Example BPMN for generic referral workflow. Would a pathway be part of that?
---
## Post #9 by @adamlees
Wouldn't it be the other way round, i.e. the referral and possibly others would be part of a pathway (e.g. for a specific cancer care) The referral might initiate it a pathway, or the diagnosis event for a specific condition might initiate the pathway.
My understanding is that many clinical pathways are too complex for modelling using eg. BPMN to be feasible. Possible yes but very hard and time consuming. Even what seems on the face of it to be a simple paper administrative workflow in the real world gets _really_ complex when you start considering all the edge cases and exceptions. At LTHT we found attempting to model the inpatient electronic discharge process as a simple flowchart was unfeasible, and that it was best represented as a state machine. You can model the high level flow like that e-Referral example like that but when you get into the detail it gets messy.
---
## Post #10 by @mayfield.g.kev
I was reading on Camunda's BPMN (Real Life BPMN 2.0 book). They split processes up into several parts, first one being the generic process - something simple that everyone grasps (as in my previous diagram).
This gets broken down into two main areas one for the process engineers and one for the technical. They are similar but not the same.
Maybe you don't need to model the edge cases or go into too much, they may make the diagram so complex it fails to get the simple model across? [Model the 20% that occurs 80+% of the time].
---
## Post #11 by @pacharanero
I think @adrian.wilkins is onto something with making the distinction between 'imperative' process mapping - where you map a pathway in terms of a fixed series of things that happen in a fixed order, and 'declarative' process mapping, in which you state the **end point** you want, and let the system figure out what needs to be done to get you there.
The difference is, that if I am being declarative, and I say the 'end point' of **this** stage of treatment is to get the patient to their first cancer MDT, then I just state 'get them to MDT'.
The _system_ knows that before they can go to MDT, the patient will need
* to have had a CT scan, and the results back
* to have had blood tests, and the results back
* booking for MDT made
* transport booking
And it will arrange these with the appropriate intervals.
It has several advantages in that it allows for complete concurrency of the tasks, and if a new pre-MDT requirement is added, this is easy to add and doesn't require re-mapping of the process to find out where the new bit fits in.
It also probably encourages us to think of "small, reusable units of process" rather than heroically trying to map the entirety of cancer care onto one great big BPMN chart.
We need a domain specific language for declarative care planning. @adrian.wilkins - up for it?
---
## Post #12 by @adrian.wilkins
My background is a medical degree, a short spell in the clinical trenches, and 17 years experience in healthcare IT on both private and public sides of the fence.
I've been hearing the noun "pathway" throughout those 17 years but have yet to see a compelling implementation...
---
## Post #13 by @adrian.wilkins
[quote="adamlees, post:9, topic:162"]
many clinical pathways are too complex for modelling using eg. BPMN
[/quote]
Looks like a point in favour of declarative vs imperative process..
[quote="wongwaikeong, post:6, topic:162"]
the same activity can be related to two pathways .. e.g. Holistic Needs Assessment
[/quote]
A declarative system could catch this ; if say, your conditions were "must have a recent Holistic Needs Assessment report on file", the report for the first pathway would satisfy the second without having to be repeated.
This reminds me of what's called a "promise" in certain protocol libraries ; if your first goal declaration is processed and creates a promise that there will be a HNA report, then second goal declaration can pick this promise up and run with it, rather than having to create it's own promise, so even if the HNA assessment hasn't happened yet, the second goal declaration can still make use of the units the first declaration is being met with.
[quote="pacharanero, post:11, topic:162"]
We need a domain specific language for declarative care planning.
[/quote]
I'd be tempted to start with some Graphviz dot / digraph files just to illustrate the point ; we could definitely illustrate @wongwaikeong's point that two goals could have their steps merged (in the case of Graphviz, just by merging the list of relationships). It doesn't seem a complex thing to specify in that the core of it is "this thing needs these things". I'd probably just go for one of the existing base dialects : YAML seems a nice fit - it looks a lot like the Debian package control file which is the basis of this notion.
