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Purpose HealthPathways is an online decision support portal, primarily aimed at General Practitioners (GPs), that provides easy to access and up to date clinical, referral and resource pathways. It is free to access, with the intent of providing the right care, at the right place, at the right time. This case study focuses on the experience and learnings of a HealthPathways program in metropolitan Sydney during the COVID-19 pandemic. It reviews the team's program management responses and looks at key factors that have facilitated the spread and scale of HealthPathways. Design/methodology/approach Available data and experiences of two HealthPathways program managers were used to recount events and aspects influencing spread and scale. Findings The key factors for successful spread and scale are a coordinated response, the maturity of the HealthPathways program, having a single source of truth, high level governance, leadership, collaboration, flexible funding and ability to make local changes where required. Originality/value There are limited published articles on HealthPathways. The focus of spread and scale of HealthPathways during COVID-19 is unique.