Clinical Pathway – Issues of Reference Model Based Approach · Clinical Pathway – Issues of...
Transcript of Clinical Pathway – Issues of Reference Model Based Approach · Clinical Pathway – Issues of...
WISE
Fakultät Wirtschaftswissenschaften, Lehrstuhl für Wirtschaftsinformatik, insbes. Systementwicklung
From Clinical Practice Guideline to Clinical Pathway – Issues of Reference ModelBased Approach
Hannes Schlieter 1 , Werner Esswein 1
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering, Dresden, Germany
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Agenda
§ Project Background § Theoretical Foundations
• Clinical Pathway (CP) vs Clinical Practice Guideline • Fundamentals of Reference Modeling • Framework for Clinical Recommendations
§ Motivation § Prior Research
§ The Reference ModelBased Approach § Analysis & Results § Future Research
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Project Background The SOSNET
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Actually ca. 500 participants
www.carusconsilium.de
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Project Background The SOSNET
§ Founded in 2007 § 13 hospitals within the network § Healthcare network for regional
stroke care (most important stroke § structure in Saxony) § Based on telemedicial
infrastructure § Goal:
• quality treatment of all stroke patients independent to the regional location
• Lyse indication in small time slot
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SOSNet Stroke Network of Saxony
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
The Internal Quality as „Greybox“
Care process in a network
process quality
structure quality
Subresults visible Subresults visible
The internal quality is not visible Fulfillment of requirements can be checked
visible
Implication: The processes in the network can not unified, however, a minimum standard of the processes, of coordination and communication of network members need to defined.
outcome quality
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
The Clinical Practice Guideline (CPG)
Characteristics:
§ CPGs are recommendations for action (no binding instructions)
§ Systematically developed recommendations to support clinical activities
§ Classified into different development stages (Level 1 to 3)
§ Aggregation of evidencebased medicine
Aim: § Improvement of clinical care and cost reduction § Faster dissemination of evidencebased medicine § Patient information of the good clinical practice
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Level 1: expert opinion Level 2: consensusbased guideline Level 3: evidencebased guideline
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Characteristics: § Instrument for clinical process management § CPs are interdisciplinary and multiprofessional aspects § Creation at local level („From the hospital for the hospital“)
Aim: § Improvement of cost and process transparency
§ Facilitate an active quality management (process quality improvement processes)
§ Improvement of medical outcome
§ Support of clinical documentation
§ Definition of local standards
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The Clinical Pathway (CP)
[Roed+2003], S.20 ff
24.09.2010 From Clinical Practice Guideline to Clinical Pathway – Issues of Reference ModelBased Approach
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Framework for Clinical Recommendations
Scenarion I: § Derivation of CPs based on
CPGs Goal: § Reduction of manual work § Methodological adaptation § =>Improve Process quality Scenario II: § Revision of CPGs § Integrations and alignment of
CPG and CP
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
ToBeSituation
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Stroke Unit Dresden
Advanced CPGs and Method for application
Network Members
Guarantee of quality level
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Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
?
Rules
Standards
Ziel Prozessübersicht Kennzahl Res source
Clinical Practice Guideline Specific Models of CPs
Motivation
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Process
Evidence Medicine
Goals KPI ….
Clinical Practice
Gap
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Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Prior Research 1/3
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Nomenclatur of MDM: •Published modeling language of Society of Medical Decision Making •Goal: Comparison of CPGs
Critics: •Insufficient adequacy of modelling language •No Methodic for Adaption / No Construction Techniques [Broc2003]
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[MDM1992]
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Prior Research 2/3
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Computerinterpretable formalization: •In discussion since 1980s •Different language with (GLIF, GUIDE, Proforma, GEM...) •Goal: Transformation in decision support system
Critics: •Formal, not good human understandable •Only parts of information system, which can formalized
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[Ohno1998],S. 365 ff.
Modelling of computerized CPGcontent
Trasnforamtion in formal format
Integration in Hospital inforamtion system
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Prior Research 3/3
13 From Clinical Practice Guideline to Clinical Pathway – Issues of Reference ModelBased Approach
Approach of Jacobs: • First reference model based approach
• Applied for mamma carcinoma
Critics: •Arbitrary design decision
• No evaluation of modeling languages • Reduction on one construction technique
•Weak validity of results
[JACOBS2006], S. 74ff
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Reference Model Reference Model
Clinical Practice Guideline
Clinical Practice Guideline
CPG incl. Model CPG incl. Model Blank CP Blank CP
CP CP
+ Placeholder
+ Model of CPG
+ Replace the placeholder
+ key performance indicator, responsibilities
Science Science Practice Practice
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Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
I
[Bec+04]
<abstract>
<speciliciable> <strict>
II
<not allowed> Rules
Standards
Ziel Prozessübersicht Kennzahl Res source
The Reference Modelbased Approach
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With Reuse
From Clinical Practice Guideline to Clinical Pathway – Issues of Reference ModelBased Approach
For Reuse Process Goals KPI ….
CPG Specific Models of CPs
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Fundamentals of Reference Modeling Definition
§ In Information System (IS) research reference models are used to communicate best practice, common practice or normative rules [Becker2004].
§ They minimize the design risk and maximize the acceptance of model results. Reusing conceptual models or parts of models represent an integral area in research about effective and efficient software engineering and organizational design [Hammel1999].
§ The purpose of reference models usage is a reduction of development costs and of development time [Schuette1998]
§ Reference models specify rules and standards that guarantee the compliance to adaptability of a standardized application system or the compliance to organizational rules.