----------
```
Package: parted
Version: 1.4.24-4
Section: admin
Priority: optional
Architecture: i386
Depends: e2fsprogs (>= 1.27-2), libc6 (>= 2.2.4-4), libncurses5 (>= \
5.2.20020112a-1), libparted1.4 (>= 1.4.13+14pre1), libreadline4 (>= \
4.2a-4), libuuid1
Suggests: parted-doc
Conflicts: fsresize
Replaces: fsresize
Installed-Size: 76
Maintainer: Timshel Knoll hi,
thanks, i am a clinically switched on technician (over 30 years working with health data)
good to talk, i have spoken far more with clinical people when not working for the nhs than working for it, that
is down to one of the many significant problems the nhs has, a hierarchical management approach which will not be
subservient to "the" team, and i am not just thinking about role playing
notes:
i think what the nhs "does" with flow diagrams and process maps relates to care pathways (aka pathway templates), in my experience the organisation that produces the best of these is NICE, i ignore the rest (that is another significant problem the nhs has, too many quangos)
i get your idea, flow diagrams can play a part but from a data modelling perspective PATIENT pathways (please, please, please, do not join the rest of the bull shitters and just use the expression pathways - it is too vague) can follow any path, any activity can be recorded against them at any time
you are not complicating things, health is the most complex of all domains, it is not4the faint hearted, however there is a solution to your problem and that has come from the leader of NHS England (SS), he has laid a trail for others to follow, the solution is integrated care models:from a data modelling perspective: 1. PATIENT pathways allow care activity to be recorded against different care settings (e.g. a surgery, hospital or a place in the community)2. integrated care models integrate physical and mental health by associating PATIENT pathways (in technical terms there is a many to many relationship between PATIENT pathways which can be realized through an integrated care model in practical terms, an integrated "cancer" care model could be created which would associates the two cancer PATIENT pathways, the integrated care model would inherit the ID and HNA of the first PATIENT pathway to be linked i hope to find some time and a way to upload a visual representation of my data model on to this site for all to share, please try and find some time to look at it, caring words are not always enough, they don't always dot it :-) if it still does make sense ...give me a shout nice to talk ps just between you and me i don't think SS bullshits, it's many of those surrounding him, (he does talk too qlickly tho :-))On 07 March 2016 at 22:44 wongwaikeong <discourse-system@openhealthhub.org> wrote:--- ## Post #27 by @mayfield.g.kev [quote="wongwaikeong, post:19, topic:162"] the PDF carrying the structured info (an openEHR composition) in it's metadata somehow as XML/JSON, does it support that?? Or the generation of a PDF from an openEHR template? [/quote] Just a plain PDF but carrying the information a clinician needs to see or get across. We have a mixed economy at the moment and some organisations won't be able to support openEHR but they can provide the same information in a PDF (or even a word document or paper). openEHR tells us what is needed in the pdf/letter, such as the medications, relevant clinical history, etc. It's not just organisation, it's also systems and people. It's where I'm coming from with distinction between clinical and technical. --- ## Post #28 by @adrian.wilkins [quote="adamlees, post:23, topic:162"] to fully implement a complex workflow in an electronic system you need all the exceptions. [/quote] Or you need a system that's more flexible - the reason people love paper and email for managing their workflow is that they cover a variety of sins. Having been doing workflows for clinical and non-clinical settings for a long time, my No.1 lament is always that you end up spending a vast amount of the SMEs valuable time on specifying a workflow with a number of negative properties ; * Tries to replicate their current manual workflow * Even if the capabilities of the software render parts of it moot - e.g. a manual check of something that can be checked faster and with more rigour by a software component * Inevitably never covers every exception or workaround * Completely rigid - step Y must occur after step X, must be approved by particular user, etc * Then, as it's "baked into" the tools as you say, improving it requires technical intervention What users need to do their job is tools to accomplish the tasks they need to get done. In my experience, asking SMEs to specify workflow (often "argue about workflow") steals valuable time with them that you could be using to produce these tools. It's my firm belief that requirements gathering should focus on the tasks that need accomplishing and that workflow should be as minimal, standardized, and flexible as possible. --- ## Post #29 by @mayfield.g.kev [quote="adamlees, post:23, topic:162"] At your top level our electronic discharge summary workflow was indeed fairly simple. All the difficult knotty stuff was hidden beneath. Which sounds good until it bites. :slight_smile: [/quote] It's from IHE Cross Enterprise Referral Workflow. http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_XBeR-WD.pdf I modified names slightly to get my head around e-Referral process. So 'Scheduling for consultation' is what we call e-Referral http://www.hscic.gov.uk/referrals with 'Clinical Report' being Transfer of Care (https://www.england.nhs.uk/digitaltechnology/info-revolution/interoperability/transfer-of-care-edischarge/). I was looking at ideas to digitize the 'consultation' process by using a workflow engine to upload the referral document into our document management system (it's currently being printed and scanned). --- ## Post #30 by @tony.shannon I'd agree with that sentiment Adrian. It should be acknowledged that within complex adaptive systems (eg Healthcare) , often acknowledged to be at the "edge of chaos" .. that we often see non-linear > linear workflow.. So flexibility (aka "loosely coupled"?) technology is key to success in may settings.. Just visit a typical ED to see this in action.. Tony --- ## Post #31 by @pacharanero @tony.shannon if you use a # at the start of a line the MarkDown interpreter in Discourse converts it into a `wongwaikeong March 7
@clive.spindley I think it is fair to say that I'm a technically switched on Doctor.
