A Method for Reporting of Variance in Informal Care Pathways

John Chelsom
Seven Informatics Ltd, Banbury, United Kingdom / Health Information Science, University of Victoria, Victoria, Canada

Conceição Granja
Norwegian Centre for E-health Research, Tromsø, Norway

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Ingår i: Proceedings from The 16th Scandinavian Conference on Health Informatics 2018, Aalborg, Denmark August 28–29, 2018

Linköping Electronic Conference Proceedings 151:16, s. 91-95

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Publicerad: 2018-08-24

ISBN: 978-91-7685-213-2

ISSN: 1650-3686 (tryckt), 1650-3740 (online)


Care pathways are commonly used as a means to ensure the implementation of proven best practice in clinical care. They can be defined in an Electronic Health Record system using formal representations of template pathways which are then instantiated for specific patients, to guide clinical users through a sequence of tasks and actions. The open source cityEHR system uses HL7 CDA documents for the formal pathway definitions, but in practice we have found that some care pathways, and clinical protocols, can be implemented effectively using less formal mechanisms. In addition to the shared patient record itself, we find that the most important of these mechanisms are notification on recording of patient events, support for care teams, annotation of the record, and the clinician-centred ’In-Tray’. One important feature lost in this approach is the ability to report on the variance of the care provided to the patient from the best practice encapsulated in a more formally defined pathway. To address this, we describe a method for transforming a formally defined care pathway to a finite state machine representation and querying the patient record to generate a retrospective report on the variance of states recorded in the patient record.


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