A clinical pathway is part of a care plan based on multidisciplinary scientific evidence, which details the actions, decisions, and criteria for the diagnosis, treatment, follow-up, and referral of a disease or symptom. Therefore, they can be used as a clinical support tool for research and decision.
Actions
When using clinical pathways, actions consist of activities that are expected to/can be performed by HCPs at specific moments.
Different versions of clinical pathways implied different features. For that reason, actions can only be consulted on stand-alone pathways, but on the other hand, on the Patient Journey version, actions, and their icons can be selected.
There are many different possibilities of selection in each action for which the HCPs are responsible, like:
Action as a whole
If there are no items
When we want all items from action to be automatically selected
The time and date of the action are recorded
One of the items
In case the item's shape is a circle, which means you can only choose one of the existing options
The time and date of the action are recorded
Several Items
When the item's shape is a square, it is recommended to choose all the options available. However, it is possible to choose one or more from the list, it's an HCP's decision.
Actions are grouped by categories, and each one is associated with a specific color:
Assessment
Diagnosis
Prescriptions
Exams
Monitoring
Treatment
Specialties
Interventions
Status of Actions
Actions have a status associated that represents the progress of each one in the patient session.
Different categories of actions have different statuses, however, the status always represents whether the action is completed, in progress, or was canceled/not done.
Complete is represented by the green
In progress is identified by the orange
Canceled is represented by a grey “dash”.
The status allows knowing detailedly at which point all the tasks are, and can/should be changed by the HCP along the journey when which one is updated. Moreover, all those updates will be saved and can always be consulted.
Actions can have multiple items inside, and each individual item can be associated with a status too.
If HCP chooses a status for the action, all of her items will automatically be marked with the selected status
In case HCP wants to give each item a status, the entire action only changes to completed when all items will have the same status.
So If at least one item is not completed, the status of the entire action is considered in Progress.
Also, for specific statuses associated, a second step is presented to the user, asking for the reason or justification for the previously defined status.
NOTE: It's possible to select only one of them or can opt to not select any status reason, as this field is optional.
It is also possible to go to the previous step and select a different status, or to select multiple statuses. In case the user clicks on a status by mistake, it can be undone in the first “X” hours.
Examples of Actions
Some of the actions have associated details that can be viewed in the right sidebar when we click on the action. The details consist of: recommendations, additional information about the action itself, and the bibliographic references that support the recommendations.
If it is an action with no details, it will appear in the right sidebar saying: "This action does not have details".
Specialties
Indicate for which specialties it's necessary to refer the patient
Interventions
When the patient's condition shows the necessity of an intervention
Prescriptions
Recommendation of the prescriptions of certain drugs
Exams
Shows when it is appropriate to request additional diagnostic tests
Gateways
Gateways are the most complex elements of the pathways, through which it's possible to choose the patient's path.
The possible decisions of a protocol for a certain disease or symptom are represented by gateways. Therefore, depending on the option/options chosen by HCPs a specific path will appear for the patient to take.
The number of options that can be selected depends on the number of the blue rectangle inserted in the gateway.
They're four types of gateways.
Types of Gateways
Exclusive Gateway
Only one option can be chosen
Parallel Gateway
The patient path will be completed when the set of available options has been executed and only after that the path continues
All options must be selected
Whenever one of the paths inside a gateway completes, this message will appear:
NOTE: After all paths are completed, the algorithm will continue
Inclusive Gateway
Depending on the options applicable to the patient in question, you can select one or more options
Each option will result in a different secondary path, but all secondary paths will end up on the same main algorithm path. And that's regardless of whether you selected one or a set of options.
Whenever a path within an inclusive gateway it's finished, a message appears, with two options:
Explore - Allows you to check and change the choices made throughout the algorithm
Continue - Move to the next phase of the algorithm
In case all paths of the inclusive gateway are finished, a message appears:
Rules Gateways
One, several, or all of the available options can be selected
Depending on the number of selected options the resulting path may differ from the pathway
In gateways, each time we click on one of the options, automatically, the next step of the path will be shown.
Medical Calculators
Medical calculators have an associated formula based on scientific evidence and depending on the result obtained, they can show different paths of the algorithm.
Our clinical pathways have the particularity of having integrated medical calculators which act as gateways and for that reason, the next step depends on the resultant value.
NOTE: Unlike gateways and actions that are filled in directly on the pathway, calculators are open on the left sidebar and this is where we choose the set of options. And in the end, the final result will appear on the pathway.
Events
Events represent and register the patient's status, and will appear during the pathway, on:
An Initial Point
Patient's status at the first moment of the appointment
An Intermediate Point
Patient's status during the pathway
A Final Point
All clinical pathways end with the final patient's status
Events Examples
Pathway Links
Pathway Links represent the connection between pathways. That way at the end of a certain algorithm the HCPs can be redirected to another pathway (for a specific location).