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Characteristics of Reference Models: • Generality • Adaptability • Recommendatory character
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Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Fundamentals of Reference Modeling Construction Techniques
§ Configuration
§ Specialization § Aggregation § Instantiation § Analogy
Not generating adaptation
Generating adaptation
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[Br03]
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Fundamentals of Reference Modeling Construction Technique: Specialization
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• Specialization of a gerneral model
freie An passung
Free Modification
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Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
24.09.2010
• Selection of reference model components in respect of criteria
• The way of composition is in general rule independent
Auswahl Kompo sition
partielle Regelunter stützung dekbar!
Selection Compo sition
Partial rule based
Fundamentals of Reference Modeling Construction Techniques: Aggregation
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
24.09.2010
• RM predefines model elements, which are needed to be concretize
• Concretion without limitation or with limitation of range
Füllen von "Platz haltern"
Fundamentals of Reference Modeling Construction Technique: Instantiation
Instantia tion
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
24.09.2010
• Rule based adaptation • Selection of forethought models • Result: Projection of variant of the model
• All variants of modification are defined ex ante
Regel
Fundamentals of Reference Modelling Construction Technique: Configuration
Rule
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Analysis & Results
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Analysis & Results
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Issue 1: ManytoMany Relation between CPs and CPGs Issue 2: Different CPGs to one indication
Issue 3: No standardization CPGs in structure Issue 4: No standardization of modeling language
Issues 5: No definition of RM Grammar for clinical context
Issue 6: Network participant use different CP designs Issue 7: CPGs are more abstract than CPs Issue 8: CPs describe addition aspect than COGs
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Further Research
§ Tool support for reference model construction and application
§ Definition of standards for conceptual modeling of clinical practice guidelines including the RM techniques
§ Extension of reference modellanguage to a reference modelbased method
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WISE
Fakultät Wirtschaftswissenschaften, Lehrstuhl für Wirtschaftsinformatik, insbes. Systementwicklung
Thank you for your attention!
Contact: Hannes.Schlieter@tudresden.de
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
References
[AWMF2001] AWMF: Leitliniendatenbank. website. – http://www.uniduesseldorf.de/AWMF/ll/ ll_list.htm;2008, Abruf 24.06.2009
[Bec+2004] Becker, J., Delfmann, P., Ralf, K.: Konstruktion von Referenzmodellierungssprachen Ein Ordnungsrahmen zur Spezifikation von Adaptionsmechanismen für Informationsmodelle. 251264 (2004).
[FeLo2004] Fettke, P.; Loos P.: Systematische Erhebung von Referenzmodellen Ergebnisse der Voruntersuchung Papers of the Research Group Information Systems & Management, Paper 16, Mainz 2004.
[Ihle04] Ihle, J.: Leitlinien und Recht Bericht zur Tagung des Instituts für Gesundheits und Medizinrecht der Universität Bremen (IGMR) am 7. und 8. Mai. In: MedR Medizinrecht, 22 (2004), August 8, S. 440
[Hev+04] Hevner, A. R.; March, S. T.; Park, J.; Ram, S.: Design Science in InformationSystems Research. In: MIS Quarterly, 28 (2004) 1, S. 75–105
[Hindle+2003] Hindle D.; et al.: Instrumente zur Behandlungsoptimierung Klinische Behandlungspfade. In: Der Chirurg, 2003.
[Jacobs2006] Jacobs, B.; Oberhoff, C.; Stausberg, J., Ableitung von klinischen Pfaden aus evidenzbasierten Leitlinien am Beispiel der Behandlung des Mammakarzinoms der Frau, In: GMS Medizinische Informatik, Biometrie und Epidemiologie, S. 110, 2007.
[MDM1992] MDM : Proposal for Clinical Algorithm Standards, Sage Journal, 12, S. 149154, 2002. [Roed+2003] Roeder, N.; Hindle, D.; Loskamp, N.; Juhra, C.; Hensen, P.; Bunzmeier, H.; Rochell,
B., Frischer Wind mit klinischen Behandlungspfaden (I), in: das Krankenhaus, vol 1., S. 2027, 2003.
[Schütte1998] Schütte, R.: Grundsätze ordnungsmäßiger Referenzmodellierung: Konstruktion konfigurations und anpassungsorientierter Modelle. Gabler Verlag, 1998.
[Thomas2006] Thomas, O.: Das Referenzmodellverständnis in der Wirtschaftsinformatik: Historie, Literaturanalyse und Begriffsexplikation. Veröffentlichung des Instituts für Wirtschaftsinformatik im Deutschen Forschungszentrum für Künstliche
Intelligenz. Heft 187, 2006.
[Trengler2003] Trengler C.:Klinische Pfade helfen Risiken verringern. In: Klinik Aktuell, 2003.
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WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
Consequences
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Issue 1: ManytoMany Relation between CPs and CPGs Issue 2: Different CPGs to one indication
Issue 3: No standardization CPGs in structure Issue 4: No standadization
Issue Network participant use different CP designs
Method, which guarantees a comparable result
WISE
Department of Business Management and Economics, Chair for Information Systems, esp. Systems Engineering
!! Rules
Standards
Ziel Prozessübersicht Kennzahl Res source
Reference Model Specific Models of CPs
Results
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Approach
Issues: • level of abstraction • different aspects • representation
Similarities: • Clinical Algorithm