Clinical Pathways
Ordered, protocol-driven sequences of care for a clinical condition.
Worked example: Sepsis Protocol (Adult, ED-Initiated)
Operating System vs. Structural Design
The source framing splits hospital design into two layers. This document models only the first.
Operating System — how the hospital works
Digital nervous system (data flow, interoperability, connectivity, AI/analytics, governance) plus the operating model itself: clinical pathways, terminology & ontologies, workflows/processes, knowledge graph, tasks & workforce, master data, policies & governance, decision rights, logistics & resources, performance & quality. Defines how work is done, by whom, with what, in what sequence, under what rules.
Structural Design — where the hospital works
Architecture & floor plans, space planning & adjacencies, MEP & infrastructure, equipment & fixtures, construction & materials — the physical environment that enables the work. Out of scope for this RDF mockup.
Source & Discussion
The framing behind this ontology traces to a LinkedIn thread on hospital operating-model design.
⚠️ This is a derived harness, not the source work
Everything in this document — the ten-category ontology, the Sepsis Protocol pathway instantiation, the Knowledge Graph Explorer — is an independently modeled RDF worked example inspired by the LinkedIn post and image below. It is not authored, reviewed, endorsed, or affiliated with Brian de Francesca, and it is not his forthcoming paper “The Hospital That Was Never Fully Designed.” Where his post is a thesis about operating-architecture design, this harness is a separate, agent-generated attempt to render that thesis as a concrete harness loosely coupled with a generated Knowledge Graph using mocked-up sample data only.
Originating post
Brian de Francesca, on the cost of never fully designing a hospital's operating architecture: “Documentation should not be confused with design.” Full post: “Most hospitals were never fully designed” on LinkedIn.
Comment thread
On a related follow-up post (“Physical structures are derivative of operating systems…”), Kingsley Uyi Idehen commented:
“Yes, this is reality.”
“The question is: how is the problem solved?”
“Fundamentally, how is the map built without introducing compounding technical debt?”
This hospital-os-rdf-harness worked example is one attempt at an answer: model the pathway/task/policy “map” as RDF against a shared ontology rather than accreted documentation, so it can be extended (new pathways, new task instances) without re-deriving the schema each time. A threaded reply to this comment exists on LinkedIn but is gated behind sign-in and could not be retrieved for quotation here — see the reply thread on LinkedIn directly.
The Ten Operating-Model Categories
Each category is an RDF class in os:hospitalOS, rooted under the Knowledge Graph marker class, with one instance from the worked pathway shown as an example.
Hospital Operating System Ontology
Models the ten operating-model concept categories (Clinical Pathways, Terminology & Ontologies, Workflows/Processes, Knowledge Graph, Tasks & Workforce, Master Data, Policies & Governance, Decision Rights, Logistics & Resources, Performance & Quality) and the relations that answer: what is done, by whom, with what, in what sequence, and under what rules. The source framing states this layer spans roughly 30,000–60,000 tasks and thousands of concepts hospital-wide; entities.ttl instantiates one representative pathway at illustrative scale, not the full inventory. Workflow/sequencing terms (ClinicalPathway, WorkflowStep, hasStep, nextStep) are cross-referenced via owl:equivalentClass/owl:inverseOf to the P-Plan ontology for interoperability with plan/step-modeling tools outside this corpus.
Terminology & Ontologies
Standardized clinical/operational terms binding pathways, tasks, and master data to a controlled vocabulary (skos:Concept).
Worked example: Sepsis (disorder)
Workflows / Processes
Ordered stages of a pathway, each grouping the tasks performed at that stage.
Worked example: Triage & Recognition
Knowledge Graph
The connective layer: every other category is rdfs:subClassOf this marker class, making every instance a graph node.
Worked example: Hospital Operating System Ontology
Tasks & Workforce
Discrete units of work, performed by workforce roles — the layer the source framing sizes at 30,000-60,000 tasks hospital-wide.
Worked example: Administer First Antibiotic Dose
Master Data
Governed reference-data records a task reads or writes: patient charts, formulary items, order-catalog entries.
Worked example: Patient / EHR Record
Policies & Governance
Governance rules constraining how tasks, steps, or pathways may be carried out.
Worked example: Antibiotic Stewardship Policy
Decision Rights
Authorities to make a specific class of decision, held by exactly one workforce role.
Worked example: Right to Escalate to ICU
Logistics & Resources
Physical or schedulable resources — beds, equipment, stock — consumed or occupied by a task.
Worked example: IV Infusion Pump
Performance & Quality
Quality/performance measures, each with a target value and unit, evaluating a pathway or task.
Worked example: Time to First Antibiotic Dose
Pathway Walkthrough: Sepsis Protocol
The pathway's own five ordered workflow steps, rendered as a HowTo — each step is simultaneously an os:WorkflowStep and a schema:HowToStep entity in the companion RDF.
