Ontology modeling for generation of clinical pathways

Purpose: Increasing costs of health care, fuelled by demand for high quality, cost-effective healthcare has drove hospitals to streamline their patient care delivery systems. One such systematic approach is the adaptation of Clinical Pathways (CP) as a tool to increase the quality of healthcare delivery. However, most organizations still rely on are paper-based pathway guidelines or specifications, which have limitations in process management and as a result can influence patient safety outcomes. In this paper, we present a method for generating clinical pathways based on organizational semiotics by capturing knowledge from syntactic, semantic and pragmatic to social level. Design/methodology/approach: The proposed modeling approach to generation of CPs adopts organizational semiotics and enables the generation of semantically rich representation of CP knowledge. Semantic Analysis Method (SAM) is applied to explicitly represent the semantics of the concepts, their relationships and patterns of behavior in terms of an ontology chart. Norm Analysis Method (NAM) is adopted to identify and formally specify patterns of behavior and rules that govern the actions identified on the ontology chart. Information collected during semantic and norm analysis is integrated to guide the generation of CPs using best practice represented in BPMN thus enabling the automation of CP. Findings: This research confirms the necessity of taking into consideration social aspects in designing information systems and automating CP. The complexity of healthcare processes can be best tackled by analyzing stakeholders, which we treat as social agents, their goals and patterns of action within the agent network. Originality/value: The current modeling methods describe CPs from a structural aspect comprising activities, properties and interrelationships. However, these methods lack a mechanism to describe possible patterns of human behavior and the conditions under which the behavior will occur. To overcome this weakness, a semiotic approach to generation of clinical pathway is introduced. The CP generated from SAM together with norms will enrich the knowledge representation of the domain through ontology modeling, which allows the recognition of human responsibilities and obligations and more importantly, the ultimate power of decision making in exceptional circumstances

A standards-based ICT framework to enable a service-oriented approach to clinical decision support

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM’s iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO’s capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch’s syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations

A Formal Framework for Data-Aware Process Interaction Models

IT support for distributed and collaborative workflows as well as related interactions between business partners are becoming increasingly important. For modeling such partner interactions as flow of message exchanges, different topdown approaches, covered under the term interaction modeling, are provided. Like for workflow models, correctness constitutes a fundamental challenge for interaction models; e.g., to ensure the boundedness and absence of deadlocks and lifelocks. Due to their distributed execution, in addition, interaction models should be message-deterministic and realizable, i.e., the same conversation (i.e. sequence of messages) should always lead to the same result, and it should be ensured that partners always have enough information about the messages they must or may send in a given context. So far, most existing approaches have addressed correctness of interaction models without explicitly considering the data exchanged through messages and used for routing decisions. However, data support is crucial for collaborative workflows and interaction models respectively. This technical report enriches interaction models with the data perspective. In particular, it defines the behavior of data-aware interaction models based on Data- Aware Interaction Nets, which use elements of both Interaction Petri Nets and Workflow Nets with Data. Finally, formal correctness criteria for Data-Aware Interaction Nets are derived, guaranteeing the boundedness and absence of deadlocks and lifelocks, and ensuring message-determinism as well as realizability

Data-Aware Interaction in Distributed and Collaborative Workflows: Modeling, Semantics, Correctness

IT support for distributed and collaborative workflows and related interactions between business partners is becoming increasingly important. For modeling such partner interactions as flow of message exchanges, different top-down approaches, covered under the term interaction modeling, are provided. Like for workflow models, correctness constitutes a fundamental challenge for interaction models as well; e.g., to ensure the boundedness and absence of deadlocks and lifelocks. Due to their distributed execution, in addition, interaction models should be message-deterministic and realizable, i.e., the same conversation (i.e. sequence of messages) should always lead to the same result, and it should be ensured that partners always have enough information about the messages they must or may send in a given context. So far, most existing approaches have addressed correctness of interaction models without explicitly considering the data exchanged through messages and used for routing decisions. However, data support is crucial for collaborative workflows and interaction models respectively. This paper therefore enriches interaction models with the data perspective. In particular, it defines the behavior of data-aware interaction models based on Data-Aware Interaction Nets, which use elements of both Interaction Petri Nets and Workflow Nets with Data. Finally, formal correctness criteria for Data-Aware Interaction Nets are derived, guaranteeing the boundedness and absence of deadlocks and lifelocks, and ensuring message-determinism as well as realizability

