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Review
. 2011 Nov-Dec;18(6):738-48.
doi: 10.1136/amiajnl-2010-000033. Epub 2011 Jul 1.

Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems

Phil Gooch  1 , Abdul Roudsari
Affiliations
Review

Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems

Phil Gooch et al. J Am Med Inform Assoc. 2011 Nov-Dec.

Abstract

Objective: There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways.

Methods: A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation 'challenge' themes.

Results: One hundred and eight relevant studies were selected for review. Twenty-five underlying 'challenge' themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed.

Discussion and conclusion: We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Screening flow-chart.
Figure 2
Figure 2
Concept map derived from RefViz Galaxy and Matrix analysis, showing association between study clusters and the ‘challenge theme’ variables. The radius of each circle is proportional to the number of studies in the cluster; the thickness of the line between cluster and theme is proportional to the strength of association between the cluster and the theme.
Figure 3
Figure 3
Conceptual model for implementing process-oriented health information systems.
See this image and copyright information in PMC

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