clinical practice and improves clinical outcomes.[3]
All the tests planned for the pathway must be coordinated according to the resources available and to the pathway schedule, including the specific variations according to the clinical situation of the patient.
Adverse events are another parameter to be included in case management. When a patient experiences an adverse event, specific guidelines or protocols are followed.
With the above premises, we hypothesized that using business process management (BPM) techniques would improve the coordination task. BPM is a discipline that has evolved since the 1990s and has been adopted in many environments to manage and optimize end-to-end processes. In healthcare, these techniques have only been used during the last two decades[4] since they provide support at the business or organization level and are usually applied to well-defined processes. In the clinical environment, the integration of this tool is innovative. A literature search, limited to PubMed, found very few articles (four) using the terms “pathways” and “business process management,” and none of them described a practical implementation.
Methods
The aims of this work were to define a clinical pathway as a process, using a pediatric kidney transplantation as a case study, and to identify the benefits obtained from using this technology by monitoring particular characteristics and many parameters. We sought to have a wider view of the complex clinical process and to manage each patient case efficiently, integrating events and variations for each individual situation. We believed that achieving this aim would lead to an increase in the quality of the work carried out by healthcare workers and a decrease in workload.
We have not limited our project to abstractions; it also includes concrete and practical aspects. We have developed a web-based application to integrate the BPM approach in the management of clinical pathways.
The context
The standard business process modeling notation (BPMN) has been already used at Bambino Gesù Children’s Hospital (Rome, Italy) for a previous project, whose objective was the optimization and planning of operating theatre activities.[5] Bambino Gesù Children’s Hospital is the largest Italian pediatric hospital managing high-complexity cases of kidney transplantation. In the hospital, transplants are performed in children with more than eight kilograms body weight. All aspects of childcare are taken into account through an integrated and multidisciplinary approach, including psychological development.[6]
During each patient admission, either in the day hospital or in the ward, a member of the transplant team has to:
- search the patient data in the hospital repository (personal data, medical reports, laboratory analysis results and follow-up plan)
- select only clinical data relevant for decision-making, assisted by creating for instance special filters on the results
- save the data in a shared document in specific folders of the file system, following an internal coding standard for classifying information
This means that for each patient at each visit, the transplant coordinator has to check which exams have already been performed and what is still to be done, and create a specific program for each patient. A patient may miss an appointment for several reasons and, in this case, another appointment has to be planned and patient lists need to be rearranged. Moreover, results are currently stored in a database which does not allow direct downloading from the hospital system.
To monitor the entire pathway of a single patient, the clinical team needs to navigate the clinical repository to access all the relevant data and copy them into a shared folder, including the specific documents for kidney transplantation.
Coping with the variability of the process is therefore a matter of considerable manual file manipulation, with a difficult-to-manage and error-prone information sharing practice. Currently we have a list of tests (laboratory, instrumental, specialist visits) that must be performed every year at a specific time point according to international guidelines[7][8][9][10][11][12][13] Feeding the database is thus a time-consuming task for the transplant coordinator.
References
- ↑ England, I.; Stewart, D.; Walkers, S. (2000). "Information technology adoption in health care: When organisations and technology collide". Australian Health Review 23 (3): 176–85. doi:10.1071/AH000176. PMID 11186051.
- ↑ Kinsman, L.; Rotter, T.; James, E. et al. (2010). "What is a clinical pathway? Development of a definition to inform the debate". BMC Medicine 8: 31. doi:10.1186/1741-7015-8-31. PMC PMC2893088. PMID 20507550. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893088.
- ↑ 3.0 3.1 3.2 Panella, M.; Marchisio, S.; Di Stanislao, F. (2003). "Reducing clinical variations with clinical pathways: Do pathways work?". International Journal for Quality in Health Care 15 (6): 509-21. doi:10.1093/intqhc/mzg057. PMID 14660534.
- ↑ González Sánchez, M.J.; Framiñán Torres, J.M.; Parra Calderón, C.L. et al. (2008). Andersen, S.K.; Klein, G.O.; Schulz, S. et al.. ed. Application of business process management to drive the deployment of a speech recognition system in a healthcare organization. Studies in Health Technology and Informatics. 136. pp. 511–16. ISBN 9781607503330.
- ↑ Barbagallo, S.; Corradi, L.; de Ville de Goyet, J. et al. (2015). "Optimization and planning of operating theatre activities: An original definition of pathways and process modeling". BMC Medical Informatics and Decision Making 15 (1): 38. doi:10.1186/s12911-015-0161-7. PMC PMC4436841. PMID 25982033. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436841.
- ↑ Tozzi, A.E.; Mazzotti, E.; Di Ciommo, V.M. et al. (2012). "Quality of life in a cohort of patients diagnosed with renal failure in childhood and who received renal transplant". Pediatric Transplantation 16 (8): 840–5. doi:10.1111/j.1399-3046.2012.01774.x. PMID 22943602.
- ↑ Cohen, D.; Galbraith, C. (2001). "General health management and long-term care of the renal transplant recipient". American Journal of Kidney Diseases 38 (6 Suppl. 6): S10–24. doi:10.1053/ajkd.2001.28922. PMID 11729002.
- ↑ Adams, P.L. (2006). "Long-term patient survival: strategies to improve overall health". American Journal of Kidney Diseases 47 (4 Suppl. 2): S65–85. doi:10.1053/j.ajkd.2005.12.043. PMID 16567242.
- ↑ Howard, A.D. (2006). "Long-term posttransplantation care: The expanding role of community nephrologists". American Journal of Kidney Diseases 47 (4 Suppl. 2): S111–24. doi:10.1053/j.ajkd.2005.12.040. PMID 16567237.
- ↑ Josephson, M.A. (2011). "Monitoring and managing graft health in the kidney transplant recipient". Clinical Journal of the American Society of Nephrology 6 (7): 1774-80. doi:10.2215/CJN.01230211. PMID 21734093.
- ↑ Hariharan, S. (2006). "Recommendations for outpatient monitoring of kidney transplant recipients". American Journal of Kidney Diseases 47 (4 Suppl. 2): S22–36. doi:10.1053/j.ajkd.2005.12.046. PMID 16567238.
- ↑ Kasiske, B.L.; Vazquez, M.A.; Harmon, W.E. et al. (2000). "Recommendations for the outpatient surveillance of renal transplant recipients". Journal of the American Society of Nephrology 11 (Suppl. 1): S1–86. PMID 11044969.
- ↑ Howard, A.D. (2001). "Long-term management of the renal transplant recipient: Optimizing the relationship between the transplant center and the community nephrologist". American Journal of Kidney Diseases 38 (6 Suppl. 6): S51–7. doi:10.1053/ajkd.2001.28926. PMID 11729006.
Notes
This presentation is faithful to the original, with only a few minor changes to presentation. In several cases the PubMed ID was missing and was added to make the reference more useful. Grammar and vocabulary were cleaned up to make the article easier to read. The original duplicated citation three and four; they have been combined into one citation (three) for this version.
