Post on 28-Jan-2015
description
Introduction to workflow technology Representation of healthcare
processes in a workflow editor and their execution in a workflow engine
Vojtech Huser MD PhDHarm Scherpbier, MD, MS
AMIA 2012, Tutorial (3hrs)
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
2
Agenda Part 1: Introduction, history, overview Part 2: Standards, SDO, related theories Part 3: Practical tools demonstration Part 4: Conclusion
This presentation is also at this URLhttp://www.slideshare.net/vojtech_huser/presentations
Accompanying bibliography and other fileshttp://code.google.com/p/healthflow/downloads/list
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
3
Part 1: Introduction to workflow technology(WT)
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Future development and research challenges Published case studies in Healthcare Difference: Workflow engine vs. Decision Support engine WT in healthcare (HS)
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
4
Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language
(BPMN 2.0 (stored as XPDL 2.2)) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
5
Part 3: Practical tools demos MainLine Health case study Demo of an JaWE editor (and engine) Process mining tool (ProM, Nitro, DISCO)
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
6
Part 4: Conclusion Momentum behind BPM Future of workflow technology Conclusion Questions & Discussion
Links General:
http://wfmc.org http://en.wikipedia.org/wiki/Xpdl http://en.wikipedia.org/wiki/BPMN http://en.wikipedia.org/wiki/Workflow_patterns http://books.google.com/books?id=I1KOAfiqfxYC http://books.google.com/books?id=O1xW1_Za-I0C
From tutorial authors http://healthcareworkflow.wordpress.com http://code.google.com/p/healthflow/downloads/list http://code.google.com/p/processmining
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
7
Software Download the following software:
JaWE Java Workflow Editor http://sourceforge.net/projects/jawe
Shark Workflow Engine (optional) http://sourceforge.net/projects/sharkwf
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
8
Part 1
9
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
10
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
11
Workflow technology BPM = business process management Adaptive workflow (Adaptive Case
Management) Computer supported collaborative
work (CSCW) Why workflow?
Separation of data into databases Separation of UI from IT system core Separation of process knowledge
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
12
Process Example
Koetter (2007)
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
13
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
14
Workflow patterns examples Parallel Split: When an intrusion alarm is
received, trigger the dispatch-patrol activity and the inform-police activity immediately.
Exclusive Choice: After the review election activity is complete, either the declare results or the recount votes activity is undertaken.
Multi Choice: Depending on the nature of the emergency call, one or more of the despatch-police, despatch-fire-engine and despatch-ambulance activities is immediately initiated.
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
15
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
16
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
17
WT development 1960s
Petri Nets (Carl A. Petri PhD work)
1960s-present Workflow components of various systems
1999 WfMC: terminology
2000s 2002: XPDL 1.0 2005 XPDL 2.0 2008 XPDL 2.1 BPMN standard
2010s BPMN 2.0 XPDL 2.2
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
18
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
19
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
20
21
22
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
23
Automating Workflow Defined by Workflow Management
Coalition (WfMC) www.wfmc.org
Terminology and Glossary http://www.wfmc.org/standards/docs/TC-
1011_term_glossary_v3.pdf
24
Terms Workflow
The automation of a business process, in whole or part, during which documents, information or tasks are passed from one participant to another for action, according to a set of procedural rules.
WfMS = Workflow Management System
BPM = Business Process Management BPMS = Business Process Management System
25
26
27
Humans & machines working together
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
28
Executable flowchart
29
30
Minimum componentslanguage edito
r
execution engine
31
Interfaces
32
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
33
WT benefits Non-programmers understand
processes Non-programmers can modify
processes Analytical tools Faster IT system development
(SOA+WT)
34
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
35
Choice of Wf vendor Major player
TIBCO BEA Global 360 IBM
Other Fujitsu IBM Oracle Microsoft SAP Lombardi
Open source JBOSS Taverna Together Bonita YAWL http://java-source.net/open-
source/workflow-engines
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
36
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
37
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
38
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
39
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
40
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
41
Workflow engine
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
42
Engine
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
43
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
44
Use of WT Pioneer domains
Banking Manufacturing Shipping Government authorities Pharmaceutical
Healthcare Gartner 2008 report: <5% use
Overview of Healtchare WT articles Haux R, Seggewies C, Baldauf-Sobez W, Kullmann P, Reichert H, Luedecke L,
et al. Soarian - workflow management applied for health care. Methods Inf Med. 2003;42(1):25-36.
J. Emanuele and L. Koetter, "Workflow Opportunities and Challenges in Healthcare," in 2007 BPM & Workflow Handbook, 2007.
