Modelling and Decision Support of Clinical Pathways

The German health care market is under a rapid rate of change, forcing especially hospitals to provide high-quality services at low costs. Appropriate measures for more effective and efficient service provision are process orientation and decision support by information technology of clinical pathway of a patient. The essential requirements are adequate modelling of clinical pathways as well as usage of adequate systems, which are capable of assisting the complete path of a patient within a hospital, and preferably also outside of it, in a digital way. To fulfil these specifications the authors present a suitable concept, which meets the challenges of well-structured clinical pathways as well as rather poorly structured diagnostic and therapeutic decisions, by interplay of process-oriented and knowledge-based hospital information systems. 1 Development of the Process-Oriented Perspective in German Hospitals to the “Clinical Pathways” Since the mid 1990s process orientation is steadily gaining importance by popular buzzwords like Business Process (Re-)Engineering in enterprises and business managements, and it is nowadays essential basis for goods and services and service offering with the aim of improving the success affecting variables time, cost and quality [5]. Further important, and often with process orientation associated objectives, are transparency of business processes as well as quality-oriented requirements or certificates [1]. Contrary to the establishment of process orientation in most industry sectors, it could not gain importance in the field of German hospitals until the 2000s. The modelling, analysis and visualisation of workflows in hospitals in the areas of diagnosis, therapy and care proceeded with the goal of getting a detailed overview of the “hospital enterprise”. The initial goal was oftentimes the process acquisition, for example in accordance with the aspired ISO 9001-Certification. During this procedure the business process of the complete enterprise was initially mapped, then in each department the process landscape with the main processes was compiled, and, in a third step, the precise process sequence was surveyed and modelled (cf. figure 1). 1 The obligation to adopt quality management in hospitals originates from §135a, subparagraph 2, sentence 1 of the German Social Security Code Book (dt. Sozial Gesetzbuch, SGB). The standards DIN EN ISO 9000ff. are one of the prevalent quality management methods and were developed for the service and production sector [1]. 2 cf. for the relationship between qualityand process-orientation in hospitals also [10], [1]. 148 R. Gabriel and T. Lux