HealthFlow, AMIA summit
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RetroGuide (new name: HealthFlow)a knowledge representation and execution system for clinical research informatics alerts based on workflow
technology
Vojtech Huser MD PhD
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
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Agenda Introduction
Background Workflow Technology (WT)
Methods Our architecture
Results Implemented processes
Discussion/Conclusion
Vojtech Huser, MD, PhDVojtech Huser, MD, PhD
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Background Knowledge representation
decision support, quality improvement, research Institutions
Marshfield Clinic (+Intermountain Healthcare)
Workflow technology engine, editor
Huser (2010) J Biomed Inform
HealthcareWorkflow.wordpress.com
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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
HealthcareWorkflow.wordpress.com
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HealthFlow System
Actions
Knowledge Base(workflow process
definitions)
Data Inquiry
Workflow Execution
Engine(Shark)
EHR System layer:
Workflow editor(JaWE)
Data Visualization
Additional Components:
Event Data Model
code.google.com/p/HealthFlow
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HealthFlow: RetroGuide, FlowGuide
EHR system
Event Listener
Notifications
Actions
Knowledge Base(workflow process
definitions)
Data Inquiry
Workflow Execution
Engine(Shark)
EHR System layer:
Prospective mode (FlowGuide):
Retrospective mode(RetroGuide):
Reports
Data Warehouse
Workflow editor(JaWE)
Data Visualization
Additional Components:
Event Data Model
Additional External Services(Terminology services, NLP services,
Statistical Analysis)
code.google.com/p/HealthFlow
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HealthFlow: RetroGuide, FlowGuide
HealthcareWorkflow.wordpress.com
EHR system
Event Listener
Notifications
Actions
Knowledge Base(workflow process
definitions)
Data Inquiry
Workflow Execution
Engine(Shark)
EHR System layer:
Prospective mode (FlowGuide):
Retrospective mode(RetroGuide):
Reports
Data Warehouse
Workflow mining(ProM)
Workflow editor(JaWE)
Data Visualization
Additional Components:
Event Data Model
Ontology Model
Host EHR Passive Interaction Model
Host EHR Active Interaction Model
Additional External Services(Terminology services, NLP services,
Statistical Analysis)
Workflow log analysis
Screenshot tour
HealthcareWorkflow.wordpress.com
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HealthFlow: RetroGuide, FlowGuide
HealthcareWorkflow.wordpress.com
EHR system
Event Listener
Notifications
Actions
Knowledge Base(workflow process
definitions)
Data Inquiry
Workflow Execution
Engine(Shark)
EHR System layer:
Prospective mode (FlowGuide):
Retrospective mode(RetroGuide):
Reports
Data Warehouse
Workflow mining(ProM)
Workflow editor(JaWE)
Data Visualization
Additional Components:
Event Data Model
Ontology Model
Host EHR Passive Interaction Model
Host EHR Active Interaction Model
Additional External Services(Terminology services, NLP services,
Statistical Analysis)
Workflow log analysis
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Code Layer (node; right click properties)
HealthcareWorkflow.wordpress.com
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code.google.com/p/HealthFlow
HealthcareWorkflow.wordpress.com
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HealthFlow: RetroGuide, FlowGuide
HealthcareWorkflow.wordpress.com
EHR system
Event Listener
Notifications
Actions
Knowledge Base(workflow process
definitions)
Data Inquiry
Workflow Execution
Engine(Shark)
EHR System layer:
Prospective mode (FlowGuide):
Retrospective mode(RetroGuide):
Reports
Data Warehouse
Workflow mining(ProM)
Workflow editor(JaWE)
Data Visualization
Additional Components:
Event Data Model
Ontology Model
Host EHR Passive Interaction Model
Host EHR Active Interaction Model
Additional External Services(Terminology services, NLP services,
Statistical Analysis)
Workflow log analysis
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Together Workflow Engine (Community edition)
HealthcareWorkflow.wordpress.com
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Together Workflow Engine (Community edition)
HealthcareWorkflow.wordpress.com
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HealthFlow: RetroGuide, FlowGuide
HealthcareWorkflow.wordpress.com
EHR system
Event Listener
Notifications
Actions
Knowledge Base(workflow process
definitions)
Data Inquiry
Workflow Execution
Engine(Shark)
EHR System layer:
Prospective mode (FlowGuide):
Retrospective mode(RetroGuide):
Reports
Data Warehouse
Workflow mining(ProM)
Workflow editor(JaWE)
Data Visualization
Additional Components:
Event Data Model
Ontology Model
Host EHR Passive Interaction Model
Host EHR Active Interaction Model
Additional External Services(Terminology services, NLP services,
Statistical Analysis)
Workflow log analysis
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Example of execution
0.9% of patients with high
risk patients with
subsequent MI
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Example of execution
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Example of execution
Results
HealthcareWorkflow.wordpress.com
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Implemented processes RetroGuide (v2) (2004-2008) (published)
Quality improvement Osteoporosis Cholesterol management Blood pressure control in diabetics
Decision support Computerized glucose management
protocol Adverse Drug Events
Research Hodgkin's lymphoma and pregnancy Hepatitis C
+ several other experimental
RetroGuide (v3) (2008 – now) IRB 1 20+ scenarios
US Prev. Services TF Health plan rules hsCRP Genetic counseling Thyroid disease, ACEi monitoring osteoporosis
FlowGuide – validation (IRB 2) Implemented (Nov 2009)
Surgical patient discharge (feasibility) (Sep 2009)
Cholesterol management Rheumatoid arthritis
Planned (IRB) Hearth failure Medical home recommendations
FlowGuide – production (IRB 3) IRB writing stage
HealthcareWorkflow.wordpress.com
Huser (2010) J Biomed Inform
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FlowGuide - Validation (RA, LDL)
HealthcareWorkflow.wordpress.com
Final Slides
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Discussion Advantages
cross industry technology graphical representation stand alone solution applicable to several domains (query problem, alert problem) retrospective/prospective switch
Disadvantages required technical infrastructure is complex complex logic will remain complex even if expressed as a flowchart Not all logic is supported by a given workflow suite - externalized (web-service,
other engines) Future work
More robust set of HealthFlow External Applications (FindEvent) Representation of phenotypes Better linkage to EHR system Support for all relevant standards (e.g., HL7 vMR, Terminology Services, HL7
DSS)
HealthcareWorkflow.wordpress.com
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Workflow technology workshop AMIA NOW!, May 2010
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Summary Successful integration of a workflow engine
with an EHR system Knowledge representation using cross-industry
technology Other institutions can implement a similar
framework, sharing of logic is possible
code.google.com/p/HealthFlow
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Thank you [email protected]
http://healthcareworkflow.wordpress.com http://code.google.com/p/healthflow
Questions? http://marshfieldclinic.org/birc Acknowledgement: programmers: Luke Rasmussen, Ryan Oberg
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