OBJECTIVES: This oncology-specific organization integrated into its electronic medical record (EMR) system a series of clinical pathways (CPs) based on national guidelines. The objective was to to evaluate adherence to pathways and develop a process for communication to practices regarding performance. METHODS: The CPs are based on clinical and economic literature and are physician-led. Adherence is measured using a combination of patient disease, stage of disease, and line of therapy. A combination of methods has been used in the reporting process, including web-based reports; involvement of staff pharmacists to promote and monitor clinical pathway adherence at the local level; multiple teleconferences among pharmacists and physicians to discuss cases, share successes, failures, and ideas; and inclusion of network pathway reports for all attendees at the organization's biannual national P&T meetings. RESULTS: Eighteen practices have EMR pathway reporting capabilities, with new practices being added every month. Currently clinical pathways for 7 cancer types have been implemented into the EMR system. Pharmacists have increased their role in promoting pathway adherence. One of the greater challenges has not been to improve pathway adherence per se, but to increase completion of key elements of evaluation, including disease stage and line of therapy. CONCLUSION: Early evaluation shows monitoring of pathways can be conducted with use of an EMR. Regular feedback on missing data has encouraged providers to update clinical data entry. The complexity and dynamic nature of oncology treatment requires frequent evaluation of clinical pathways to ensure they are current and are based on both clinical and economic evidence.