I completely get your what you mean by having a Pathway ID that can be linked to the particular care activity. For eg. a cancer OP appt can be linked to a Pathway ID for a cancer pathway, scans, blood tests, chemo and so forth.
The tricky bit is when the pathway becomes a bit of like process map. For example one that can be represented by a BPMN diagram. Gets even worse then there are different actors and the progression on the steps on the pathway is conditional.
For eg. 2ww cancer referral -> Triage -> If scans done already go to [1] else go to [2] -> [1] book OPA -> [2] book scan -> have scan -> go to [1]
You get the idea. And each point of the pathway can act as a trigger. For eg. once scan is done, inform MDT coordinator via an email.
And then of course the same activity can be related to two pathways! For eg. a patient with two cancers, on two pathways can have the same Holistic Needs Assessment, so then a HNA will have two pathways IDs?
Maybe I'm complicating matters! IMHO, BPMN provides most of the requirements for a pathway modelling specification on which a pathway tool/ service can be based on.
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` tag heading --- ## Post #32 by @tony.shannon Thanks Marcus #lesson learnt ....use # carefully! Dr. Tony Shannon Director, Frectal Ltd www.frectal.com tony.shannon@frectal.com +44.789.988.5068 (UK) +353.89.457.6011 (Ireland) --- ## Post #33 by @clive.spindley
IT is not difficult, you ID the PATIENT pathway, maybe click on a picture, then record the activity against it. Or you could ID the patient, then select the PATIENT pathway from a list.
Never too late to make a start.
Clive
I gnore the waffle and politics which exists within the NHS
On 08 March 2016 at 12:05 "tony.shannon" <discourse-system@openhealthhub.org> wrote:--- ## Post #34 by @ian Hi Adam, No, definitely not. The focus is very definitely on the clinical document, whether that is inside a system, or the payload transferred between systems. We would expect other technologies to handle the layer you described, though some clinically/patient relevant acknowledgements might also need to appear in the patient record e.g. Referral received, lab test request received. --- ## Post #35 by @beckywassall As a Community Dentist (read dentist for people living with complex medical conditions/disabilities) my clinical practice is governed by my ability to adapt and flex...to get a job done (eg absess on tooth requires extraction of a tooth for an older person with memory loss and several significant comorbidities). @adrian.wilkins - I like your idea [quote="adrian.wilkins, post:28, topic:162"] What users need to do their job is tools to accomplish the tasks they need to get done. [/quote] When work clinically, most of my clinical procedures are standard but it is the patients medical/care needs that are infinitely variable and require me to be flexible @pacharanero - I would agree [quote="pacharanero, post:11, topic:162"] I think @adrian.wilkins is onto something with making the distinction between 'imperative' process mapping - where you map a pathway in terms of a fixed series of things that happen in a fixed order, and 'declarative' process mapping, in which you state the end point you want, and let the system figure out what needs to be done to get you there. [/quote] Because my patients have such varied disabilities and co-morbidities I have found the best approach to planning care is to ask the patient what 'end point' they want (and if the patient doesn't have capacity I work with those caring for that person to allow me to make that decision in their best interest). I then work back from that end point...delivering bits of care (in a flexible way) to get to that end point. I often feel "at the edge of chaos" @tony.shannon its part of my job and its also I think why ALL of the current dental systems fail to support community dentistry. [quote="tony.shannon, post:30, topic:162"] It should be acknowledged that within complex adaptive systems (egHealthcare) , often acknowledged to be at the "edge of chaos" .. that weoften see non-linear > linear workflow.. So flexibility (aka "loosely coupled"?) technology is key to success inmay settings.. [/quote] --- ## Post #36 by @adamlees Thanks Ian, that is the clarification I was inarticulately seeking in my question last week. :thumbsup: The payload is definitely where I see this stuff in an inter-system messaging context. --- ## Post #37 by @clive.spindleytony.shannon March 8
I've also heard the term "pathway" discussed and debated more times than I like to recall. The challenge is that if you get clinical/IT folk in a room to try to agree the definition of a "care plan" or "care pathway" you'll get a different definition every time. Such is the state of maturity of the art/science of informatics, we have some distance to go to get a common language between the clinical/management/technical folk that need to be involved.
