title: The eClinical Care Pathway Framework: a novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections.
abstract: Despite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which comprehensive online clinical care could be linked, facilitating completely self-directed, remote care. We describe a new framework for developing complex online clinical care pathways and its application to clinical management of people with genital chlamydia infection, the commonest sexually transmitted infection (STI) in England.
  
  
  
  Using the existing evidence-base, guidelines and examples from contemporary clinical practice, we developed the eClinical Care Pathway Framework, a nine-step iterative process. Step 1: define the aims of the online pathway; Step 2: define the functional units; Step 3: draft the clinical consultation; Step 4: expert review; Step 5: cognitive testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: software testing, usability testing and further comprehension testing; Step 9: piloting. We then applied the Framework to create a chlamydia online clinical care pathway (Online Chlamydia Pathway).
  
  
  
  Use of the Framework elucidated content and structure of the care pathway and identified the need for significant changes in sequences of care (Traditional: history, diagnosis, information versus Online: diagnosis, information, history) and prescribing safety assessment. The Framework met the needs of complex STI management and enabled development of a multi-faceted, fully-automated consultation.
  
  
  
  The Framework provides a comprehensive structure on which complex online care pathways such as those needed for STI management, which involve clinical services, public health surveillance functions and third party (sexual partner) management, can be developed to meet national clinical and public health standards. The Online Chlamydia Pathway's standardised method of collecting data on demographics and sexual behaviour, with potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management.
authors.affiliation: Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK. jo.gibbs@ucl.ac.uk.|Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, UK. jo.gibbs@ucl.ac.uk.
authors.forename: Jo
authors.identifier: 0000-0001-5696-0260
authors.initials: J
authors.lastname: Gibbs
authors.affiliation: Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
authors.forename: Lorna J
authors.initials: LJ
authors.lastname: Sutcliffe
authors.affiliation: School of Information Systems & Computing, Brunel University London, Uxbridge, UK.
authors.forename: Voula
authors.initials: V
authors.lastname: Gkatzidou
authors.affiliation: School of Information Systems & Computing, Brunel University London, Uxbridge, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Hone
authors.affiliation: School of Law, Queen Mary University of London, Mile End Road, London, UK.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Ashcroft
authors.affiliation: HIV/STI Department, Public Health England, London, UK.
authors.forename: Emma M
authors.initials: EM
authors.lastname: Harding-Esch
authors.affiliation: HIV/STI Department, Public Health England, London, UK.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Lowndes
authors.affiliation: Institute of Infection and Immunity, St George's, University of London, London, UK.
authors.forename: S Tariq
authors.initials: ST
authors.lastname: Sadiq
authors.affiliation: Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Sonnenberg
authors.affiliation: Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Estcourt
mesh_terms: D002690:Chlamydia Infections / Q000628:therapy*; D016358:Contact Tracing / Q000379:methods*; D019091:Critical Pathways; D011307:Drug Prescriptions; D004739:England; D006801:Humans; D020407:Internet; D017410:Practice Guidelines as Topic; D017216:Telemedicine / Q000379:methods*
keywords: Chlamydia trachomatis; Framework; Online clinical care pathway; Sexual health; Sexually transmitted infections; eHealth