Building a computerised pathway
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and supports regular review/development of the computerised care pathway.
Creating rules and tasks Using best practice guidelines and clinical evidence, sets of 'rules' and 'tasks' were created. The rules represent, in computerised form, the 'decision trees' which are commonly found in clinical guidelines and protocols, plus other local agreements about flow of work between professionals within the stroke team. The tasks may include treatments, checks or investigations to be carried out, data items and observations to be captured. These are put into action according to the rules relating to certain data, e.g. lifestyle factors, performance measures, blood pressure ranges, weight, smoking/drinking habits etc. For example, in the assessment section of the previous paper version of the care pathway there was a section on smoking history. Once this information had been collected by the clinician it was passed to a clerk and entered into the community patient contact management system. The data were held mainly as a historic record and did not directly affect the clinical work-flow for the individual patient. The actual data on a given patient's smoking habits might or might not generate a referral to the smoking cessation team, due to operational and communications obstacles to efficient work-flow. In the electronic equivalent, the team had to research the evidence base for smoking cessation counselling as a therapeutic input and then build the rule set which automatically produced the referral if certain conditions were met. Clearly, changes in clinical work-flow which are enabled by the computerised care pathway had to be agreed by all stakeholders and properly resourced. Similar development work was replicated in many different parts of the stroke follow-up care pathway. Appendix 4.1 shows example screen shots of the user's view of the system.
Time to develop Overall, the team have taken approximately one year to develop the working computerised system. This includes identifying the rules, evidence base, data entry forms, user interface, messages, test plans, documentation, training plans and materials, security controls, system design and configuration. In total, the net effort by the project co-ordinator, clinical staff and IT staff involved in the pilot has been estimated as approximately one person year. This may seem like a long time and a significant effort. However, this was a new undertaking for all concerned, which added to the time and