Having looked at this in the past, if you want to delve into pathways I would draw attention to a few things. "Designing Guideline-based Workflow-integrated Electronic Health Records" http://www.openehr.org/resources/publications#workflowinhealthcare & a related (brief) paper here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480104/
I would suggest that pathway material generally involves crafting a blend of people + process + information + technology. One way of explaining it, which Barretto does so well in her thesis is that the information elements involve a mix of
WHAT needs to be done (clinical content, ie archetypes/EHR content)
WHY (rules , such as IF, ELSE etc... rules engine)
WHO #WHEN (workflow/task management .... workflow engine)
So to support any 1 pathway could require quite a bit of kit... IF you are trying to support pathway(s) at scale..otherwise you'd hack something together.. that won't scale ;o)
To start that journey, many of us focus on the WHAT first .. the clinical content.. which usually closely relates to the clinical process. One other nugget is that typical business process analysis/management (eg BPMN) usually explores a change from the Physical As-Is .. to Physical To-Be. If you look at healthcare with those eyes you see a dizzying variety of process. What is missing is the fractal patterns of generic/logical clinical process that underpin the breadth of healthcare.. So whats needed to make sense of this space is a generic/logical modelling layer is needed in the middle.. Physical As Is +Logical As Is +Logical To Be Physical To Be
That search for logical/generic clinical process support led me to openEHR, which has 4 core/generic process-oriented classes (Observation, Evaluation, Instruction & Action) which is why openEHR imho is the critical foundation layer we are currently building out.. the more fanciful/sophisticated "pathway" support can come later..
More related writings here.. http://frectal.com/book/healthcare-change-the-way-forward/
Hope that helps>hinders.
Tony
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adrian.wilkins March 8My background is a medical degree, a short spell in the clinical trenches, and 17 years experience in healthcare IT on both private and public sides of the fence. I've been hearing the noun "pathway" throughout those 17 years but have yet to see a compelling implementation...
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hi marcus,
the nhs is gr8 at managing clinical data, it is a world leader
with regard to PATIENT admin data it may still be a world leader, but it is certainly not gr8, quiet the opposite
it is the efficient management of PATIENT admin data which will lead to significant cost savings4nhs, releasing money
to be spent on providing better care
nhs managers are not as bright (or strong? tbc) as clinciains and that is why historically the above has come about
PATIENT pathways can cope with operational, financial and clinicial indicators
...
do you know if there is any visualisation (or other easy to understand documentation) of the data model that you and you and others are working with?
do you know if there is an easy way to upload and share documents to this chatter site?
clive
On 08 March 2016 at 10:58 Marcus Baw <discourse-system@openhealthhub.org> wrote:--- ## Post #38 by @john.salter Hi Re care planning I have been working for some time as a spare time project on a prototype for care planning (mainly for mental health but the principles are transferable our physios are very interested) this is based around the care process (assessment, planning, implementation, evaluation) so it ties together a number of functions and tries to replicate a care plan as we feel it should exist in the real world and incorporate things like integrated care plans, decision support and exception recording. [cid:image002.jpg@01D17AB4.8ED08FF0] This is no more than a functioning GUI, no current data model behind it so it really is no more than an example and needs an awful lot of work. I built this using JQueryUI and grab the care items from XML documents according to the formulation that falls out of the assessment. When you mention a domain specific language for declarative care planning, would you be thinking about this for the data model or something for the GUI (or something else?) Many Thanks JohnpacharaneroOpen Health Hub Founder March 8
I think @adrian.wilkins is onto something with making the distinction between 'imperative' process mapping - where you map a pathway in terms of a fixed series of things that happen in a fixed order, and 'declarative' process mapping, in which you state the end point you want, and let the system figure out what needs to be done to get you there.
The difference is, that if I am being declarative, and I say the 'end point' of this stage of treatment is to get the patient to their first cancer MDT, then I just state 'get them to MDT'.
The system knows that before they can go to MDT, the patient will need
- to have had a CT scan, and the results back
- to have had blood tests, and the results back
- booking for MDT made
- transport booking
And it will arrange these with the appropriate intervals.
