During the Hospital HealthPathways webinar held on Thursday 25th of March, a number of questions were asked, some of which we did not have time to answer during the session. Below are all the questions asked, click on a question to reveal the answer.
Community HealthPathways has clearly displayed criteria for accessing outpatients assessments. At the moment HHP doesn't have guidance for what to do when the patient is seen in outpatients. However, it has been identified that this is an area for work - for example, when should a patient be discharged from outpatient followup.
SME buy-in is a major challenge. The 'starter-set' of pathways comes from a tertiary hospital environment (Canterbury) and, generally, has input from specialists/sub-specialists. For a smaller centre the role of the SME would mostly be 'does this work here or, if not, what do we need to change?' So, for SMEs who are thinner on the ground and more generalists, ideally the role would be no more than determining the process issues that are different and the threshold for referral to a bigger centre.
Not that we're aware of to date, although the NZ Ministry of Health will soon be funding a specific Hospital HealthPathways implementation which is likely to have evaluation wrapped around it.
Hunter New England in NSW are using HHP, the team there has asked that all initial enquiries be directed through Streamliners i.e. Andy.Froggatt@HealthPathwaysCommunity.org
No, we haven't developed pathways on those specific conditions. We hope/expect that HHP and CHP could be used to address some important integration problems - transitions from hospital to community and from paeds to adult services.
The key to this issue is ensuring the guidance in your instance of Community HealthPathways is clear on these matters and that general practice, after hours services, and ambulance all trust and use HealthPathways. Hospital HealthPathways covers most conditions presenting in ED, and for the lower acuity and less urgent conditions it cross-references Community HealthPathways, so the ED staff know how the condition would be managed in the community and that it can in fact be triaged straight back there.
There's now 47 implementations of Community HealthPathways sharing and adapting each others content. We are noticing that where the teams engage effectively in the regional collaboration and pathway sharing forums, and where clinical editors receive and apply the training provided, the amount of unnecessary variation occurring between regions is reducing. This is particularly evident in Queensland where the state is a partner at the table with us and the 12 separate regional implementation teams. With Hospital HealthPathways it's still early days in assessing the amount of necessary variation between sites, but we have noticed that Hunter New England aren't making a lot of changes to the clinical content of the original Canterbury pathways. The differences are in the 'requests' for services from other parts of the hospital service, and in the multi-hospital escalations. In partnership with Hunter New England we've develop what seems to be an effective set of templates for dealing with the multi-hospital challenges.
For both Community and Hospital HealthPathways the site content is for registered health professionals only. The rationale for this has been reviewed and debated many times and, while there are plausible arguments for patient access, the balance of arguments still favours keeping access restricted to health professionals. This is largely to do with the way the pathways are written in very cut-down form and requiring a high degree of clinical knowledge to interpret to a particular patient context. Anyone without that clinical knowledge risks misunderstanding and potentially harming themselves and/or making consultations doubly difficult. That said, may clinical users of HealthPathways will spin the screen around so the patient can see the guidance, and talk them through the assessment and management sections, adding context relevant to that patient.
Yes, in two ways. Firstly, the editors of the community and hospital pathways for the same condition aim to ensure the two mesh i.e. referral and discharge expectations are aligned, the same subject matter experts have been consulted for both. Secondly, at a pathway level in each site, there are links to the corresponding pathway in the other site. CHP and HHP are designed to work closely together to give an aligned response across the primary and secondary care continuum.
There is a critical governance issue to address here. In Canterbury, Hunter New England, North Cumbria, and Mid Central where Hospital HealthPathways is, or soon will be, being implemented the geographic catchments for both Community and Hospital HealthPathways is in each case the same and under a single governance model. However in other places, such as Melbourne for example, Community HealthPathways is led by a partnership of PHNs who have within their catchments multiple independently governed hospital networks. Each of those hospital networks probably warrant separate instances of Hospital HealthPathways to reflect their unique circumstances and hence, getting to the root of your observation, there will be a challenge in getting good alignment between their hospital pathways and the community pathways that wrap around all of the hospital networks in the region. This challenge may also be an opportunity to drive out unnecessary variation in practice across the hospital networks, and perhaps there's an option for alliancing model where the PHNs, the hospital networks, and their state funder sponsor a metropolitan-wide governance framework for the Hospital HealthPathways work. There may be many other options, and we'd be happy to explore those with you. Our contact is Andy.Froggatt@HealthPathwaysCommunity.org
Yes, there's always room for improvement.
Please see https://api.healthpathwayscommunity.org. Note that at present the API enables searching of HealthPathways from a third party application and launching of the resulting pathway in its own browser frame. It's not in XML format for rendering within the third party system. Please see the videos on the link above for a better understanding of this.
Yes, the same concepts apply and work in both contexts.
Smart linking is via the APIs. Please see https://api.healthpathwayscommunity.org. In Canterbury the Cortex clinical notes tool is using the API. Please note though that while pathway content can be pasted into patient notes, the pathways themselves are patient agnostic i.e. no patient data is linked to the pathway, nor is it an automated algorithm. The Doctor's desktop computer must still be engaged.
The two sites meet the needs of two different audiences each working in very different contexts, while the pathways themselves are designed to mesh and cross-reference where appropriate. One of the reasons HealthPathways has been so effective and successful is that it's designed to meet the needs of clearly defined end-users. Whole-of-system process maps are great for analysts and system designers, but not so good for a clinician sitting with a patient needing to find a specific piece of information within seconds.
This was discussed during he webinar. It is an important question although it is a big one. The answer is mostly about recognising the value of HHP and the processes of engagement. When a region adopts HHP this will be an important discussion.
Discussed briefly during the webinar. The short answer is that Allied Health Ways is for allied health profesionals giving guidance about how to manage patients in front of them. The allied health tab in CHP is a development prior to AHW - so there is overlap - but has more of a focus on how the GP team interacts with allied health.
In terms of local staffing it's about the same as recommended for Community HealthPathways. There are some efficiencies at the programme management level, and in time investment by subject matter experts. The licencing model is the same as being applied for Community HealthPathways in the UK and Ireland, but a bit different from what Australian and New Zealand members are used to. To discuss your particular situation please contact Andy.Froggatt@HealthPathwaysCommunity.org
Most hospital book shelves and intranets are littered with clinical pathway publications. A very few of those are well maintained, often thanks to a very dedicated few who, in due course, retire. The effort of developing and maintaining those publications is immense. The power of the HealthPathways Community is that we share a common platform and collaborate on new pathway developments and reviews. The New Zealand, Queensland, NSW and other state Ministries of Health are increasingly seeing the value in the platform and collaborative activities of the HealthPathways Community and are quite respectfully obtaining a seat at the table to support ongoing collaboration, efficiency, and avoidance of unnecessary variation in practice. The isolated guideline manuals on the bookshelves are a useful reference when localising pathways to a particular hospital's context, but once that's done they should be retired. Utilising Hospital HealthPathways provides a process and platform to effectively use clinicians time and ensure that guidelines are available, up-to-date and easily adopted in clinical practice.
Community HealthPathways, as it reflects local agreements between primary care and their hospital colleagues and other specialists about what to refer, when and how.
All health systems struggle with growing demands on their services and funding that doesn't keep up. Health systems that are fragmented and don't have clear pathways for managing patients in the community and in hospital settings will struggle even more. Most hospitals have issues with, amongst other things, the unwarranted use of testing, ordering of diagnostics, poor internal flow and discharge processes. These all negatively impact patient care, are an inefficient use of resources and have significant cost implications.