A service oriented architecture to implement clinical guidelines for evidence-based medical practice

Health information technology (HIT) has been identified as the fundamental driver to streamline the healthcare delivery processes to improve care quality and reduce operational costs. Of the many facets of HIT is Clinical Decision Support (CDS) which provides the physician with patient-specific inferences, intelligently filtered and organized, at appropriate times. This research has been conducted to develop an agile solution to Clinical Decision Support at the point of care in a healthcare setting as a potential solution to the challenges of interoperability and the complexity of possible solutions. The capabilities of Business Process Management (BPM) and Workflow Management systems are leveraged to support a Service Oriented Architecture development approach for ensuring evidence based medical practice. The aim of this study is to present an architecture solution that is based on SOA principles and embeds clinical guidelines within a healthcare setting. Since the solution is designed to implement real life healthcare scenarios, it essentially supports evidence-based clinical guidelines that are liable to change over a period of time. The thesis is divided into four parts. The first part consists of an Introduction to the study and a background to existing approaches for development and integration of Clinical Decision Support Systems. The second part focuses on the development of a Clinical Decision Support Framework based on Service Oriented Architecture. The CDS Framework is composed of standards based open source technologies including JBoss SwitchYard (enterprise service bus), rule-based CDS enabled by JBoss Drools, process modelling using Business Process Modelling and Notation. To ensure interoperability among various components, healthcare standards by HL7 and OMG are implemented. The third part provides implementation of this CDS Framework in healthcare scenarios. Two scenarios are concerned with the medical practice for diagnosis and early intervention (Chronic Obstructive Pulmonary Disease and Lung Cancer), one case study for Genetic data enablement of CDS systems (New born screening for Cystic Fibrosis) and the last case study is about using BPM techniques for managing healthcare organizational perspectives including human interaction with automated clinical workflows. The last part concludes the research with contributions in design and architecture of CDS systems. This thesis has primarily adopted the Design Science Research Methodology for Information Systems. Additionally, Business Process Management Life Cycle, Agile Business Rules Development methodology and Pattern-Based Cycle for E-Workflow Design for individual case studies are used. Using evidence-based clinical guidelines published by UK’s National Institute of Health and Care Excellence, the integration of latest research in clinical practice has been employed in the automated workflows. The case studies implemented using the CDS Framework are evaluated against implementation requirements, conformance to SOA principles and response time using load testing strategy. For a healthcare organization to achieve its strategic goals in administrative and clinical practice, this research has provided a standards based integration solution in the field of clinical decision support. A SOA based CDS can serve as a potential solution to complexities in IT interventions as the core data and business logic functions are loosely coupled from the presentation. Additionally, the results of this this research can serve as an exemplar for other industrial domains requiring rapid response to evolving business processes

A pattern based method for simplifying a BPMN process model

BPMN (Business Process Model and Notation) is currently the preferred standard for the representation and analysis of business processes. The elaboration of these BPMN diagrams is usually carried out in an entirely manual manner. As a result of this human-driven process, it is not uncommon to find diagrams that are not in their most simplified version possible (regarding the number of elements). This work presents a fully automatic method to simplify a BPMN process model document. A two-phase iterative algorithm to achieve this simplification is described in detail. This algorithm follows a heuristic approach that makes intensive use of a Pattern Repository. This software element is concerned with the description of feasible reductions and its enactment. The critical concept lies in the discovery of small reducible patterns in the whole model and their substitution with optimised versions. This approach has been verified through a double validation testing in total 8102 cases taken from real world BPMN process models. Details for its implementation and usage by practitioners are provided in this paper along with a comparison with other existing techniques concerned with similar goals.Xunta de Galicia | Ref. ED481A-2017/323Universidade de Vigo/CISU

An Adaptive Mediation Framework for Workflow Management in the Internet of Things