It has several advantages in that it allows for complete concurrency of the tasks, and if a new pre-MDT requirement is added, this is easy to add and doesn't require re-mapping of the process to find out where the new bit fits in.
It also probably encourages us to think of "small, reusable units of process" rather than heroically trying to map the entirety of cancer care onto one great big BPMN chart.
We need a domain specific language for declarative care planning. @adrian.wilkins - up for it?
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---
## Post #39 by @mayfield.g.kev
[quote="john.salter, post:38, topic:162"]
care process (assessment, planning, implementation, evaluation)
[/quote]
My wife described pathways to me last night and I understood her!
It sounded quite like this care process you mentioned, which creates a care plan possibly from a template/pre defined CarePlan. Your screen shots are pretty similar to FHIR CarePlan https://www.hl7.org/fhir/careplan.html
Am I using the wrong terminology? Can I replace some of this with pathway
---
## Post #40 by @clive.spindley
please do not use the term pathway, without being more specific, it's just waffle, are you talking PATIENT pathways or what?
On 10 March 2016 at 10:49 "mayfield.g.kev" <discourse-system@openhealthhub.org> wrote:--- ## Post #41 by @john.salter Well Done! My wife mostly describes handbags to me and I never understand her! I will take a look at the FIHR care plan shortly. For me the most significant thing is not to see care planning in isolation they are the “planning” phase of a cyclical process that needs to be joined up. I keep thinking I understand pathways and then find a new understanding, I think we are all just viewing different parts of the elephant! --- ## Post #42 by @mayfield.g.kev Clive, I'm still trying to understand what people mean by pathway. It's getting clearer.. --- ## Post #43 by @adamlees Clive, can you elaborate the difference between patient pathways and other kinds and why use of the generic term "pathway" might be ambiguous? I'm a techie integration type with a background in health SW dev so open to correction by clinical colleagues, but I have taken all references to the word to mean generic pathways of patient care, which are clinically designed and documented to form a map of how to diagnose, treat or manage certain conditions. So a specific patient may be on none, one or more than one of these generic care pathways at any moment in time. The "journey" taken by a patient through the care system will most likely encompass time on multiple different care pathways especially if they have multiple conditions. Is this latter what is meant by "PATIENT pathway"? Cheers Adam --- ## Post #44 by @clive.spindleymayfield.g.kev March 10
john.salter:
care process (assessment, planning, implementation, evaluation)
My wife described pathways to me last night and I understood her!
It sounded quite like this care process you mentioned, which creates a care plan possibly from a template/pre defined CarePlan. Your screen shots are pretty similar to FHIR CarePlan https://www.hl7.org/fhir/careplan.html
Am I using the wrong terminology? Can I replace some of this with pathway
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john.salter March 10Hi Re care planning I have been working for some time as a spare time project on a prototype for care planning (mainly for mental health but the principles are transferable our physios are very interested) this is based around the care process (assessment, planning, implementation, evaluation) so …
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hi adam, i am not used to this forum yet, do you know if there is a place where i can upload documents, as i have a good one which
describes the different ways people use the term pathway, then i could send you a link ...
or is it just exchanging chat?
in the mean time, PATIENT pathways (some people call them 188 week wait pathways or RTT pathways) were introduced to accurately measure waiting times, in my mind the most important indicator of all (that's assuming the quality of care is good, which most of the time it is) - PATIENT pathways have played a n enormous part in improving the measurement of waiting times, but trust me, they have so much more to offer ..On 10 March 2016 at 12:02 adamlees <discourse-system@openhealthhub.org> wrote:--- ## Post #45 by @john.salter Thanks Clive, Indeed you make a good, if slightly curt, point. Yes I was originally referring to “clinical pathways” being set as opposed to service pathways which are implicit or intervention pathways which make up the body of the care plan in the context of what I was trying to describe or indeed the patient pathway which is the resultant delivered combination of the clinical, service and intervention pathways. However that said the term pathway still remains a valid descriptor of a bracket category and doesn’t mean that it cant be used, but as you point out in most instances it does require the specific type of pathway articulating. Regards John --- ## Post #46 by @richard.pugmire @adrian.wilkins it's a good idea, but you don't always get the goal you might have intended. If you think about a pathway of care for cancer, for example, it has many different goals or potential outcomes which you don't know at the start. Until you've done a set of actions and observed the results you don't know the next step in the path, and trying to model every pathway twist and turn will make you wish you hadn't! Based on work with a great team at Leeds, I have tried to think more simply in terms of, "from