Case Study of the Promotion of Clinical Pathways in the Department of Ophthalmology: Practical Report in a Medical School Hospital

Research Article

Austin J Clin Ophthalmol. 2015; 2(5): 1060.

Case Study of the Promotion of Clinical Pathways in the Department of Ophthalmology: Practical Report in a Medical School Hospital

Wakamiya S¹*, Ono T¹, Morihara Y¹, Yamauchi K¹ and Kiryu J¹

¹Department of Ophthalmology, Kawasaki Medical School, Japan

²Department of Ophthalmology, Toin Hospital, Japan

*Corresponding author: Wakamiya S, Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan

Received: September 29, 2015; Accepted: December 24, 2015; Published: December 31, 2015


A case study was performed to examine factors associated with the promotion of Clinical Pathways (CPs) in the department of ophthalmology. The relationship between the change in application rate of CPs and the correspondence of doctors with the authority to apply CPs in patients was investigated. Four factors related to promotion of CP use were identified: (i) whether the chairman appreciates the value of CPs in medical treatment and care; (ii) putting a capable doctor in charge of CPs; (iii) implementation of a management policy to promote CPs within a hospital; and (iv) the applicability of CPs to a particular medical department.

Keywords: Electronic clinical pathway; Promotion; Ophthalmology; Application rate; Factor


CPs: Clinical Pathways; PDT: Photodynamic Therapy; DRG/PPS: Prospective Payment System/Diagnosis Related Group; VEGF: Anti- Vascular Endothelial Growth Factor


Clinical Pathways (CPs) as technological process management methods were first applied to medical care by Zander in 1985 [1]. In Japan, CPs were imported from the USA in 1992, and their use was promoted after the establishment of the Japanese Society for Clinical Pathways in 1999 [2]. Although CPs has developed to correspond to Prospective Payment System/Diagnosis Related Group (DRG/PPS) in the USA [3], CPs has been introduced to improve the quality of medical care in Japan [4].

Initially, paper-based CPs was implemented. After the promotion of electronic medical records as a national policy by the Ministry of Health, Labour and Welfare in 2001, electronic CPs has been increasingly used instead of paper-based CPs in Japan. Various functions of electronic medical records for managing and implementing CPs have been developed, almost all of which were included in a package of several electronic medical records products.

However, the functions of paper-based CPs were not always available with electronic CPs, and therefore the shift from paperbased CPs to electronic CPs has not always been easy. As cataract surgery is readily adaptable to CPs, the department of ophthalmology is one department with a high CP application rate. However, CPs was little used at the department of ophthalmology in our hospital during the period of paper-based CPs when orders were mainly used with order entry systems. After the introduction of electronic medical records to our hospital in 2010, CPs was not used at all as they were implemented in electronic medical records. This was because of differences in the environment of medical treatment and care between university hospitals, such as ours, and general hospitals where electronic CPs were usually used.

Some trials have been carried out to improve CPs over the past 2 years in the department of ophthalmology. This has resulted in an increase in the application rate of CPs from 0% - 10% to more than 30%.

This study was performed to investigate the factors involved in promoting electronic CPs and to explore the solutions peculiar to electronic CPs. Although many studies on CPs have been reported, there have been no previous studies regarding factors involved in promoting CPs in a hospital or increasing the adoption of CPs from the viewpoint of a case study, rather than being based on experience. As there are many differences in the medical care system among countries, a study of CPs in Japan may not be applicable in other countries without modification. However, such studies will contribute to the promotion of CPs even in other countries.


The present study was performed in the Department of Ophthalmology of Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan. The outline of this hospital is shown in (Table 1). Paper-based CPs were implemented before January 2010, and electronic CPs were introduced along with electronic medical records using EGMAIN-GX (now Ver. 5, originally Ver. 2) as electronic medical records software developed by Fujitsu Ltd. Management of outcomes, tasks, directions to nurses, etc., have been computerized, with the exception of patients’ informed consent and CPs for patients.