Pathway definition
Describes the intended model of care. This is the primary business artefact held in the catalogue and should not be tied to named applications, interfaces, provider locations or local procedures.
Working proposal
HPDS is being developed by Agile Health Informatics Ltd for open review and testing against real pathway catalogues. It has not been submitted to, reviewed by or approved by ISO, IEC or a national standards body. The proposal remains subject to change.
The problem
Healthcare pathways are important business knowledge, but they are rarely managed like business information.
Healthcare organisations routinely catalogue applications, interfaces, services, data assets and standards. Pathways are more often distributed across guidance documents, diagrams, spreadsheets, local operating procedures and system configuration. That makes them difficult to discover, compare, govern, reuse and relate consistently to information requirements and technology.
What becomes difficult
When pathway meaning is dispersed across documents and systems, important distinctions can become implicit: who is responsible, what information is required, which decisions change the route, what outcome is intended, and which parts belong to local implementation rather than to the pathway itself.
The proposed response
HPDS treats the pathway definition as a governed business artefact in its own right. It is intended to remain intelligible to clinicians, managers and architects while also supporting structured processing and controlled lifecycle management.
1. Pathway catalogueA governed collection in which pathway definitions can be found, compared and maintained.
2. Pathway definitionThe intended model of care, expressed independently of a particular EPR, workflow engine, supplier or exchange technology.
3. Local implementationThe services, workforce, applications, interfaces, locations and procedures through which a particular organisation realises the definition.
A central distinction
Definition, implementation and instance are different things.
Keeping these layers separate allows the intended model of care to remain stable and comparable even when organisations use different teams, systems and local operating arrangements.
Pathway implementation
Describes how an organisation or health system realises a pathway definition through particular organisational and technical arrangements, including explicit deviations where they exist.
Pathway instance
Represents the actual course of care experienced by an individual. Patient-level instances contain personal health information and sit outside the normative scope of the proposed standard.
What a catalogue can hold
A pathway record describes more than a sequence of activities.
The proposed model brings the principal business concerns of a pathway into one governed description while allowing the level of detail to reflect the purpose of the catalogue.
Identity and governance
- Persistent identifier and version
- Lifecycle and authority status
- Owner, steward and approvals
- Intended use and provenance
Population, entry and exit
- Target population
- Entry routes and criteria
- Exit routes and criteria
- Transfer and escalation points
Pathway behaviour
- Stages and activities
- Decision points and branches
- Events, timing and exceptions
- Sub-pathways and relationships
Roles and services
- Responsible roles
- Participating services
- Care settings
- Clinical responsibility
Information dependencies
- Information requirements
- Information products
- Clinical concepts and bindings
- Technology-neutral interoperability requirements
Outcomes and evidence
- Expected outcomes
- Measures
- Evidence sources
- Traceability to decisions and activities
Relationship with other standards
HPDS is intended to complement existing standards, not replace them.
The proposal occupies a catalogue-oriented business layer. Other standards and modelling languages can provide conceptual foundations, semantic bindings, exchange representations, behavioural models and computable implementation artefacts.
Different artefacts answer different questions
ISO 13940 provides a conceptual basis for continuity of care. HL7 FHIR can represent shareable plan definitions and implementation artefacts. BPMN, CMMN and DMN can provide precise behavioural and decision views. WHO SMART Guidelines and Digital Adaptation Kits provide structured, software-neutral guidance artefacts.
HPDS proposes the catalogue-ready pathway business artefact that can reference, map to or be realised through those approaches without requiring one of them to serve every purpose.
HPDS
Catalogue-ready pathway business artefact
Catalogue-ready pathway business artefact
ISO 13940Continuity-of-care concepts
Clinical terminologiesSemantic binding
HL7 FHIRShareable and implementation artefacts
BPMN · CMMN · DMNProcess, case and decision views
SMART Guidelines / DAKsStructured guidance
Architecture modelsImplementation mapping
Proportionate formality
Conformance is graded according to intended use.
The working draft defines four cumulative levels. A higher level is not inherently better. A catalogue used for discovery or commissioning discussion may be fit for purpose without computable expressions.
1
Catalogue-readyGoverned minimum dataset, persistent identity and a human-readable catalogue record.
2
StructuredExplicit identified elements with complete structural and behavioural relationships.
3
Semantically boundImportant concepts and criteria linked to versioned semantic resources or declared as local terms.
4
Computably specifiedCriteria and temporal constraints expressed under a declared expression profile where appropriate.
Scope boundary
The proposal deliberately stops short of implementation prescription.
Its purpose is to make pathway meaning governable and reusable, while leaving clinical authority and technical implementation with the appropriate people and standards.
Conformance to the representation does not establish that the clinical content is safe, appropriate or approved.
Individual pathway instances and personal health information remain outside the normative pathway definition.
Messages, endpoints, protocols and integration products belong to implementation architecture.
The proposal does not require a particular process notation, terminology, information standard or enterprise architecture tool.
See the idea applied
Frailty and multimorbidity neighbourhood care demonstrator
The demonstrator uses a synthetic reference catalogue to show how pathway definitions can remain clinically recognisable while being separated from local delivery arrangements, shared-record capabilities and technical implementation detail.
It includes a guided clinical tour, an interactive pathway catalogue, examples of reference versus local delivery, evidence provenance and a technical view of the draft HPDS mapping.
For reviewers and implementers
What to test in the working proposal.
The working draft is intended to be challenged against real pathway catalogues rather than accepted on the basis of the model alone.
Information loss and catalogue usability
Can an existing pathway catalogue be mapped into the model without losing clinically or operationally important meaning, and does the resulting representation remain intelligible as a business artefact rather than becoming a technical schema?
Definition versus implementation
Can local provider, workforce, application and interface choices be separated from the pathway definition without making the pathway too abstract to be useful?
Governance burden
Are identity, provenance, approval, lifecycle and versioning requirements proportionate to the value gained from comparison, reuse and traceability?
Interoperability derivation
Can information dependencies between pathway activities, roles and services be translated into useful technology-neutral interoperability requirements before implementation standards are selected?
Working status
The current material should be read as a proposal for review and practical testing. The name “Healthcare Pathway Description Standard” describes the intended subject and form of the work; it does not imply formal standardisation or accreditation.