Clinical Pathways System; An Evidence-based Tool in Care Quality Management and Improvement

A clinical pathway is one of the main tools used to manage quality inpatient care in relation to the standardization of care workflow and processes. Implementation of clinical pathways reduces the variability in clinical practice and improves outcomes. Clinical pathways aim to promote organized and efficient care rooted in evidence-based medicine and optimize outcomes in inpatient and ambulatory settings. 

A clinical pathway provides the means for clinicians and institutions to achieve 4 common goals  – decreased care fragmentation, optimized cost-effectiveness, improved patient throughput, and enhanced patient and family education regarding an anticipated treatment course. 

Integration of clinical pathways within the Electronic Health Record further helps to facilitate evidence-based practice.  

Business Goals 

Our client – a leading Academic Medical Center in the United States, has engaged First Line Software to design and implement a software application that would allow the institution to define and execute a range of clinical pathways on a single technological platform that is integrated with the EPIC EHR system on multiple levels. 

Each pathway depicts the workflow expected of health care practitioners, establishing the time frame for evidence-based practice to occur. The pathways provide a standard framework of expectations in the pre-, intra-, and post-operative phases for integrating the practical deliverables from the clinical practice guidelines. 

Each pathway would be represented as a sequence of documentation checkpoints that clinicians need to complete in the course of a surgery or a procedure. 

The system would consist of two main components: 

• A provider dashboard reflecting the state of the pathway for each enrolled patient. 
• A pathway application where providers can enroll/unenroll patients and update the pathway documentation. 

The system would collect and aggregate usage data for subsequent processing and analytics. 

Implementation Highlights 

Working jointly with clinicians, an analytical team, and leadership of the IT organization from the client institution, the First Line team has created a flexible Clinical Pathways platform where analysts can author virtually any pathway, define clinical dependencies and business logic, and document the workflow. 

Highlights of this system include: 

Flexible infrastructure for any pathways 

The Clinical Pathway platform is designed to support a wide range of multidisciplinary pathway flows that cross the boundaries of encounters and institutions. 

Seamless integration with Epic EHR 

Integration on the User Interface level: The Clinical Pathways application is invoked and provides a single Sign-On directly within Epic EHR Hyperspace. 

Back-end Integration: The business logic in the system relies on real-time patient data pulled from Epic via the back-end integration services. The same integration service infrastructure is used to present users with the relevant clinical data from the patient’s medical record stored in Epic. 

Technology and Infrastructure 

SQL Server; C#; .Net; Angular.