Integrated Care Pathway Pilot Program Overview

Details

This fixed-scope engagement from Pontegra Software Technologies is a pilot program focused on establishing an operational integrated care pathway for a selected disease (e.g., diabetes screening, hypertension monitoring). The goal is to create a working clinical workflow that enables care team members to follow when creating shared care plans. Technically, the pilot utilizes FHIR CarePlan resources for care coordination and modeling of shared care plans. Integration with FHIR endpoints is included for retrieving patient data and saving the shared care plan. Practitioner dashboards/forms are provided for multiple user roles such as nurses or GPs. The initial 4–6 week scope focuses on high-impact essentials, meaning large-scale EHR integration from underlying systems or advanced decision support (CDS) features are excluded. This pilot is designed as the first step in a long-term partnership, leading to 'Clinical Workflow Rollout' (3–4 months). The subsequent stages include full localization and implementation of governance, culminating in Decision Support Upgrades for personalized care plans using SMART/CDS integration. This service is best suited for care programs needing standardized coordination across practitioners, aiming to build an efficient care delivery system utilizing FHIR-based data linkage.