L. Koetter, "MRSA infection control with workflow technology," Spring AMIA Conference, Orlando, FL, 2007.
R. Hess, "The Chester County Hospital: Case Study," in 2007 Excellence in Practice: Moving the Goalposts., 2007.
Process Mining of Clinical Workflows for Quality and Process Improvement http://chuckwebster.com/process-mining/HIMSS12/process-mining-clinical-
workflows-quality-process-mprovement.pdf Huser V, Narus SP, Rocha RA. Evaluation of a flowchart-based EHR query
system: a case study of RetroGuide. J Biomed Inform 2010;43(1):41-50. Huser V, Rasmussen LV, Oberg R, Starren JB. Representation and execution
of clinical decision support using workflow engine technology. BMC Med Res Methodol
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
45
Process Definition A process is:
Multiple steps… For multiple people… Over time… To achieve a goal.
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
46
Main Line Health examples Clinical Guidelines and Core Measures Infection Control - e.g. CLABSI Adverse Drug Events prevention Heparin Protocol, Insulin Drip Rate
Calculator Research Protocols … and more
First: look at the Alerts worklist to see these at work…
Foley Reminders, ADE’s Foley Workflow Goal: Timely removal, reduce risk
for UTIs ADE Workflow Goal: Early detection of ADEs,
change medications
AMI and CHF Pathways Identify patients, initiate pathway, apply Core
Measures AMI:
CHF:
Video: CHF pathway Video of CHF pathway
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
50
Central Line Insertion Checklist
Guidance to most preferred line location
Guidelines
Checklist!!
Central Line Insertion Checklist - continued
Checklist!!
Central Line – Procedure Note
Line Follow-up – Removal reminders
Dr. Clark Piatt Short video – Dr. Clark Piatt on
automated Central Line management
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
55
Workflow Engine for Clinical Trials
Osteoporosis Research Study - Dr. Matthew DiPaola MD, supported by Sharpe-Strumia Foundation, performed at Lankenau Hospital, with LIMR research staff – 2008 – 2009
Objective: identify patients >65 years old, with hip fracture, and initiate endocrinology management in the acute phase of the care. Identify and treat osteoporosis, by endocrinologist, to prevent future fractures.
Identify Candidates – Consent/Enroll – Randomize - Automate Study Protocol – Collect Data
Osteoporosis Research Study Workflow
Identify Candidates for Study
Osteoporosis Research Study Workflow
Obtain Consent
RandomizationStudy/Control
Automate Study Protocol
Collect Data
Data Collection Form
Clinical Trial Management
Goal: Identify Candidates for Clinical Trials, and Track Enrolled Patients
Implement Protocols – including randomization
Volume of Alerts Per Site
234
69
24
171
87
50
143
5535
173
73
38
187
113
15
0
100
200
300
LMC BMH PH
SeptemberOctoberNovemberDecemberJ anuary
Heparin Alert Utilization for Sept. 2011 thru Jan. 2012
Percent Alert Utilization Per Site
37
69
17
54
686061
67
5464
7161
74 7567
010
20304050
607080
90100
LMC BMH PH
SeptemberOctoberNovemberDecemberJanuary
Workflow Engine vs. Rules Engine Workflow Engine with Rules
Engine Process Automation / Business
Process Management
Multiple steps, over time, for multiple users
State-aware: keeps track of point in time and waits (listens) for next event to happen
Asynchronous Plug-in services (EAI) Graphical programming
Rules Engine Rule-based Clinical Decision
Support
Single decision point for single user
Not State-aware – runs at trigger event
Synchronous
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
63
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
64
Future of WT Improvements
Adoption is growing Software tools sophistication is improving Competition, consolidation
Future similar to a database server inclusion in IT systems
Standards consolidation Research challenges
Process model visualization challenges Process model cross-vendor portability Adaptive workflow
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
65
Workflow patterns
http://
workflowpatterns.com/
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
66
Adaptive workflow
informationcentric
process centric
structuredprocess
unstructuredprocess
computer-supported collaborative work
ad-hoc workflow
production workflow
Part 2
67
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
68
Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
69
Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
70
WfMC Started in 1990 5 interfaces XPDL 1.0, 2.0, 2.1,2.2 Yearly Workflow handbook
…
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
71
Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
72
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
73
Workflow Technology Business process management system (BPMS)
Workflow = The automation of a business process, in whole or part, during which documents, information or tasks are passed from one participant to another for action, according to a set of procedural rules.
