Pathways for integrated eCare

Pathways for integrated eCare are one of SmartCare's first important outcomes and play an important role in the work of the project.

Learn more about the SmartCare pathways and their use.

Why pathways?

Real-life implementation and mainstreaming of innovative care services never occurs in a vacuum, neither organisationally nor technology-wise (Allen, Glasby and Rodrigues, 2013). It is clear that the implementation of any new service is influenced by structural framework conditions, which sometimes act as strong barriers towards joint working. In current care systems, a range of specialist health and social services tend to be delivered by organisations which are funded, managed and regulated under different rules. Existing care systems tend to be slow in adopting new ways of collaborative working and information sharing, particularly where these cut across established organisational boundaries. Likewise, the process of implementing new ICT tools has to address legacy technologies which were created to support a range of silo processes prior to the concept of better joined-up service provision (Kubitschke et al., 2014). A simplistic approach towards service innovation can easily be interpreted as the wholesale migration to new service processes and ICT tools supporting them. Such an approach poses however major budgetary problems for service providers, and introduces risks in terms of system delivery and potential loss of service (and data) continuity.

The regions participating in SmartCare share many of the structural challenges mentioned above. They differ in terms of

  • health and care systems and their objectives,
  • legal and regulatory frameworks,
  • stakeholders and their role in service provision,
  • health and care processes,
  • existing ICT infrastructures

and a number of other factors. SmartCare’s first challenge therefore was to find a way of working within the framework of this diversity while at the same time achieving common goals. In order to reach its objectives, the project needed an instrument that

  1. would result in a common vision for integrated eCare services cutting across the many European regions with their different frameworks and settings and preconditions, and
  2. would support the controlled migration towards integrated eCare services by managing change within these conditions.

On the one hand, this instrument needed to be concrete enough to structure integrated care processes and to serve as a model that each deployment site could work towards. On the other hand, it also had to be flexible enough to allow for a wide-ranging consensus to be established between the regions and the stakeholders working in them.

A widely used instrument to structure processes in care delivery are pathways. The predominant use of pathways is in healthcare where they are most commonly used as a concept associated with specific clinical conditions such as heart failure or diabetes (e.g. Turner et al. 2008). While clinical pathways are an excellent tool to regulate, prioritize and manage a sequence of events and actions assigned to different healthcare professionals in the delivery of healthcare, their granularity is for the purposes of SmartCare not suitable and productive. They are for example too detailed to achieve a common vision that works for many European regions and too bound to actors and roles that normally change from region to region and context to context. Further to this, clinical pathways identified by a dedicated stocktaking exercise were too difficult to adapt for the purposes of SmartCare as they are too specific to support subsequent phases of needs- und requirements-based development processes.

For this reason, SmartCare introduced pathways as presenting a high-level view on a typical service flow involving health, social and informal care. The pathways present a service flow on a more abstract level, i.e. structured along types of activities or groups of tasks and do not specify actor roles for a clearly defined set of tasks within a specified time. A further differentiation to clinical pathways is that the SmartCare pathways do not specify detailed processes for specific interventions but span the entire integrated care service provision from enrolment to leaving the service instead.

Learn more


Allen, K., Glasby, J & Rodrigues, R. (2013). ‘Joint Working Between Health and Social Care’ in Long-Term Care in Europe Improving Policy and Practice. Palgrave Macmillan. Editors: Leichsenring, K., Billings, J. & Nies, H.

Kubitschke, L., Müller, S., & Meyer, I. (2014). Do all roads lead to Rome? Models for integrated eCare services in Europe. In I. Meyer, S. Müller & L. Kubitschke (Eds.), Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global.

Turner, J., Lattimer, V. and Helen Snooks (2008). An evaluation of the accuracy and safety of NHS Pathways. Retrieved from