Modeling a Clinical Pathway for Contraception

Appl Clin Inform. 2019 Oct;10(5):935-943. doi: 10.1055/s-0039-3400749. Epub 2019 Dec 11.


Background: The Centers for Disease Control and Prevention (CDC) produced a 72-page document titled "U.S. Selective Practice Recommendations for Contraceptive Use" in 2016. This document contains the medical eligibility criteria (MEC) for contraceptive initiation or continuation based on a patient's current health status. Notations such as Business Process Model and Notation (BPMN) and Decision Model and Notation (DMN) might be useful to model such recommendations.

Objective: Our objective was to use BPMN and DMN to model and standardize the processes and decisions involved in initiating birth control according to the CDC's MEC for birth control initiation. This model could then be incorporated into an electronic health records system or other digital platform.

Methods: Medical terminology, processes, and decisions were modeled in coordination with the CDC to ensure correctness. Challenges in terminology bindings were identified and categorized.

Results: A model was successfully produced. Integration of clearly defined data elements proved to be the biggest challenge.

Conclusion: BPMN and DMN have strengths and weaknesses when modeling medical processes; however, they can be used to successfully create models for clinical pathways.

MeSH terms

  • Centers for Disease Control and Prevention, U.S.
  • Contraception / statistics & numerical data*
  • Critical Pathways / statistics & numerical data*
  • Humans
  • Models, Statistical*
  • United States