Tärkavad värkvõrksüsteemid koosnevad arvukast hulgast heterogeensetest füüsilistest seadmetest, mis ühenduvad Internetiga. Need seadmed suudavad pidevalt ümbritseva keskkonnaga suhelda ja osana lõppkasutaja rakendusestest edendada valdkondi nagu tark kodu, e-tervis, logistika jne. Selleks, et integreerida füüsilisi seadmeid värkvõrgu haldussüssteemidega, on töövoo haldussüsteemid kerkinud esile sobiva lahendusena. Ent töövoo haldussüsteemide rakendamine värkvõrku toob kaasa reaalajas teenuste komponeerimise väljakutseid nagu pidev teenusavastus ja -käivitus. Lisaks kerkib küsimus, kuidas piiratud resurssidega värkvõrgu seadmeid töövoo haldussüsteemidega integreerida ning kuidas töövooge värkvõrgu seadmetel käivitada. Tööülesanded (nagu pidev seadmeavastus) võivad värkvõrgus osalevatele piiratud arvutusjõudluse ja akukestvusega seadmetele nagu nutitelefonid koormavaks osutuda. Siinkohal on võimalikuks lahenduseks töö delegeerimine pilve. Käesolev magistritöö esitleb kontekstipõhist raamistikku tööülesannete vahendamiseks värkvõrgurakendustes. Antud raamistikus modelleeritakse ning käitatakse tööülesandeid kasutades töövoogusid. Raamistiku prototüübiga läbi viidud uurimus näitas, et raamistik on võimeline tuvastama, millal seadme avastusülesannete pilve delegeerimine on kuluefektiivsem. Vahel aga pole töövoo käitamistarkvara paigaldamine värkvõrgu seadmetele soovitav, arvestades energiasäästlikkust ning käituskiirust. Käesolev töö võrdles kaht tüüpi töövookäitust: a) töövoo mudeli käitamine käitusmootoriga ning b) töövoo mudelist tõlgitud programmikoodi käitamine. Lähtudes katsetest päris seadmetega, võrreldi nimetatud kahte meetodit silmas pidades süsteemiressursside- ning energiakasutust.Emerging Internet of Things (IoT) systems consist of great numbers of heterogeneous physical entities that are interconnected via the Internet. These devices can continuously interact with the surrounding environment and be used for user applications that benefit human life in domains such as assisted living, e-health, transportation etc. In order to integrate the frontend physical things with IoT management systems, Workflow Management Systems (WfMS) have gained attention as a viable option. However, applying WfMS in IoT faces real-time service composition challenges such as continuous service discovery and invocation. Another question is how to integrate resource-contained IoT devices with the WfMS and execute workflows on the IoT devices. Tasks such as continuous device discovery can be taxing for IoT-involved devices with limited processing power and battery life such as smartphones. In order to overcome this, some tasks can be delegated to a utility Cloud instance. This thesis proposes a context-based framework for task mediation in Internet of Things applications. In the framework, tasks are modelled and executed as workflows. A case study carried out with a prototype of the framework showed that the proposed framework is able to decide when it is more cost-efficient to delegate discovery tasks to the cloud. However, sometimes embedding a workflow engine in an IoT device is not beneficial considering agility and energy conservation. This thesis compared two types of workflow execution: a) execution of workflow models using an embedded workflow engine and b) execution of program code translations based on the workflow models. Based on experiments with real devices, the two methods were compared in terms of system resource and energy usage

DCCSS:a meta-model for dynamic clinical checklist support systems

Clinical safety checklists receive much research attention since they can reduce medical errors and improve patient safety. Computerized checklist support systems are also being developed actively. Such systems should individualize checklists based on information from the patient’s medical record while also considering the context of the clinical workflows. Unfortunately, the form definitions, database queries and workflow definitions related to dynamic checklists are too often hard-coded in the source code of the support systems. This increases the cognitive effort for the clinical stakeholders in the design process, it complicates the sharing of dynamic checklist definitions as well as the interoperability with other information systems. In this paper, we address these issues by contributing the DCCSS meta-model which enables the model-based development of dynamic checklist support systems. DCCSS was designed as an incremental extension of standard meta-models, which enables the reuse of generic model editors in a novel setting. In particular, DCCSS integrates the Business Process Model and Notation (BPMN) and the Guideline Interchange Format (GLIF), which represent best of breed languages for clinical workflow modeling and clinical rule modeling respectively. We also demonstrate one of the use cases where DCCSS has already been applied in a clinical setting