JMIR Publications

ABSTRACT

Background:

Patient pathways (PP) are presented as a ‘panacea solution’ to enhance health system functions. It is a complex concept that needs to be described and communicated well. Modeling plays a crucial role in promoting communication, fostering a shared understanding, and streamlining processes. A few existing systematic reviews focused on modeling methods and standardized modeling languages. There remains a gap in consolidated knowledge regarding the utilization of diverse visual modeling languages.

Objective:

This scoping review aimed to compile visual modeling languages employed in representing PPs, including the justification and the context in which a modeling language was adopted, adapted, combined, or developed.

Methods:

After initial experimentation with the keywords used to describe the concepts of PPs and visual modeling languages, we developed a search strategy that was further refined and customized to the major databases identified as topically relevant. In addition, we made gray literature and hand searches of referenced articles. Two reviewers independently screened in two stages using preset inclusion criteria and a third reviewer voted on the discordance. Data charting was done using an iteratively developed form in the Covidence software. Descriptive and thematic summaries were presented following rounds of discussion to produce the final report.

Results:

Out of 1838 articles retrieved after deduplication, 22 papers satisfied our inclusion criteria. Clinical pathway is the most used phrase to represent the PP concept and most papers discussed the concept without providing their operational definition. We categorized the visual modeling languages into five categories: 1) General-Purpose Modeling Language (GPML) adopted without major extension or modification, 2) GPML employed formal extension recommendations, 3) Combination of two or more modeling languages, 4) A developed Domain-Specific Modeling Language (DSML), and 5) Ontological modeling languages. The justifications for adopting, adapting, combining, and developing visual modeling languages varied accordingly and ranged from versatility, expressiveness, tool support, and extensibility of a language to domain needs, integration, and simplification.

Conclusions:

Various visual modeling languages were employed in PP modeling, each with varying levels of abstraction and granularity. The categorization we made could aid in a better understanding of the complex combination of PP and modeling languages. Standardized GPMLs were employed with or without any modifications. The rationale to propose any modification to GPMLs evolved as more evidence was presented following requirement analyses to support domain constructs. The DSMLs are infrequently utilized due to their resource-intensive development, often initiated at a project level. The justifications provided and the context where DSMLs were created are paramount. Future studies should assess the merits and demerits of using a visual modeling language to facilitate PP communications among stakeholders and use evaluation frameworks to identify, modify, or develop depending on the scope and goal of the modeling need.