this action in this context, what is my next set of available actions?", simple state machine stuff, with a receipt or timeline for the end user to interpret as needed. You could then build decision support/alerting around patterns of actions in certain contexts (repeated tests, re-admission in 30 days, etc). I've seen this done well in a number of places. The difficulty we found was having an underlying event engine and model that is connected to all of the potential tasks, actions and actors - a large integrated mess! Rich --- ## Post #47 by @adamlees Hi Clive, if it's a web link, if you just paste the link into the message it should come through. --- ## Post #48 by @karen.j.green Hi, I am new to this discussion, although my colleague @john.salter has previously mentioned I work for our Trust as the Pathways lead. We too have spent a lot of time attempting to define pathways and develop a shared common understanding. We have always referred back to the definition of pathways given by the European Care Pathway Association which defines the key characteristics of a pathways as: 1.An explicit statement of the goals and key elements of care based on evidence, best practice, and patient expectations; 2.The facilitation of the communication, coordination of roles, and sequencing the activities of the multidisciplinary care team, patients and their relatives; 3.The documentation, monitoring, and evaluation of variances and outcomes; and 4.The identification of the appropriate resources. Further information can be found here http://e-p-a.org/care-pathways/ We have further categorised pathways as John describes below: service level (task focussed and what everyone should receive) and would include referral management and discharges, condition specific pathways which outline evidence based interventions and intervention pathways which again are task focussed and describe how a specific intervention is delivered and it is the combination of these that create the individual patient pathway. This is the methodology used by our Trust. Data capture and reporting for each of these has always proved difficult which led to @john.salter building the prototype previously referred, which has been reviewed by frontline clinicians who would be keen to adopt this solution. If implemented this would allow us to: · Provide clinical decision support · Capture adherence to the pathway as well as variance · Use that data and information to improve the quality of care and patient experience. It sounds like we are not alone in trying to make sense of this and it would be helpful to see how other areas have tried to capture and use pathway information, although I am clinical by background and have very limited technical knowledge. --- ## Post #49 by @mayfield.g.kev In the ideal world (simple cases) and assuming no exceptions (by exceptions I mean referral could be rejected, implementation may change the plan, etc). Is this the workflow? (Have seen this a few times in community systems)adamlees March 10
Clive, can you elaborate the difference between patient pathways and other kinds and why use of the generic term "pathway" might be ambiguous?
I'm a techie integration type with a background in health SW dev so open to correction by clinical colleagues, but I have taken all references to the word to mean generic pathways of patient care, which are clinically designed and documented to form a map of how to diagnose, treat or manage certain conditions.
So a specific patient may be on none, one or more than one of these generic care pathways at any moment in time. The "journey" taken by a patient through the care system will most likely encompass time on multiple different care pathways especially if they have multiple conditions. Is this latter what is meant by "PATIENT pathway"?
Cheers
Adam
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clive.spindley March 10please do not use the term pathway, without being more specific, it's just waffle, are you talking PATIENT pathways or what? On 10 March 2016 at 10:49 "mayfield.g.kev" <discourse-system@openhealthhub.org> wrote: []#3b5998; ; font-size: 13px; font-family: 'lucida grande',tahoma,verdana,a…
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---
## Post #50 by @clive.spindley
Good eve,
Does the trust you work for accept eReferrals/PP ID ?
ERefferals are key to the efficient use of health data to reduce the
unacceptable use
Of admin/paper in health
Care.
---
## Post #51 by @clive.spindley
do not be be frightened of talking about this, the info (plus utilization rates)
is, quiet rightly, in the public domain, it will just take me and other some
time to track down
clive
"respect patient confidentiality"
"public service requires public accountability"
---
## Post #52 by @clive.spindley
Will be using the Google cloud (free, thanks) just as soon as I get
myData model data back
Please be ...
---
## Post #53 by @clive.spindley
as promised here is a link to a document about pathways ...
(please note, for Consumer Health Integrated Pathway [CHIP] read PATIENT
Pathway, were called CHIPs 'cause
I think EVERYONE is a health consumer i.e. a PATIENT, or @least will be in the
future, but that didn't do down to well,
shame I thought it was quiet clever for a techie ...
I also think health IT could, in the right hands, be a significant revenue
generator for the NHS, and let's be honest and non
hypocritical, the NHS needs all the revenue it can get @the moment ...
https://drive.google.com/drive/folders/0B0qAojQ_-2qoMDQtYmVBbG5aMFU
made public4all to see
PATIENT centered data model will be made available soon ...
