The Children's Memorial Hospital, a 265-bed pediatric hospital in Chicago, Illinois, is a leader in pediatric clinical pathway development. Significant improvements in care coordination and cost savings have been realized from the 14 pathways implemented to date. Use of a project management methodology and adaptation of continuous quality improvement tools for pathway development have proven effective to streamline and standardize this process. Despite its success in pathway development, Children's Memorial Hospital has realized the need to go further. It is necessary to measure outcomes--real clinical, patient outcomes--not just financial or utilization outcomes. Solid comparative data from which practice changes can be made are needed. Additional ways must be found to facilitate movement along the care continuum. Pathways must be used consistently. This article will outline the process Children's Memorial Hospital used and share the development tools that have been implemented. Children's Memorial Hospital's vision for the future and the technology designed to realize that vision are delineated.