Automated Conflict Resolution in Clinical Pathways

By 2018, it is estimated that the number of people in the UK with three or more long-term conditions, also known as multimorbidity , will have grown from 1.9 million to 2.9 million. Various chronic diseases develop simultaneously in response to common risk factors such as smoking, diet, ageing and inactivity. The four most common chronic diseases are cancer, chronic obstructive pulmonary disease (COPD), coronary heart disease and diabetes. A recent study found that over 97% of patients with moderate to severe COPD had at least one concomitant chronic disease.

In clinical settings processes are complex and are influenced by a number of social, technical and organisational factors. This complexity can result in variation in how physicians practice, appropriate care is documented, and healthcare costs managed. To reduce inconsistencies, clinical guidelines have emerged based on the best existing evidence, with the aim to support clinical staff and improve the quality of healthcare. Current guidelines almost entirely focus on single conditions. As a result, applying multiple guidelines to a patient may potentially result in conflicting recommendations for care.

In software system design and development, we create computer systems capable to support diverse interactions between the environment/users and the system. These interactions often reflect different and possibly conflicting viewpoints, such as those presented by different users or stakeholders. Although software system specification and patient care guidelines seem different, inherently they have something in common. In both cases we have procedures and executions of (partially) ordered sequence of actions (aka activities or tasks) called "traces of execution" in computer science or "pathways" in clinical practice. In the case of computer-based systems, actions are carried out by users or computers (more specifically individual components or objects in the system). In the case of care guidelines, actions are carried out by physicians, patients and carers. In both cases, conflict may arise when individual executions and pathways are incompatible. In this proposal, we investigate automated methods of detection of conflicts in clinical pathways for multimorbidities and propose solutions that resolve them .

Our industrial partner is a leading developer of clinical management systems in the UK. Their flagship product is extensively used within primary care settings and the wider healthcare environment. Furthermore it supports a language for expressing pathways currently being piloted across a number of sites within the UK, West Midlands included. They will be involved in the development and commercialisation of the new technologies developed in this project to compliment their existing software. Two members of staff will be seconded to work on this project. In addition, other software companies which are active in health management will also benefit from our research. We will also invite other companies that develop software for use in primary and secondary care to explore possible avenues for future collaboration and commercialisation by introducing them to new technologies that complement their existing software.

Heart of England Foundation Trust (HEFT), is a large 3 site foundation Trust serving a diverse population around Birmingham and Solihull. There are high rates of multimorbidity in the areas served, particularly around Heartlands hospital, which is in one of the more deprived areas of the city. HEFT also has an active respiratory clinical practice, of which co-investigator is part, which runs over 30000 outpatient appointments per year, as well as over 100 in-patient respiratory beds. our work will inform existing methods of patient management to improve integration of care.

Birmingham Cross City Clinical Commissioning Group (BCCG) Birmingham Cross-city Clinical Commissioning Group (BCCG) is a clinically-led organisation with the aim of improving health care across Birmingham, based on the best available understanding of the health needs of the local population. BCCG has 117 practices over 125 sites managing a budget of $886 million this year. The involvement of the manager for primary care intelligence from the BCCG will help ensure applicability of our work on a strategic level and introduce them to software based solutions to conflicts in treating patients.

Government funded bodies involved in healthcare such as the Care Quality Commission, Monitor, and NHS England will be informed of our study via our website and annual workshops. This project will raise awareness of the potential for this technology to be applied to patients with multiple morbidity with the potential to inform changes in policy.

Charities such as Diabetes UK, British Lung Foundation and Picker Institute will be informed of our progress via our annual workshops and website. This will inform them of new ways to address challenges in multi morbidity. This would pave the way for them to collaborate in addressing the need of patients with multiple chronic conditions.


After demonstrating the validity, reliability, and utility of the approach our industrial partners will be encouraged and helped to develop products based on the concept at the heart of our study. Our clinical partners will be encouraged to assimilate our findings in to the methods of patient management. Commercial impact will also be achieved in two further ways. First, by developing approaches that we expect to have direct commercial and
clinical impact in the middle future (5-7 years time). Second, by offering consultancy services
to organisations that require more in-depth detail and through the University's Research Office
investigate further commercialisation.