Integrated Clinical Pathways: A Model-based Holistic Method

Against the background of increasing multidisciplinarity as well as the focus on quality, transparency and economic efficiency of medical services, clinical pathways (CPs) have been established as a promising tool at the organizational level in recent years. They are primarily intended to ensure an adequate description of the care processes and to manage the balance between best treatment practice and economic viability. CPs standardize the internal care services by explicating the institution-specific knowledge with regard to recommendations for action, service portfolio, organizational structures, infrastructure, etc. of a specific service provider. The development of hospital information systems (HIS) has so far been characterized by an evolutionary development of modules in the field of laboratory, radiology, nursing and picture archiving systems as well as in the area of administrative systems. As one result of this development, the HIS usually comprises a heterogeneous network of software systems of different types and manufacturers. However, the actual control of patients by means of evidence-based processes and integration of CPs into HIS was not addressed until the recent years, when HIS manufacturers started developing modules for CP modeling and workflow support. The objective of this thesis is to provide a holistic methodical support for the description of clinical pathways and their integration into a hospital information system to finally improve the compliance of daily care to standard process definitions. Therefore, conceptual models provide an adequate mean to describe and communicate complex matters in a comprehensible form as well as to configure IT systems due to their semi-formal nature. Hence, a first research thread investigates the question, how clinical pathways can be described adequately using conceptual models. This results in an iterative design of adequate modeling languages for clinical pathways. A second research thread further investigates the question, how conceptual models of clinical pathways can be used to configure process-oriented application systems in health care. This thread therefore describes the design of a model-based method, that enables a consecutive transformation of CPs into technical (workflow) specifications, based on the principles of the Model-Driven Architecture.:A. Synopsis of the Doctoral Dissertation B. Agility in Medical Treatment Processes C. Domain Specific Modeling Language - CPmod D. BPMN4CP - Version 1.0 E. BPMN4CP - Version 2.0 F. BPMN4CP - Version 2.1 G. MDA in Health Care IS Development H. Transforming Clinical Pathways into Care Workflows I. CDA Templates - Utilizing the MediCUB

Extensibility of Enterprise Modelling Languages

Die Arbeit adressiert insgesamt drei Forschungsschwerpunkte. Der erste Schwerpunkt setzt sich mit zu entwickelnden BPMN-Erweiterungen auseinander und stellt deren methodische Implikationen im Rahmen der bestehenden Sprachstandards dar. Dies umfasst zum einen ganz konkrete Spracherweiterungen wie z. B. BPMN4CP, eine BPMN-Erweiterung zur multi-perspektivischen Modellierung von klinischen Behandlungspfaden. Zum anderen betrifft dieser Teil auch modellierungsmethodische Konsequenzen, um parallel sowohl die zugrunde liegende Sprache (d. h. das BPMN-Metamodell) als auch die Methode zur Erweiterungsentwicklung zu verbessern und somit den festgestellten Unzulänglichkeiten zu begegnen. Der zweite Schwerpunkt adressiert die Untersuchung von sprachunabhängigen Fragen der Erweiterbarkeit, welche sich entweder während der Bearbeitung des ersten Teils ergeben haben oder aus dessen Ergebnissen induktiv geschlossen wurden. Der Forschungsschwerpunkt fokussiert dabei insbesondere eine Konsolidierung bestehender Terminologien, die Beschreibung generisch anwendbarer Erweiterungsmechanismen sowie die nutzerorientierte Analyse eines potentiellen Erweiterungsbedarfs. Dieser Teil bereitet somit die Entwicklung einer generischen Erweiterungsmethode grundlegend vor. Hierzu zählt auch die fundamentale Auseinandersetzung mit Unternehmensmodellierungssprachen generell, da nur eine ganzheitliche, widerspruchsfreie und integrierte Sprachdefinition Erweiterungen überhaupt ermöglichen und gelingen lassen kann. Dies betrifft beispielsweise die Spezifikation der intendierten Semantik einer Sprache

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

A Method for Information Systems Development According to SOA

While service-oriented architecture (SOA) is gaining momentum in research and industry, we believe the field of methods for designing information systems according to SOA still leaves room for improvement. Nevertheless, the implementation of SOA design principles demands a methodical approach. All existing methods have shortcomings of some kind, but also propose some useful concepts. In this paper, the SOA method (SOAM) is presented. It is based on an understanding of the useful concepts from existing methods and puts them together with new ideas that address the key shortcomings. It has been tested in practice at Vattenfall Europe, one of the largest European energy and heat providers and three other companies. The evaluation has shown that SOAM is well-defined, supports the design of information systems according to the SOA design principles and can be applied in practice

Towards an understanding of process model quality. Methodological considerations

Quality is one of the main topics in current conceptual modelling research, as is the field of business process modelling. Yet, widely acknowledged academic contributions towards an understanding or measurement of business process model quality are limited at best. In this paper I argue that the development of methodical theories concerning the problem of process model quality must be preceded by methodological elaborations on business process modelling. I further argue that existing epistemological foundations of process modelling are insufficient for describing the extrinsic and intrinsic traits of model quality. Taking into account the inherent social and purpose-oriented character of process modelling in contemporary organizations I present a socio-pragmatic constructionist methodology of business process modelling and sketch out implications of this perspective towards an understanding of process model quality. I anticipate that, based on this research, theories can be developed that facilitate the evaluation of the ’goodness’ of a business process model

Technical Consequences of the Nature of Business Processes

The paper is a reflection on the nature of business processes and the way which their nature necessarily manifests itself in business process modeling methodologies and languages. Respecting the nature of business processes is an essential condition for the meaningfulness of a process model. The importance of this topic is also emphasized with the fact that not all methodologies nor languages respect the nature of business processes sufficiently. The paper briefly summarizes main facts about and principles of business process management and points out the main natural features of business processes which have to be necessarily respected in modeling methodologies and languages. Then their main resulting features are analyzed in mutual relationships by examples from MMABP methodology. In occasional contexts the paper also contains some critical reflection of current process modeling approaches and BPMN language