ICP's and EHR

An ICP determines locally agreed, multidisciplinary practice based on guidelines and evidence where available, for a specific patient/client group. It forms all or part of the clinical record, documents the care given and facilitates the evaluation of outcomes for continuous quality improvement".

National Pathway Association (1998)

ICP’s have their origin in providing coordinated care to patients by different specialist teams within a healthcare organisation. Each team records their interventions on a patient for a specific health condition in the organisation’s Electronic Patient Record (EPR) system and other teams intervene accordingly based on the notes provided. This paved the way to define electronic ICP’s (e-ICP) in EPR systems.

The advent of Electronic Health Records (EHR) brought the possibility of extending ICP’s across multiple healthcare organisations from different care settings. EHR's facilitate flow of information across different care setting boundaries even to agencies outside healthcare (e.g. social care) who are involved in the care of a patient.

Benefits of Electronic Care Pathways over EHR's:

• Allows care pathways to be built around patients and not institutions by providing real time recording and allowing different organisations involved in the patient care to have the same view
• e-ICP’s provide quick access to information(instead of browsing though bundles of paper for which each organisation has different format and different recording styles) and provide multiple views – high level summary view from different organisations as well as detailed view of each organisation in a chronological fashion
• e-ICP’s allow faster remodelling and review of business processes to suite each patient

However the difficulties in deploying e-ICPS’ through EHR is not a technological one but cultural and business one involving the need for agreeing common data formats and sharing the data owned by an organisation across different care settings and agencies.

EMR from Prespective of Pharma

Pharma companies have started working with clinical service providers and started using EMR's from two prespectives

• Data and Study Setup


• Secondary Users Service

Data and Study Setup

Data and Study setup can be incorporated in a EMR to exploit the following features

• Implement screening parameters into core EMR to identify prospective patients for pharma trials at point of care
• Setup data capture from trials as part of clinical care and clinical documentation workflow
• Populate data in care report forms automatically from EMR
• Embed care record forms as tabs in core EMR so data is collected and stored against patient record
• Implement clinical rules and alerts for compliance and range checks for data and structured documentation checks

Secondary Users Service

It can be used for the following

• Easier data extraction from EMR for proper reporting on adverse events
• Unified reporting of current and historical data
• Findings can be published as standard clinical documentation
• Monitor outcomes based on ICP’s and evidence based decision support

Example Implementations

Pfizer – Drug Safety -Supporting Physician Reporting of Adverse Reactions and Public Health Threats

NOVARTIS – Clinical Trial: Lab and Image Data - Innovating Clinical Data Capture for Labs and Images using EMR lab ordering and results reporting using HL7

Eli Lilly – Patient Visit Workflow – Streamlining the patient workflow using standard Inpatient and Outpatient workflows

genzyme – Disease Registry – Profiling diseases geographically and using other statistical profiling such as gender , age etc

SAIC – Biosurveillance -Standardizing and Facilitating Data Collection for Enhanced Biosurveillance