Automated conflict resolution for patients with multiple morbidity being treated using more than one set of single condition clinical guidance: A case study.

BACKGROUND: The number of people in the UK with two or more conditions continues to grow and their clinical management is complicated by the reliance on guidance focused on a single condition. This leaves individual clinicians responsible for collating disparate information from patient management systems and care recommendations to manually manage the contradictions that exist in the simultaneous treatment of various conditions. METHODS/DESIGN: We have devised a modelling language based on BPMN that allows us to create computer interpretable representations of single condition guidance and incorporate patient data to detect the points of conflict between multiple conditions based on their transformation to logical constraints. This has been used to develop a prototype clinical decision support tool that we can use to highlight the causes of conflict between them in three main areas: medication, lifestyle and well-being, and appointment bookings. RESULTS: The prototype tool was used to discern contradictions in the care recommendations of chronic obstructive pulmonary disease and osteoarthritis. These were presented to a panel of clinicians who confirmed that the tool produced clinically relevant alerts that can advise clinicians of the presence of conflicts between guidelines relating to both clashes in medication or lifestyle advice. CONCLUSIONS: The need for supporting general practitioners in their treatment of patients remains and this proof of concept has demonstrated that by converting this guidance into computer-interpretable pathways we can use constraint solvers to readily identify clinically relevant points of conflict between critical elements of the pathway.

MedPath: A process-based modeling language for designing care pathways.

CONTEXT: Medical professionals and hospitals promote solutions like care pathways and Health Information Systems (HIS) to support medical conduct and improve the quality of medical care. PURPOSE: This study proposes MedPath: a Domain Specific Language (DSL) for modeling care pathways based on the paradigms of Model-Based Engineering (MBE) that can be integrated into software solutions. PROCEDURES: We have developed MedPath's abstract syntax with the Eclipse Modeling Framework by employing Ecore technology and concrete syntax with the Eclipse Sirius. FINDINGS: We have modeled over 85 care pathways that are in use in 45 hospitals in Brazil. MedPath-originated pathways have been used over 3.2 million times since October 2017. We conducted a survey among the professionals who used MedPath to evaluate user satisfaction. CONCLUSIONS: We believe MedPath can translate any care pathway into an action flow with its current abstractions. MedPath makes care pathways more easily integrated into HIS and electronic patient records, as it enables programmatic modeling and generates consumable artifacts.

Automated conflict resolution between multiple clinical pathways: a technology report.

BACKGROUND: The number of people in the UK with three or more long-term conditions continues to grow and the management of patients with co-morbidities is complex. In treating patients with multimorbidities, a fundamental problem is understanding and detecting points of conflict between different guidelines which to date has relied on individual clinicians collating disparate information. OBJECTIVE: We will develop a framework for modelling a diverse set of care pathways, and investigate how conflicts can be detected and resolved automatically. We will use this knowledge to develop a software tool for use by clinicians that can map guidelines, highlight root causes of conflict between these guidelines and suggest ways they might be resolved. METHOD: Our work consists of three phases. First, we will accurately model clinical pathways for six of the most common chronic diseases; second, we will automatically identify and detect sources of conflict across the pathways and howthey might be resolved. Third, we will present a case study to prove the validity of our approach using a team of clinicians to detect and resolve the conflicts in the treatment of a fictional patient with multiple common morbidities and compare their findings and recommendations with those derived automatically using our novel software. DISCUSSION: This paper describes the development of an important software-based method for identifying a conflict between clinical guidelines. Our findings will support clinicians treating patients with multimorbidity in both primary and secondary care settings.

Impacto da implantação de um novo modelo de gestão embasado em indicadores no bloco cirúrgico de um hospital universitário terciário / Impact of the implementation of a new model management indicators inthe surgical pack of a tertiary teaching hospital

O centro cirúrgico, por suas particularidades e características, constitui uma das unidades mais complexas do ambiente hospitalar. Assim, percebe-se que o bom desempenho de um centro cirúrgico está diretamente relacionado com a qualidade de seus próprios processos e com os processos dos serviços que o apoiam. Em Julho de 2012, com a portaria 194 – HCRP (5), é estabelecido as Diretrizes Gerais de Funcionamento do Bloco Cirúrgico do HC campus.O objetivo do presente estudo é avaliar o impacto do novo modelo gerencial do Bloco Cirúrgico do Campus implantado.Trata-se de séria histórica descritiva e retrospectiva com análise de alguns indicadores comparando anova gestão com a fase prévia.Nota-se melhora progressiva em alguns indicadores analisados, alcançando metas estipuladas pelo próprio Planejamento estratégico vigente.O presente estudo pode ilustrar o impacto de um modelo gerencial dentro do Centro Cirúrgico de um Hospital Escola Terciário de grande porte, mostrando os avanços alcançados e os pontos com oportunidades de melhoria...

