• The ‘Community’ version of HealthPathways is used by general practitioners, practice nurses, pharmacists, physios, and other primary care health professionals to make better informed decisions with their patients about their care options. HealthPathways covers over 600 clinical conditions, and provides guidance on the assessment, management, and requests for further specialist supports from other community providers and hospital services. The guidance is tailored to each local health system through a process of review, discussion and agreement between primary care experts and hospital colleagues.
• The ‘Hospital’ version of HealthPathways is relatively new, and is used in Christchurch (NZ), Palmerston North (NZ), Hunter New England (NSW), Cumbria (UK) by hospital staff to support improved clinical decision-making in a hospital context.
• The ‘Community’ and ‘Hospital’ versions of HealthPathways are designed to work together to improve the transition for patients between community and hospital settings.
• HealthPathways is proven to reduce unwarranted clinical variation and to improve the quality of care received by patients. See the full suite of evaluations, case studies, and research papers.
• When a peak body, such as a department of health, gets involved with HealthPathways it has the opportunity to look across all HealthPathways implementations in its jurisdiction to assess differing levels of access to health services, region by region. This is sometimes referred to as truly understanding post-code lottery.
• Pathways can be used to help trigger awareness of possible unconscious bias, which can affect equity of health outcomes.

• HealthPathways started in Canterbury, New Zealand, in 2008. The leadership team at the Canterbury District Health Board were embarking on a long term programme of building a high trust, low bureaucracy, integrated healthcare system. Their approach was to support clinicians to design improvements in the care of patients, condition by condition, and cohort by cohort. A lot of the early opportunities for improvement were at the interfaces between community, primary and hospital services. Consumers and clinicians from all parts of the system would agree who would do what, when, and how they would share or transfer care at the appropriate time. Those agreements were written down as quick-reference guidance for clinicians, and became HealthPathways. The tools and services for making the pathways usable during clinician-patient consultations were provided by Streamliners. Streamliners subsequently developed systems for keeping the pathways up-to-date, sharing them across New Zealand and the rest of the world, and building an international collaborative model for sharing clinical best practice and pathway content.
• The Canterbury health system received international recognition of its high performance during and after the devastating 2011 earthquakes. HealthPathways was one of several critical elements in that performance. The highly respected Kings Fund has reported on the performance of the Canterbury health system.  

• The guidance in HealthPathways is informed by the latest clinical evidence from around the world. This is achieved by harnessing the collective capability of over 60 health systems around the world who are members of the HealthPathways Community. When any one of those members updates one of their pathways based on new evidence, all other members have access to that update.
• Unwarranted variation occurs when clinicians in a health system are working to outdated evidence and models of care.
• Because HealthPathways makes transparent the models of care in use in any member health system, it is easy to see where models and services vary from best practice.
• All members are able to compare their pathways with those of other members, in order to make comparisons and learn from each other. Peak bodies, like departments of health, can also work with members to help address the causes of unwarranted variation. 
• Some variation in clinical services can be warranted. For example, not every small town has every service available to it, and so substitute services or travel options need to be included in the pathways. 

• The term post-code lottery can be used when people living in one part of a country or region have different access to services than those living in another part of that same country or region.
• HealthPathways makes those differences transparent. Transparency then informs discussions between funders and health service providers about why the differences occur, and what can be done about it.

• Equality of health service assumes everyone can get themselves easily to the same services and engage with those services in the same way, with the same levels of understanding and cultural background. This assumption has been proven flawed over and over again, leading to very different, inequitable, health outcomes for different groups and individuals in our communities. Not everyone can get themselves easily to health services, and the way that the health services are configured and staffed needs to be adaptable and responsive to the people they’re serving.
• The guidance in HealthPathways seeks to support equity of health outcomes for all groups and individuals in our communities by prompting health professionals to adapt and respond to the person they are there to assist. This includes adding prompts about engaging special/different services (if they exist) that may be most suitable to support the person (and family) in need. HealthPathways also helps inform system / process changes that need to occur to support person-centred care.  

Streamliners is owned 20% by Te Whatu Ora via the New Zealand Health Innovation Hub (in recognition of CDHB’s early contributions to some of the intellectual property in HealthPathways), and 80% by the founders Ian Anderson and Emma Harding. Ian and Emma are in the process of transferring their 80% to a trust with the charitable purpose “to encourage and support improved integration of health and social care services.”

• Streamliners currently employs 120 people in its Christchurch head office. Another 20 people are scattered across New Zealand, Australia, and the UK. Streamliners’ UK subsidiary, Pathways Alliance Ltd (PAL), is growing rapidly.

• Membership of the HealthPathways Community is expected to grow substantially throughout the United Kingdom and Ireland in coming years. Streamliners is also interested in expanding the membership opportunity to Canada. These CANZUK countries have similar models of government and universal public health care, and this is the sort of environment where HealthPathways can have the biggest impact on improving the performance of the health system.

• Streamliners also supports:
  • General Practices with its GPDocs service. GPDocs is a set of policies for running a general practice in full compliance with the Foundation and Cornerstone standards set and overseen by the College of General Practice. GPDocs works with each practice to tailor the policies to their circumstance and to keep the policies up-to-date and compliant. Individual practices directly subscribe to this service.
  • Primary and intermediate schools with ‘well-being guidance’ to help teachers and support staff to respond to a wide range of health and wellbeing behaviours exhibited by children in the class. Stronger Schools is well used and trusted by front line educators in Canterbury (NZ) and South Tyneside (UK).