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!
Clive,
I’m still trying to understand what people mean by pathway. It’s getting clearer…
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
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: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
Visit Topic or reply to this email to respond
In Reply To
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…
Visit Topic or reply to this email to respond
To stop receiving notifications for this particular topic, click here. To unsubscribe from these emails, change your user preferences
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
@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
Hi Clive, if it’s a web link, if you just paste the link into the message it should come through.
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.
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)
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.
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”
Will be using the Google cloud (free, thanks) just as soon as I get
myData model data back
Please be …
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 …
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 …
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
https://drive.google.com/file/d/0B0qAojQ_-2qoSDl6c2dBRTVYU2c/view?usp=sharing
appologies the previous link was not shared, this one should do it…
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
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
I think I see what you mean by pathway.
In HL7 FHIR this would be
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?
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?