Workflow Process = A set of one or more linked procedures or activities which collectively realize a business objective or policy goal, normally within the context of an organizational structure defining functional roles and relationships (definition vs. instance)
Worklist Handler = A software component that manages the interaction between the user and the worklist maintained by a workflow engine (task display, completion, acceptance, referral)
WfMC: Terminology & Glossary, Document Number WFMC-TC-1011, Feb 99 http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
74
Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language
(XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
75
XPDL XML file based on a XSD schema
http://wfmc.org/xpdl.html http://www.xpdl.org/standards/xpdl-2.2/bpmnxpdl_40a.xsd
First introduced in 1999 Conformance testing available
http://www.xpdl.org/cloudapps.html Exchange format Adoption (70+ products)
http://wfmc.org/xpdl-implementations.html
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
76
Standards Timeline
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
77
Example.xpdl
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
78
Process Schema
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
79
Activities
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
80
Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
81
WT standards Historical
WSDL Current major
XPDL, BPMN, BPEL Proprietary (vendor specific):
JBPM (JBoss) Win Workflow Foundation (Microsoft) T2Flow->SCUFL2 (Taverna) internal format (Weka)
Research ones YAWL
Standards trending
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
82
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
83
Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
84
p2 p1
t1
Petri Nets Mathematical theory Basics
Petri net consist two types of nodes: places and transitions.
A place may have zero or more tokens.
Graphic representations :Places (circles), transitions (bars), arcs (arrows), and tokens (dots)
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
85
Definition of Petri Net C = ( P, T, F)
Places (circles) P = { p1, p2, p3, …, pn}
Transitions (bars) T = { t1, t2, t3, …, tn}
Flow relations (arcs) F ⊂ (P × T ) ∪ (T × P )
Extensions Hierarchical Petri Netns Coloured Petri Nets
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
86
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
87
Petri Net for Math lovers
Part 3 - DEMOS
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
88
HS Demo (30 min) Editor and EMR portions Activy example Basic editing Roundtrip between editor and EMR
(changes) MLM logic vs. flowchart logic
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
89
Main Line Health Demo Integration points to EMR via services:
Events Decision Rules Tasks, messages, actions
Wait-steps Nesting Workflow Engine Demonstration:
http://intranet/Soarian/Support/Links.htm
VH Demo part (30 min) Screenshot tour of editor, processes
and process mining editor process mining tool
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
91
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
92
Software shown Editor
JaWE Together Workflow Editor (TWE) v1.4, v2, v3, v4.3 Engine
Shark Together Workflow Engine (TWS) Web-based module Integration with Outlook
ProM (processmining.org)
V5.2, V6 Fluxicon (www.fluxicon.com)
Nitro Disco
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
93
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
94
More CDS examplesWorkflow mining tour
Vojtech Huser, Harm Scherpbier: workflow tutorial 95
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
96
Log schema
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
97
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
98
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
99
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
100
2012: Mercy Health case study
Process Mining of Clinical Workflows for Quality and Process Improvement http://chuckwebster.com/process-mining/HIMSS12/process-mining-clinical-
workflows-quality-process-mprovement.pdf
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
101
Editor live demo
Vojtech Huser, Harm Scherpbier: workflow tutorial 102
Part 4: Conclusion
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
103
Agenda for part 4 Vojtech’s points Harm’s points
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
104
Modelling paradigm Flowcharts
Several historical revisions Different vendors used different paradigm Standardization (BPMN) Swim lanes example Split/Join example Annotation elements
Complex flowcharts Flowchart can’t remove it
different views, hierarchical layers Exception handling General standards (XPDL) vs. medicine specific standards
(GLIF, SAGE)
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
105
Healthcare is different Current workflow standards
YAWL Current workflow vendors
implementations
Complexity of medicine
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
106
WT and EHR vendors Current status
One vendor uses a third party workflow engine
Variable support for workflow constructs Work list (push [single clinician, team], pull) Obtain current performer of a certain role Obtain patient data Maintain process state
Limited or now workflow features
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
107
WT and EHR vendors Future state
Status quo stays More vendors adopt 3rd party workflow
engine Internal “CDS [rule] engines” gain more
workflow features New CDS standard with workflow
components HL7 DSS
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
108
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
109
Sage flowchart example P. Ram (2004)
“Executing Clinical Practice Guidelines Using the SAGE Execution Engine,” Medinfo, pp. 251-5, 2004
SAGE’s decision maps subflows