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1
Triage & Recognition
Triage nurse performs qSOFA/SIRS screening against the patient record, governed by the sepsis screening policy.
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2
Diagnostics: Lactate & Cultures
Lab technician orders and draws serum lactate and pre-antibiotic blood cultures.
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3
Broad-Spectrum Antibiotic Administration
Pharmacist reviews the antibiotic order for stewardship (with override right in a Code Sepsis emergency); ED physician administers the first dose, measured against the time-to-antibiotics metric.
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4
IV Fluid Resuscitation
Triage nurse administers a 30 mL/kg IV fluid bolus, consuming the infusion pump and ED bed.
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5
Reassessment & Escalation Decision
Lab technician repeats lactate and vital-sign reassessment; charge nurse exercises the ICU-escalation decision right under the critical care escalation policy.
Cast of the Pathway
Every workforce role, master-data record, resource, policy, decision right, metric, and terminology concept the sepsis pathway touches.
Workforce Roles
Logistics Resources
Decision Rights
Performance Metrics
Knowledge Graph Explorer
Rendered directly from the companion RDF (ontology.ttl TBox + entities.ttl ABox): 112 nodes, 230 edges, zero orphans. Click any node or edge label to open its full description via the URIBurner resolver.
— nodes / — links
Class
Property
Instance
Click outside to release zoom
Graph Settings
Physics
Predicate Display
Predicate Filters
Node Type Filters
Literal Filter
Resolver & Arrows
Frequently Asked Questions
Ten questions and answers, sourced directly from the companion RDF's schema:Question / schema:Answer entities.
In the source framing, the Knowledge Graph is the connective layer that indexes and links the other nine categories, not an isolated concept type sitting beside them. os:KnowledgeGraphComponent is therefore a marker rdfs:Class that every other category rdfs:subClassOf's, so any instance of any category is automatically a graph node.
os:hasTask/os:Task answers what is done; os:performedBy answers by whom; os:referencesMasterData and os:consumesResource answer with what; os:stepOrder and os:nextStep answer in what sequence; and os:governedByPolicy plus os:hasDecisionRight answer under what rules.
The source infographic states the Operating System layer spans roughly 30,000 to 60,000 tasks hospital-wide, across thousands of concepts. This worked example instantiates one pathway (9 tasks, os:estimatedAnnualTaskVolume 8,400 firings/year) as a representative sample, not the full inventory.
An os:ClinicalPathway is an ordered, protocol-driven sequence of care for a condition, composed of os:WorkflowStep instances via os:hasStep. This example's :sepsisPathway has five ordered steps from triage through escalation decision.
os:TerminologyConcept is declared rdfs:subClassOf skos:Concept, so every terminology instance can use skos:prefLabel, skos:notation, and skos:broader/skos:narrower directly rather than a bespoke vocabulary. The example's terminology codes (e.g. Sepsis (disorder)) are marked illustrative and not verified against a live terminology server.
An os:Policy is a governance rule that constrains how work is carried out; an os:DecisionRight is a specific authority to make a decision, held by exactly one workforce role via os:heldBy. A single task can be governed by a Policy and simultaneously require exercising a Decision Right — for example, antibiotic review is governed by the stewardship Policy while the physician separately holds the right to override its hold in a documented emergency.
os:measuredBy links a Task or ClinicalPathway to a os:PerformanceMetric, which carries os:metricTargetValue and os:metricUnit. The pathway-level metrics (time-to-antibiotics, lactate clearance, bundle compliance, 30-day mortality) roll up task-level measurement points into pathway-level quality evaluation.
Glossary
Eleven terms from the companion RDF's schema:DefinedTermSet.
- Clinical Pathway
- An ordered, protocol-driven sequence of care for a clinical condition, composed of ordered workflow steps.
- Terminology Concept
- A standardized clinical or operational term used to bind pathways, tasks, and master data to a controlled vocabulary, modeled as a skos:Concept.
- Workflow Step
- One ordered stage of a clinical pathway, grouping the tasks performed at that stage.
- Knowledge Graph Component
- The marker superclass for any entity that participates as a node in the hospital operating-model knowledge graph — the connective layer spanning the other nine categories.
- Task
- A discrete unit of work within a workflow step; the operating model is described as spanning roughly 30,000-60,000 such tasks hospital-wide.
- Workforce Role
- A staff role, by job function rather than named individual, that performs tasks.
- Master Data Entity
- A governed reference-data record — a patient record, formulary item, or order-catalog entry — that a task reads or writes.
- Policy
- A governance rule that constrains how a task, workflow step, or pathway may be carried out.
- Decision Right
- An authority to make a specific class of decision, held by a workforce role and scoped to a task or pathway.
- Logistics Resource
- A physical or schedulable resource — a bed, piece of equipment, or stock item — consumed or occupied by a task.
- Performance Metric
- A quality or performance measure, with a target value and unit, used to evaluate a pathway or task.