Reconceptualising clinical pathway system design

Increased patient throughput and patient acuity resulting from the introduction of prospective funding mechanisms, such as Case Mix (based on the Diagnosis Related Groups) for in-patient acute care, raised serious concerns about compromising quality of care delivered to patients. The paper clinical pathway has been introduced as a tool to streamline documentation, implement standardised clinical management protocols and improve quality of care provided to patients. However, the checklist format and its lack of connection to clinical data reflecting changes in patient status have imposed severe limitations on the ability of clinical pathway to be used as an effective information management and decision support tool. This is the first of two papers reporting on a research effort that was undertaken to identify, validate and address the limitations of paper clinical pathways. A set of functional specifications and a functional model were developed following the initial exploratory study. The work led to a set of reconceptualised system (CCPMS) design guidelines for the development of a robust computerised clinical pathway management system that could provide dynamic information management and decision support to clinicians in response to changing patient clinical status. The second paper will report on the features and benefits demonstrated by the CCPMS prototype. Implications to nursing brought about by the introduction of such a tool will also be explored.