Rule-in and Rule-out contructs
Linking workflow engine with a rule engine
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
110Mulyar at al (2007)
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
111
GLIF guideline
Sharing CDS content MLM content (code logic) Workflow content (flowchart + code
logic)
2 levels of sharing (WT) Share complete process definition Share only the flowchart (description)
http://healthcareworkflow.wordpress.com/2012/02/09/healtflow-hepatitis-a-scenario/
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
112
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
113
Splitting the CDS representation format
maintenance: title: Hepatitis A Immunization MLM;; library: links: to be added;; knowledge: type: data_driven;; data: /* text within curly brackets would be replaced with an institution’s own query */
Let PatientIDRecord BE OBJECT [AccountNum, Name, Birthdate, Sex]; LET Patient BE Read As PatientIDRecord Latest {select accountnum, name, dateofbirth, sex from EHR} ;
LET HAVRIX BE Read As Medication {select med, form, dose, route, schedule from EHR where med = ‘HAVRIX’} ; LET TWINRIX BE Read As Medication {select med, form, dose, route, schedule from EHR where med = ‘TWINRIX’} ; Let GenericMessage BE OBJECT [MessageID, MessageCode, Message_Text]; Let Vaccine_Message BE New GenericMessage; ;; evoke: outpatient_visit;; logic: /* Check age */ if Patient_Age Is Null then /* Rules-one previous vaccination. */ if Count(VAQTA) + Count(HAVRIX) + Count(TWINRIX) = 1 then Needs_second_dose := true; endif;
/* Second dose young people */ if Apply_young_patient_rules and Needs_second_dose and Exist(VAQTA) and Latest VAQTA Occurred Before 6 months Ago then Vaccine_Message.Message_Text := "Give VAQTA vaccine, 25U, IM now. This completes Hepatitis A vaccinations."; Conclude true; endif; if Apply_young_patient_rules and Needs_second_dose and Exist(HAVRIX) and Latest HAVRIX Occurred Before 6 months Ago then Vaccine_Message.Message_Text := "Give HAVRIX vaccine, 720EL.U, IM now. This completes Hepatitis A vaccinations."; Conclude true; endif; if Apply_young_patient_rules and Needs_second_dose and Exist(TWINRIX) and Latest TWINRIX Occurred Before 1 months Ago then Vaccine_Message.Message_Text := "Give TWINRIX vaccine, 720 EL.U/20ug, IM now. This is the second Hepatitis A/B vaccination."; Conclude true; endif;
/* Second dose Older people */ if Apply_older_patient_rules and Needs_second_dose and Exist(VAQTA) and Latest VAQTA Occurred Before 6 months Ago then Vaccine_Message.Message_Text := "Give VAQTA vaccine, 50 U, IM now. This completes Hepatitis A vaccinations."; Conclude true; endif; if Apply_older_patient_rules and Needs_second_dose and Exist(HAVRIX) and Latest HAVRIX Occurred Before 6 months Ago then Vaccine_Message.Message_Text := "Give HAVRIX vaccine, 1440 U, IM now. This completes Hepatitis A vaccinations."; Conclude true; endif; if Apply_older_patient_rules and Needs_second_dose and Exist(TWINRIX) and Latest TWINRIX Occurred Before 1 months Ago then Vaccine_Message.Message_Text := "Give TWINRIX vaccine, 720EL.U/20ug, IM now. This is the second Hepatitis A/B vaccination."; Conclude true; endif; /* Third dose of TWINRIX */ if Exist(TWINRIX) and Count(TWINRIX) = 2 and Latest(TWINRIX) Occurred Before 5 months Ago then Vaccine_Message.Message_Text := "Give TWINRIX vaccine, 720EL.U/20ug, IM now. This completes Hepatitis A/B vaccinations."; Conclude true; endif; ;; action: write Vaccine_Message.Message_Text;; end:
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
114
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
115
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
116
Approach comparison
WT and healthcare institutions Current status
No adoption (majority, Gartner report)
EHR vendor supports WT 3rd party engine implementation
(Marshfield Clinic)
Different institutions are at different stages
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
117
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
118
WT future (software components) Core components
Editor Engine
Additional components Administration application (deplay, terminate, versioning)
Work list handler User management (LDAP, MS, other)
Organizational roles Monitoring/Analytical application Simulation tools Worfklow mining
Harm Sherpbier’s conclusion
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
119
Learnings Powerful Complex Importance of integration to EMR
EMR represents the users, the data, and the transactions
Need for services: events, work-lists, tasks and notifications, actions (e.g. orders), EAI
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
120
Healthcare Processes Healthcare Processes waiting to be
automated: Clinical Pathways, Care Management Transitions and Discharges Surveillance and monitoring Administrative processes … and many more
Many opportunities for use of BPM technology in healthcare
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
121
Platform for outsourced knowledge
Currently: managing decision rules internally, linked into the workflows
Future: opportunity to call outside knowledge sources HL7 DSS, OpenCDS standards
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
122
Future of BPM in Healthcare? Opportunity, processes to be
automated? Yes! Technology available? Yes! Advantage of BPM over other decision
support and process management tools? Yes!
Can healthcare organizations manage the complexity (build and maintain)? Maybe…
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
123
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
124
Questions ?
Covered topics Introduction to workflow technology WT standards Examples WT and healthcare
Contact us vojtech.huser at nih.gov
Vojtech Huser, Harm Scherpbier: workflow tutorialVojtech Huser, Harm Scherpbier: workflow tutorial
125