Flexible guideline-based patient careflow systems

Workflow Management Systems integrate domain and organisational knowledge t o support business processes. When applied to the medical environment, they can be termed "Careflow Management Systems", and may be used to manage car e delivery by enhancing co-operation among healthcare professionals. This p aper focuses on care delivery based on clinical practice guidelines. Health care organisations are very different from industrial or commercial compani es: their main goal is not profit, but maintaining and improving the health of the public. Therefore, outcomes are difficult to measure. Firstly, phys icians, while playing a variety of roles, are quite independent decision-ma kers: secondly, the object of the process, i.e. the patient, may be involve d in choosing treatment options, and may be treated by different institutio ns. For these reasons, the standard functionality of typical Workflow Manag ement Systems must be strongly enhanced in order to cope with healthcare de livery needs. A major issue is accounting for exceptions. In most non-clini cal settings this is not a problem because processes are very well defined and can often be easily controlled by some higher authority. As explained a bove, this does not happen in healthcare organisations, Responsibilities ar e widely shared, and health carl professionals may be noncompliant with gui delines for a variety of reasons. The paper presents a classification of po ssible exceptions, and shows how the sequence of tasks described by a guide line may be altered, at the implementation level, in order to meet actual u ser needs, while maintaining guideline intentions as much as possible. A te rminology server is also exploited towards this end. This work illustrates a prototype of a Careflow Management System based on an international guide line for ischemic stroke treatment, developed by the American Heart Associa tion, (C) 2001 Elsevier Science B.V. All rights reserved.