Journal:Experimental application of business process management technology to manage clinical pathways: A pediatric kidney transplantation follow-up case
| 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.
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.
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.