The surgical center, by their features and characteristics, is one of the drives more complex hospitalenvironment. Thus, it is clear that the good performance of a surgical center is directly related to thequality of their own processes and with the processes of the services that support it. In July 2012, with ordinance 194 - HCRP, is established General guidelines for the Operation of Block Círurgico HC campus. The objective of this study is to evaluate the impact of the new management model of Surgical Block the HCRP-campus deployed. It would be historic descriptive and retrospective analysis of some indicators comparing the new management with the prior phase. Note progressive improvement in some indicators analyzed, reaching targets set by the strategic Planning current. The present study may serve to illustrate the impact of a management model with in the Surgical Center of a Hospital Tertiary School large, showing the progress made and the points with opportunities for improvement...

Padronizaçäo de medicamentos psicoativos no Rio de Janeiro / Standardization of psychoactive drugs in Rio de Janeiro

Por solicitaçäo da Secretaria Municipal de Saúde ao Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, é feita análise crítica de lista provisória para padronizaçäo de medicamentos psicoativos. A conveniência desta forma de intercâmbio e sua consonância com as recomendaçöes da Organizaçäo Mundial de Saúde (OMS) é destacada. Tomando a Oitava Lista de Medicamentos Essenciais da OMS como referência, a relaçäo é examinada, recomendando-se a exclusäo daqueles que näo apresentam vantagens inequívocas em eficácia, tolerância, riscos, custos ou aceitaçäo social em relaçäo às substâncias-padräo (Clorpromazina, Haloperidol, Flufenazina depot, Amitriptilina, Carbnato de Lítio, Diazepam e Clomipramina). A implementaçäo, porém, de mecanismos que permitam eventual acesso a medicamentos näo-padronizados, quando clinicamente justificado, é recomendado. Sugere-se a padronizaçäo por indicaçöes principais (antipsicóticos, antidepressivos e estabilizadores do humor, ansiolíticos e distúrbio obsessivo-compulsivo e pânico) mas a utilidade auxiliar de substâncias padronizadas para indicaçöes näo-psiquiátricas (betabloqueadores dos canais de cálcio, anti-histamínicos e antiepilépticos) é lembrada. Considera-se ampliaçäo aceitável da lista da OMS a inlusäo do Clonazepam, do Penfluridol e da Fluoxetina (esta em substituiçäo à Clomipramina) mas ainda se tem como precoce a padronizaçäo de antipsicóticos atípicos e novíssimos antidepressivos sem melhor demonstraçäo de sua conveniência sanitária

Padronizacao de medicamentos psicoativos no Rio de Janeiro: analise critica da lista provisoria da secretaria municipal de saude

Por solicitacao da Secretaria Municipal de Saude ao Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro e feita analise critica de lista provisoria para padronizacao de medicamentos psicoativos. A conveniencia desta forma de intercambio e sua consonancia com as recomendacoes da Organizacao Mundial de Saude (OMS) e destacada. Tomando a Oitava Lista de Medicamentos Essenciais da OMS como referencia, a relacao e examinada, recomendando-se a exclusao daqueles que nao apresentam vantagens inequivocas em eficacia, tolerancia, riscos ou aceitacao social em relacao as substancias-padrao (Clopromazina, Holoperidol, Flufenazina depot, Amitriptilina, Carbonato de Litio, Diazepam e Clomipramina). A implementacao, porem, de mecanismo que permitam eventual acesso a medicamentos nao-padronizados, quando clinicamente justificado, e recomendado. Sugere-se a padronizacao por indicacoes principais (antipsicoticos, antidepressivos e estabilizadores do humor, ansioliticos e disturbio obsessivo-compulsivo e panico) mas a utilidade auxiliar de substancias padronizadas para indicacoes nao-psiquiatricas (betabloqueadores, bloqueadores dos canais de calcio, anti-histaminicos e antiepilepticos) e lembrada. Considera-se ampliacao aceitavel da lista da OMS a inclusao do Clonazepam, do Penfluridol e da Fluoxetina (esta em substituicao a Clomipramina) mas ainda se tem como precoce a padronizacao de antipsicoticos atipicos e novissimos antidepressivos sem melhor demonstracao de sua conveniencia sanitaria.