---
## Post #54 by @clive.spindley
please, please, please do not use the term pathway, to a techie, it's like
saying someone has cancer to a cancer specialist
please be more specific ...
---
## Post #55 by @clive.spindley
as promised here is a link:
i have decided to drip feed myModel as it is really, really complicated (it's not possible to overload it
with data but i suspect it could be possible to overload the people trying to understand it)
notes:
1.all health transactions should be assigned to a PATIENT pathway (even if it is just the NHS TimeLine,
uniquely ID'd bi the NHS Number)
2. care pathways are color coded e.g. a child PATIENT pathway where the care pathways is autism might
be coloured PURPLE (all the BI technologies make heavy use of color including Tableau ;-))
IF THIS IS OF INTEREST TO YOU PLEASE LET ME KNOW AS I INTEND TO PASSWORD PROTECT
(i am 'appy to be open with those that i trust, but i am not an idiot, nothing is free and in myWorld the
most important thing "i can do" is to develop my data model and play with it using Qlik tech)
i use Qlik technology to model data for and develop PATIENT health apps, I am comfortable with it,
Qlik Sense app tech is in it's early stage of development, they really are a way
of rendering their dashboards on mobile devices, they are not that "appy" yet but THEY are
able to invest in and "DO" the right things
Qlik will not share their plans4the future, why should they? they live in the real world, the competitive
world, they must stay ahead of the competition :-) but i trust they are "heading" in the right direction ...
(i.e. they do not have the same usability as, say, a bank app giving customers access to their
financial transactions) - i am looking @ other technologies
ps thanx 2Google for allowing me to share my model with others in a similar world to me
NEXT ? integarted Care Teams, then integarted Care Models
--- ## Post #56 by @clive.spindley https://drive.google.com/file/d/0B0qAojQ_-2qoSDl6c2dBRTVYU2c/view?usp=sharing appologies the previous link was not shared, this one should do it... --- ## Post #57 by @clive.spindley https://drive.google.com/file/d/0B0qAojQ_-2qodTZGVGQxVnZ3eG8/view?usp=sharing talking it quick is good but doing it quick is better ... to follow: more on integarted Teams inetgarted care models into. to (patient level) health transactions ... things will start to get a bit complex now, quiet often "normal" people start to drift away when things start to get complex but please don't, if you do not understand (DNU) ask --- ## Post #58 by @clive.spindley integrated multi discipline Teams are responsible for PATIENTs there will be such a Team for each of the PATIENT pathways that are currently active for the PATIENT in myModel, after the PATIENT and PATIENT pathway, the Team is probably the next most important class when the members of Team for a PATIENT pathway change then this will result in a xFERiMDT transaction --- ## Post #59 by @mayfield.g.kev I think I see what you mean by pathway. In HL7 FHIR this would be * patient would be FHIR **Patient** (https://www.hl7.org/fhir/patient.html). NHS Number would be found in _Patient.identifier_ * Patient Pathway = FHIR **CarePlan** (https://www.hl7.org/fhir/careplan.html) which is linked to a patient via _CarePlan.subject_ and pathway ID in _CarePlan.identifier_ * Health Tranx = FHIR **CarePlan.Activity** I'm not seeing Care Pathway fully yet but I understand this is like a template defining what the generic plan would be. As soon as it's assigned to a patient it becomes a Patient Pathway (so also a FHIR **CarePlan** with status _CarePlan.status = active|proposed_? Presume openEHR can document this Care Pathway? --- ## Post #60 by @clive.spindley thanx4sharing that, it looks like i need to "plan" to work together as i think there is synergy ... NICE produce a really good list of care pathways (including autism), it is the best list i have tracked down, NICE are not the slightest bit technical, but, i must be honest, very few NHS organisations are and you are right in my model a care pathway is like a template ps even the HSCIC which employs 1,000's employs very people who i would call technical, some of them are brilliant but there are not enough, that is probably because, i must be honest, it does offer career "paths" for technicians (mainly clinicians and managers), that's a significant historic problem that still exists within the NHS are there any pictures of the FHIR model? --- ## Post #61 by @mayfield.g.kev I'll have a look for one. Agree about NICE. Sometimes is good to have a non technical take on things, I