Extracting and transforming clinical guidelines into pathway models for different hospital information systems

Healthcare providers are facing an enormous cost pressure and a scarcity of resources. They need to realign in the tension between economic efficiency and demand-oriented healthcare. Clinical guidelines and clinical pathways are used in German hospitals to improve the quality of care and to reduce costs at the same time. Clinical guidelines provide evident medical knowledge for diagnostic and therapeutic issues, while clinical pathways are a road map of patient management. The consideration of clinical guidelines during pathway development is highly recommended. But the transfer of evident knowledge (clinical guidelines) to care processes (clinical pathways) is not straightforward due to different information contents and structures.

We propose a model-based approach to support the development of guideline-compliant pathways and the generation of ready-to-use pathway models for different hospital information systems. A meta-model merges the structures of clinical guidelines and clinical pathways into one generic model. It is encoded through artefacts of Health Level 7 (HL7) in version 3. The deployment process to integrate the defined guideline-compliant pathways into different target systems is supported by an ontology management approach.

We defined a step-by-step instruction for translating the narrative guideline content into formalized care processes. The meta-model provides all necessary structures to capture the pertinent knowledge. The entire process of defining and deploying guideline-compliant pathways is supported by one consistent IT system. The deployment process is designed detached from specific systems so that the defined pathways can be enacted within different hospital information systems (HIS).

The approach enables hospitals to develop guideline-compliant pathways and to integrate them into their HIS without time-consuming manual transformations. That way, best practice advices based on clinical guidelines can be provided at the point of care and therefore improve patient treatment.