A way forward?
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it is to 'push' information out to the clinicians, e.g. the Virtual Branch Libraries of NeLH (discussed in Chapter 2). • Organisations could choose to form a mini-CoP, allowing the possibility of Virtual clinical networks' to co-operate on clinical audit and research projects to more systematically develop evidence where it was lacking. This would allow for immediate access to larger sample sizes to measure the impact of service changes introduced via care pathways.
4 Consistent, structured standards for care pathways The case for care pathway standards was made in Chapter 6. We believe there needs to be a model which outlines a structure and standards for care pathways. This would contain the 'clinical work-flow' expressed as a hierarchy of stages, steps and tasks, with defined roles, data items and links to other documents. It would also include a definition of software requirements to ensure that suppliers/developers can support e-pathways properly. These standards and structure would be independent of means of implementation, i.e. paper, electronic, work-flow type system, in-house software development and bought-in software. The purpose would be to: • support a validation framework to improve care pathway quality • provide a means of exchanging pathways more easily (e.g. generic to local version, local 1 to local 2 comparison) • provide a starting point for implementing service redesign (e.g. a template for modernised outpatient services) • provide a means of more easily implementing care pathways in clinical computer systems • support the maintenance of the clinical evidence and knowledge management required by care pathways. To date in the UK, local teams have carried out most of the effort on care pathway development and implementation. At this point in time what is missing is explicit, whole systems management of the topic. What is needed is an overall care pathway framework that involves national and local levels.
An e-pathways framework The four developments outlined above could provide the principal building blocks of an overall care pathway management framework. Some of the main objectives for this framework are listed below: