A Process Modelling Framework Based on Point Interval Temporal Logic with an Application to Modelling Patient Flows

This thesis considers an application of a temporal theory to describe and model the patient journey in the hospital accident and emergency (A&E) department. The aim is to introduce a generic but dynamic method applied to any setting, including healthcare. Constructing a consistent process model can be instrumental in streamlining healthcare issues. Current process modelling techniques used in healthcare such as flowcharts, unified modelling language activity diagram (UML AD), and business process modelling notation (BPMN) are intuitive and imprecise. They cannot fully capture the complexities of the types of activities and the full extent of temporal constraints to an extent where one could reason about the flows. Formal approaches such as Petri have also been reviewed to investigate their applicability to the healthcare domain to model processes. Additionally, to schedule patient flows, current modelling standards do not offer any formal mechanism, so healthcare relies on critical path method (CPM) and program evaluation review technique (PERT), that also have limitations, i.e. finish-start barrier. It is imperative to specify the temporal constraints between the start and/or end of a process, e.g., the beginning of a process A precedes the start (or end) of a process B. However, these approaches failed to provide us with a mechanism for handling these temporal situations. If provided, a formal representation can assist in effective knowledge representation and quality enhancement concerning a process. Also, it would help in uncovering complexities of a system and assist in modelling it in a consistent way which is not possible with the existing modelling techniques. The above issues are addressed in this thesis by proposing a framework that would provide a knowledge base to model patient flows for accurate representation based on point interval temporal logic (PITL) that treats point and interval as primitives. These objects would constitute the knowledge base for the formal description of a system. With the aid of the inference mechanism of the temporal theory presented here, exhaustive temporal constraints derived from the proposed axiomatic system’ components serves as a knowledge base. The proposed methodological framework would adopt a model-theoretic approach in which a theory is developed and considered as a model while the corresponding instance is considered as its application. Using this approach would assist in identifying core components of the system and their precise operation representing a real-life domain deemed suitable to the process modelling issues specified in this thesis. Thus, I have evaluated the modelling standards for their most-used terminologies and constructs to identify their key components. It will also assist in the generalisation of the critical terms (of process modelling standards) based on their ontology. A set of generalised terms proposed would serve as an enumeration of the theory and subsume the core modelling elements of the process modelling standards. The catalogue presents a knowledge base for the business and healthcare domains, and its components are formally defined (semantics). Furthermore, a resolution theorem-proof is used to show the structural features of the theory (model) to establish it is sound and complete. After establishing that the theory is sound and complete, the next step is to provide the instantiation of the theory. This is achieved by mapping the core components of the theory to their corresponding instances. Additionally, a formal graphical tool termed as point graph (PG) is used to visualise the cases of the proposed axiomatic system. PG facilitates in modelling, and scheduling patient flows and enables analysing existing models for possible inaccuracies and inconsistencies supported by a reasoning mechanism based on PITL. Following that, a transformation is developed to map the core modelling components of the standards into the extended PG (PG*) based on the semantics presented by the axiomatic system. A real-life case (from the King’s College hospital accident and emergency (A&E) department’s trauma patient pathway) is considered to validate the framework. It is divided into three patient flows to depict the journey of a patient with significant trauma, arriving at A&E, undergoing a procedure and subsequently discharged. Their staff relied upon the UML-AD and BPMN to model the patient flows. An evaluation of their representation is presented to show the shortfalls of the modelling standards to model patient flows. The last step is to model these patient flows using the developed approach, which is supported by enhanced reasoning and scheduling

Modeling IoT-aware Business Processes - A State of the Art Report

This research report presents an analysis of the state of the art of modeling Internet of Things (IoT)-aware business processes. IOT links the physical world to the digital world. Traditionally, we would find information about events and processes in the physical world in the digital world entered by humans and humans using this information to control the physical world. In the IoT paradigm, the physical world is equipped with sensors and actuators to create a direct link with the digital world. Business processes are used to coordinate a complex environment including multiple actors for a common goal, typically in the context of administrative work. In the past few years, we have seen research efforts on the possibilities to model IoT- aware business processes, extending process coordination to real world entities directly. This set of research efforts is relatively small when compared to the overall research effort into the IoT and much of the work is still in the early research stage. To create a basis for a bridge between IoT and BPM, the goal of this report is to collect and analyze the state of the art of existing frameworks for modeling IoT-aware business processes.Comment: 42 page

A service oriented approach for guidelines-based clinical decision support using BPMN

Evidence-based medical practice requires that clinical guidelines need to be documented in such a way that they represent a clinical workflow in its most accessible form. In order to optimize clinical processes to improve clinical outcomes, we propose a Service Oriented Architecture (SOA) based approach for implementing clinical guidelines that can be accessed from an Electronic Health Record (EHR) application with a Web Services enabled communication mechanism with the Enterprise Service Bus. We have used Business Process Modelling Notation (BPMN) for modelling and presenting the clinical pathway in the form of a workflow. The aim of this study is to produce spontaneous alerts in the healthcare workflow in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The use of BPMN as a tool to automate clinical guidelines has not been previously employed for providing Clinical Decision Support (CDS)

Measuring performance in healthcare

Hospitals invest in process management and process optimization from an organizational and patient perspective to increase efficiency and simultaneously the quality of their operations. Consequently, the use of process-oriented performance measurement systems gains importance. This study contributes to the development of a dashboard for the process of hip surgery using a case study design. We integrate strategic goals of hospital management and different stakeholders with the analysis of Business Process Management and Hospital Information Systems’ data. Process-oriented KPIs were integrated into the dashboard using a three-step approach. Dashboards enable healthcare organizations to put process-oriented performance measurement into practice

Customizing BPMN Diagrams Using Timelines

BPMN (Business Process Model and Notation) is widely used standard modeling technique for representing Business Processes by using diagrams, but lacks in some aspects. Representing execution-dependent and time-dependent decisions in BPMN Diagrams may be a daunting challenge [Carlo Combi et al., 2017]. In many cases such constraints are omitted in order to preserve the simplicity and the readability of the process model. However, for purposes such as compliance checking, process mining, and verification, formalizing such constraints could be very useful. In this paper, we propose a novel approach for annotating BPMN Diagrams with Temporal Synchronization Rules borrowed from the timeline-based planning field. We discuss the expressivity of the proposed approach and show that it is able to capture a lot of complex temporally-related constraints without affecting the structure of BPMN diagrams. Finally, we provide a mapping from annotated BPMN diagrams to timeline-based planning problems that allows one to take advantage of the last twenty years of theoretical and practical developments in the field

A model-driven method for the systematic literature review of qualitative empirical research

This paper explores a model-driven method for systematic literature reviews (SLRs), for use where the empirical studies found in the literature search are based on qualitative research. SLRs are an important component of the evidence-based practice (EBP) paradigm, which is receiving increasing attention in information systems (IS) but has not yet been widely-adopted. We illustrate the model-driven approach to SLRs via an example focused on the use of BPMN (Business Process Modelling Notation) in organizations. We discuss in detail the process followed in using the model-driven SLR method, and show how it is based on a hermeneutic cycle of reading and interpreting, in order to develop and refine a model which synthesizes the research findings of previous qualitative studies. This study can serve as an exemplar for other researchers wishing to carry out model-driven SLRs. We conclude with our reflections on the method and some suggestions for further researc

Data in Business Process Models. A Preliminary Empirical Study

Traditional activity-centric process modeling languages treat data as simple black boxes acting as input or output for activities. Many alternate and emerging process modeling paradigms, such as case handling and artifact-centric process modeling, give data a more central role. This is achieved by introducing lifecycles and states for data objects, which is beneficial when modeling data-or knowledge-intensive processes. We assume that traditional activity-centric process modeling languages lack the capabilities to adequately capture the complexity of such processes. To verify this assumption we conducted an online interview among BPM experts. The results not only allow us to identify various profiles of persons modeling business processes, but also the problems that exist in contemporary modeling languages w.r.t. The modeling of business data. Overall, this preliminary empirical study confirms the necessity of data-awareness in process modeling notations in general

Preventing Hospital Acquired Infections Through a Workflow-Based Cyber-Physical System

Hospital acquired infections (HAI) are infections acquired within the hospital from healthcare workers, patients or from the environment, but which have no connection to the initial reason for the patient's hospital admission. HAI are a serious world-wide problem, leading to an increase in mortality rates, duration of hospitalisation as well as significant economic burden on hospitals. Although clear preventive guidelines exist, studies show that compliance to them is frequently poor. This paper details the software perspective for an innovative, business process software based cyber-physical system that will be implemented as part of a European Union-funded research project. The system is composed of a network of sensors mounted in different sites around the hospital, a series of wearables used by the healthcare workers and a server side workflow engine. For better understanding, we describe the system through the lens of a single, simple clinical workflow that is responsible for a significant portion of all hospital infections. The goal is that when completed, the system will be configurable in the sense of facilitating the creation and automated monitoring of those clinical workflows that when combined, account for over 90\% of hospital infections.Comment: Proceedings of ENASE 2016, ISBN: 978-989-758-189-

Process-Based Design and Integration of Wireless Sensor Network Applications

Abstract Wireless Sensor and Actuator Networks (WSNs) are distributed sensor and actuator networks that monitor and control real-world phenomena, enabling the integration of the physical with the virtual world. They are used in domains like building automation, control systems, remote healthcare, etc., which are all highly process-driven. Today, tools and insights of Business Process Modeling (BPM) are not used to model WSN logic, as BPM focuses mostly on the coordination of people and IT systems and neglects the integration of embedded IT. WSN development still requires significant special-purpose, low-level, and manual coding of process logic. By exploiting similarities between WSN applications and business processes, this work aims to create a holistic system enabling the modeling and execution of executable processes that integrate, coordinate, and control WSNs. Concretely, we present a WSNspecific extension for Business Process Modeling Notation (BPMN) and a compiler that transforms the extended BPMN models into WSN-specific code to distribute process execution over both a WSN and a standard business process engine. The developed tool-chain allows modeling of an independent control loop for the WSN.