By Rick Halton, VP Product & Marketing, Lumeon
In my recent blog, I talked about the top 10 misconceptions of next generation care delivery, I’d now like to move on to the elements of success.
Clinical pathways are rapidly becoming the primary clinical and operational model for health care delivery. Their popularity has increased as healthcare administrators and clinicians come to realize that these pathways are more than just evidence-based guidelines. Care pathways, when effectively implemented, can be a game-changer for medical staff – helping them focus on patients most at risk, make timely decisions, and manage routine and repetitive tasks more efficiently along the patient journey.
The concept of the clinical pathway has been around for years, but its applicability has grown as technology has evolved. Over time, clinical pathways have shifted from paper-based guidelines to online publications, to clinical decision support, and now to automated care delivery workflows.
As we evolve to a new understanding of what next-generation pathways are, here are ten essential ingredients to make clinical pathways effective and useful:
1. Workflow. A workflow is like a GPS tracker with waypoints that indicate where a patient is and where they are going during their journey. A workflow defines the sequencing, timing, roles and responsibilities for a series of clinical, administrative and communication tasks. Next-generation workflow automates activity, helping the care team progress, monitor, and complete tasks which can be assigned to clinicians, patients, and caregivers. Tasks are automatically assigned and escalated to the most appropriate and available care team members.
2. Clinical decision support (CDS). CDS is very powerful when used in conjunction with workflow, enabling the care team to have hands-on control, personalizing activity to each patient’s needs. CDS guides the workflow so it is always in context and appropriate. CDS may also provide clinical recommendations for the care team to act upon where necessary, leveraging EHR data to branch and adapt workflow.
3. Algorithms. These mathematical equations and models enable CDS to help assess patient needs and make recommendations. Algorithms can be used to assess a wide variety of factors such as health risk, readmission risk, compliance, engagement, severity, deterioration, life expectancy, and mortality. Algorithms typically provide numerical results on a scale. This scale must be interpreted into a recommendation that the care team can easily understand and act on. Reliable recommendations depend on an algorithm’s sensitivity (the ability to positively identify someone at risk) and specificity (the ability to avoid false positives).
4. Communication. Next-generation pathways help the care team by weaving in automated communication and outreach throughout the patient journey. With many communication channels available, such as email, voice, SMS, chat, postal, patient portal and apps, choosing the right method for the right patient is essential to ensuring patient compliance. Communication techniques must respect HIPAA requirements at all times.
5. Forms. As care progresses, the pathway requires regular updates to status, issues, preferences, and compliance. Form information can be gathered via several channels, such as electronic forms, websites, chatbots, and voice calls. Forms can be adaptive, asking the least number of questions possible based on data already available in the EHR and prior responses from the patient. Forms data must be made available as part of the pathway decision tree so patients can follow the fastest route.
6. Events. Unlike electronic health record data, pathways help execute activity over time, producing a breadcrumb trail as they go. Time series data can help providers and administrators query and troubleshoot what has happened to patients, log activity for auditing and governance purposes and analyze pathway design to improve care delivery models. Events recorded in this data set can be of many different types such as messages sent, forms completed, clinical decisions taken, appointments booked, appointments attended, care transitions made and pathway routes taken.
7. Goals. Every clinical pathway needs one or more goals. These are the core objectives of the pathway against which one can measure its level of success. Goals may relate to broad corporate priorities such as organizational efficiency, the improvement in patient flow, the cost of care delivered, the quality of care, outcomes achieved, the reduction in variation in care, or the patient experience. Alternatively, they may be about more specific priorities such as reducing operating room cancellations and appointment no-shows or improving physician scheduling slot utilization. Whatever the goal, a correctly designed pathway will produce vital source data to monitor the achievement of those goals across a patient population.
8. Roles. Clinical pathways are distinctive in their ability to route care tasks to different care team members, both faculty and non-faculty, at different care locations. Pathways must take account of the care roles available, including their skills and availability. Pathways can then leverage these roles as a resource pool to ensure that the right patient gets to see the right person at the right time.
9. Care plan. A care plan is a document that describes a patient’s medical issues and care needs. Care plans encourage patients to take an active role in their own care and empower caregivers to assist in that effort. Care plans play a useful role within a clinical pathway to educate patients about their condition, risks and how to recover quickly. In patients with chronic diseases, care plans also define the milestones of care a patient should receive, or the key clinical activities that should be performed on an on-going basis. Using all the capabilities of a next-generation pathway to enact that plan leads to reduced variation in care and improved care outcomes.
10. Content. Clinicians can help ensure compliance to a clinical pathway by instructing, educating and coaching patients. A good example is teaching patients about hydration, opioid tapering and gradual exercise to enhance recovery after surgery. By delivering contextual content in engaging ways, providers can encourage patients to do the right thing – whether they are at the care setting, at home, or at work. Content may also be served to the care team, helping instruct them during the delivery of care. Care content is broadly available in many media forms, such as documents, images, web pages, audio and video.
Whilst you won’t need all these ingredients to get started, you should aim to have them in your toolbox. As your organization’s requirements and ambitions rapidly evolve, new technology is making it possible to increasingly automate care delivery making the practice of medicine more standardized, transparent, functional, personalized – to the benefit of clinicians and patients alike.