Conformance Analysis of Clinical Pathway Using Electronic Health Record Data.
OBJECTIVE
The objective of this study was to confirm the conformance rate of the actual usage of the clinical pathway (CP) using Electronic Health Record (EHR) log data in a tertiary general university hospital to improve the CP by reflecting real-world care processes.


METHODS
We analyzed the application and matching rates of clinicians' orders with predefined CP order sets based on data from 164 inpatients who received appendectomies out of all patients who were hospitalized from August 2013 to June 2014. We collected EHR log data on patient information, medication orders, operation performed, diagnosis, transfer, and CP order sets. The data were statistically analyzed.


RESULTS
The average value of the actual application rate of the prescribed CP order ranged from 0.75 to 0.89. The application rate decreased when the order date was factored in along with the order code and type. Among CP pre-operation, intra-operation, post-operation, routine, and discharge orders, orders pertaining to operations had higher application rates than other types of orders. Routine orders and discharge orders had lower application rates.


CONCLUSIONS
This analysis of the application and matching rates of CP orders suggests that it is possible to improve these rates by updating the existing CP order sets for routine discharge orders to reflect data-driven evidence. This study shows that it is possible to improve the application and matching rates of the CP using EHR log data. However, further research should be performed to analyze the effects of these rates on care outcomes.
Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea.
Sooyoung
S
Yoo
School of Technology Management, Ulsan National Institute of Science and Technology, Ulsan, Korea.
Minsu
M
Cho
Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea.
Seok
S
Kim
Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea.
Eunhye
E
Kim
Management Innovation Team, Seoul National University Bundang Hospital, Seongnam, Korea.
So Min
SM
Park
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
Kidong
K
Kim
Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea.
Hee
H
Hwang
School of Technology Management, Ulsan National Institute of Science and Technology, Ulsan, Korea.
Minseok
M
Song
Assessments Process; Conformance; Critical Pathways; Electronic Health Records; Matching Rate