Quaglini S, Saracco R, Dazzi L, Stefanelli M, Fassino C; Association for Health Services Research. Meeting.

Abstr Book Assoc Health Serv Res Meet. 1997; 14: 13-14.

Dpt. Informatica e Sistemistica, University of Pavia, Italy.

RESEARCH OBJECTIVE(S): To show how information technology may be used to integrate in a common framework both clinical and organization issues involved in the patient management. More specifically, to develop a patient both clincal and organizational issues involved in the patient management. More specifically, to develop a patient workflow management system based on underlying guidelines and protocols. The ultimate goal of such a system is to increase productivity and to reduce costs without adversely affecting patient care quality. STUDY DESIGN: Many participants in the health care system now regocnize the importance of the clinical practice Guidelines (GLs) to avoid treatment dissimilarities, malpractice and resource waste. Nevertheless, GLs are often diffused as "generic plans" of clincal procedures, and their effective implementation requires a customization process for taking into account the organization characteristics, policies and preferences. On the other hand, several studies highlight that the quality of care depends not only the care providers' professional skills but also on the level of collaboration they reach inside the organization. Thus, our idea was to apply the concept of "workflow management system" (WfMS), which is widely recognized as crucial within industrial and commercial activities, to the clinical setting, and in particular to he GLs application (workflow management systems are defined as "tools to support and control administrative and technical tasks in large organizations"). First, a formal representation for GLs was developed: a sequence of parallel or sequential procedures and subprocedures, each one represented by a set of attributes. Some of them describe the procedure (Type, Comment, Intention, Activation Condition, Skill required, etc.), other ones allocate it within the GL flow (Next-Procedure, Subprocedures, Synchronization Conditions, Time constraints, etc.). A graphical GL Editing Tool has been developed using JAVA programming language, by means of which the procedural knowledge provided by a GL is representd according to the above formalism. This kind of knowledge needs to be completed with other kinds of knowledge, i.e. patient record and organizational constraints, to build an effective intervention model. A WfMS provides a dynamic model of the process of interest, with all the involved entities explicitly defined, so as to make it possible to simulate the process evolution, to clarify where and when information and/or resources are produced and consumed, etc.. We choose High Level Petri Nets (PNs) [1], as the formalism for representing patient workflow. Very shortly, a PN is a graph representing a system in terms of its possible states and transitions among states; basic concepts of WfMS such as Activities, Resources, Roles, etc., can be easily mapped into High Level PNs. Considering the several kinds of attributes used to model GLs, it was possible to establish a close correspondence between these attributes and appropriate sequences of states and transitions of the PN. Thus, an algorithmic translation of formalized GLs into High Level PNs was implemented, so obtaining a computational formalism capable of providing facilities for design, specification, simulation, validation obtaining a computational formalism capable of providing facilities for design, specification, simulation, validation and implementation of workflow processes. To build a real Wf model, each transition must be represented with a subsystem where all the possible workable aspects (participants, resources, time, outputs, accountabiliyt, etc.) are made explicit. Given that the same medical activity can be used within several different processes, all these subsystems describing activities should be stored in a PNs Library, in such a way that they can be shared, and each organization will hold its own PNs Library. PRINCIPAL FINDINGS: As a test bench for the proposed methodology, a real-world GL was used: it is a generic GL to manage Acute Myelooid Leukemia (AML) in children, and it was developed by the AIEOP (Italian Association of Pediatric Hematology and Oncology). The System has been proved capable of adapting itself to different hospital organizations, and to simulate different clinical settings, in order to compare resource consumption. CONCLUSIONS: We propose a method of modeling clinical workflow processes where expertise in medical care can be serparated from expertise in organizational structure. This methodlogy should improve knowledge acquisition in terms of medical knowledge contained in clinical practice GLs and in terms of site-specific working formalities. In addition, it should improve easy maintenance of an accurate Workflow model in face of changes both in clinical processes and in the organizational structure. RELEVANCE TO CLINICAL PRACTICE AND POLICY: Patient management involves data collection and data and opinion exchange among several operators.

Publication Types:

• Meeting Abstracts

Keywords:

• Child
• Communications Media
• Delivery of Health Care
• Guidelines as Topic
• Hospital Administration
• Humans
• Indonesia
• Models, Biological
• Patient Care
• Patient Care Management
• Practice Guidelines as Topic
• Programming Languages
• methods
• standards
• hsrmtgs

Other ID:

• HTX/98601884

UI: 102233429

From Meeting Abstracts