struggle sometimes to see the wood from the trees when everything is technical. --- ## Post #62 by @clive.spindley communication? struggle? so do I, not just some of the time, all of the time :-) --- ## Post #63 by @clive.spindley https://drive.google.com/file/d/0B0qAojQ_-2qobW1GbEtlVVdlME0/view?usp=sharing ASK:where is the documentation for the FHIR model that people are discussing on this forum? notes: 1. there are currently Six or Seven "types" of care model being discussed @ vanguard sites, mymodel fully supports itegrated CARE MODELs 2. Where is investment supposed to come from? if you care about Health, be Honest, public money is running out and historically too much public money has been wasted 3. The integarted care model does not need a new ID to be defined (that is the last thing that's needed, another ID), the care model adopts the first PP ID of the first PATIENT PATHWAY thatis assigned to it 4. integarted CARE MODEL types are color coded --- ## Post #64 by @clive.spindley [quote="mayfield.g.kev, post:59, topic:162"] patient would be FHIR Patient (https://www.hl7.org/fhir/patient.html). NHS Number would be found in Patient.identifier Patient Pathway = FHIR CarePlan (https://www.hl7.org/fhir/careplan.html) which is linked to a patient via CarePlan.subject and pathway ID in CarePlan.identifier Health Tranx = FHIR CarePlan.Activity [/quote] app_ologies Gary4Delay in replying (myEmails are ****ed, so I will stick to this site) please point me towards the source of the terms you are using i.e. FHIR CarePlan and FHIR CarePlan.Actvity KIS - All myComms is going to within this box, too many layers otherwise :frowning: --- ## Post #65 by @clive.spindley please use the term PERSON pathway (or if you insist, PATIENT pathway) or CARE pathway (i.e. template), please do not just use the term "pathway" on it's own, this opens the doors4all the gobshites, theNHS does not need gobshites --- ## Post #66 by @clive.spindley please confirm, are you talking about templates? please do not just use the term "pathway", it is too confusing ... every unique person has 0 or more unique PERSON pathways and each unique PERSON pathway is of a particular type (or template, what I and NICE call a care pathway) ps i do not design pathway templates, i design national health data models for national health apps (they are person (including clinicians) not clinically focussed) --- ## Post #67 by @clive.spindley i have changed the name of the class PATIENT pathway to PERSON pathway, why?, because the NHS "thinks" in terms of patients and is increasingly being forced, thank goodness, in terms of service users, in my world thinking like this is no longer good enough because H&SC are being integrated - ALL PEOPLE HAVE HEALTH EVEN IF THE nhs ARE CONTENT TO PLOD ALONG THINKING IN TERMS OF "PATIENTS" ,FROM A NATIONAL PERSPECTIVE, IT IS LETTING PEOPLE DOWN BECAUSE IT HAS THE VAST MAJORITY OF HEALTH DATA (IE THE KEY TO IT) AND IT HAS FAILED TO KEEP UP WITH THOSE WORKING WITH DATA IN MANY AREAS OUTSIDE OF THE NHS IF PEOPLE ARE UNABLE TO LEAD IN THIS REGARD THEY SHOULD HAND IT (PEOPLES DATA ) OVER TO OTHERS THAT CAN app ologies for shouting but the NHS seems to be deaf in both right and left ears, a clinically problem, it needs to listen and, with regard to PEOPLEs health data, rethink :-) --- ## Post #68 by @clive.spindley yes the work clinicians "do" is very complicated, so their (clinical) care pathways are very complicated, far more than a PERSON pathway (which contain real PERSON health ACTIVITY) ... but it is no more complicated that what a health technician does (... that is what needs strong health management) --- ## Post #69 by @clive.spindleythankU
On 07 April 2016 at 07:55 "clive.spindley" <discourse-system@openhealthhub.org> wrote:--- **Canonical:** https://openhealthhub.org/t/what-is-a-pathway-in-human-and-computer-terms/162 **Original content:** https://openhealthhub.org/t/what-is-a-pathway-in-human-and-computer-terms/162mayfield.g.kev:
patient would be FHIR Patient (https://www.hl7.org/fhir/patient.html). NHS Number would be found in Patient.identifier
Patient Pathway = FHIR CarePlan (https://www.hl7.org/fhir/careplan.html) which is linked to a patient via CarePlan.subject and pathway ID in CarePlan.identifier
Health Tranx = FHIR CarePlan.Activity
app_ologies Gary4Delay in replying (myEmails are ****ed, so I will stick to this site)
please point me towards the source of the terms you are using i.e. FHIR CarePlan and FHIR CarePlan.Actvity
KIS - All myComms is going to within this box, too many layers otherwise
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