Design approaches for executable clinical pathways at the point of care in limited resource settings to support the clinical decision process: review of the state of the art

Decision support clinical pathways are used to improve the performance of the health-care management system. An effective clinical pathway(CP) helps to know the optimal treatment route that patients will follow. The extent of the CP goes from the first contact in the health-center(or hospital) to the completion of the treatment until the patient is dismissed. Up to now, far too little attention has been paid to a systematic review, the research and the development of CPs in a low resource setting(LRS). The main focus has been primarily on data-intensive environments where there is no shortage of resources. A systematic search in PubMed and Web of Science was conducted for bundling and categorizing the relevant approaches for LRS. Of 45 full reviewed articles, 25/45(55.6%) and 20/45(44.4%) of the studies were conducted using knowledge-based and data-driven approaches respectively. Among the knowledge-based studies, 9/25(36%) were reporting a stand-alone applications,10/25(40%) attempting to deliver a paper-based CP, and the remaining focus was on web-based applications. In the data-driven approaches,15/20(75%) tried to integrate with the electronic health record. The paper identifies the approaches for executing CPs and highlights key considerations for building LRS-compatible CPs. Data-driven CPs do not only resolve the challenges of improving the quality of existing knowledge-based CPs, but also enable evidence-based practice, improve outcomes, and reduce cost and delay.