Computerised clinical pathway management systems and the implications.

This is the second paper of the two-part series. Part 1 of the series (Reconceptualising Clinical Pathway System Design) reported defects existed in the paper clinical pathways and proposed a set of design premises to guide the development of a computerised clinical pathway management system (CCPMS). This paper provides an overview of a robust CCPMS that was designed to accurately map patients' changing clinical states and support dynamic modification of the clinical pathway structure and associated interventions. This electronic system provides clinicians with real time outcome feedback on care delivered and generates alerts on out of range assessment results, deteriorating trends and potential problems such as drug interactions. It has been rated by clinicians who participated in an evaluative study as a highly useful information management and decision support tool. However, the introduction of a power tool like the clinical pathway management system has raised very important issues such as the need for work practice redesign, education of clinicians and more research to maximise the benefits of the tool and achieve better process quality improvement. It also generates serious concerns about legal liabilities and the potential threat of the cost cutting strategies taken by senior management in search of paybacks after their implementation. These issues and their implications are also explored in this paper.