Clinical guidelines as plans: An ontological theory

Clinical guidelines are special types of plans realized by collective agents. We provide an ontological theory of such plans that is designed to support the construction of a framework in which guideline-based information systems can be employed in the management of workflow in health care organizations. The framework we propose allows us to represent in formal terms how clinical guidelines are realized through the actions of are realized through the actions of individuals organized into teams. We provide various levels of implementation representing different levels of conformity on the part of health care organizations. Implementations built in conformity with our framework are marked by two dimensions of flexibility that are designed to make them more likely to be accepted by health care professionals than standard guideline-based management systems. They do justice to the fact 1) that responsibilities within a health care organization are widely shared, and 2) that health care professionals may on different occasions be non-compliant with guidelines for a variety of well justified reasons. The advantage of the framework lies in its built-in flexibility, its sensitivity to clinical context, and its ability to use inference tools based on a robust ontology. One disadvantage lies in its complicated implementation

Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

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)

Optimized Time Management for Declarative Workflows

Declarative process models are increasingly used since they fit better with the nature of flexible process-aware information systems and the requirements of the stakeholders involved. When managing business processes, in addition, support for representing time and reasoning about it becomes crucial. Given a declarative process model, users may choose among different ways to execute it, i.e., there exist numerous possible enactment plans, each one presenting specific values for the given objective functions (e.g., overall completion time). This paper suggests a method for generating optimized enactment plans (e.g., plans minimizing overall completion time) from declarative process models with explicit temporal constraints. The latter covers a number of well-known workflow time patterns. The generated plans can be used for different purposes like providing personal schedules to users, facilitating early detection of critical situations, or predicting execution times for process activities. The proposed approach is applied to a range of test models of varying complexity. Although the optimization of process execution is a highly constrained problem, results indicate that our approach produces a satisfactory number of suitable solutions, i.e., solutions optimal in many cases

Knowledge-Intensive Processes: Characteristics, Requirements and Analysis of Contemporary Approaches

Engineering of knowledge-intensive processes (KiPs) is far from being mastered, since they are genuinely knowledge- and data-centric, and require substantial flexibility, at both design- and run-time. In this work, starting from a scientific literature analysis in the area of KiPs and from three real-world domains and application scenarios, we provide a precise characterization of KiPs. Furthermore, we devise some general requirements related to KiPs management and execution. Such requirements contribute to the definition of an evaluation framework to assess current system support for KiPs. To this end, we present a critical analysis on a number of existing process-oriented approaches by discussing their efficacy against the requirements

Two Case Studies of Subsystem Design for General-Purpose CSCW Software Architectures

This paper discusses subsystem design guidelines for the software architecture of general-purpose computer supported cooperative work systems, i.e., systems that are designed to be applicable in various application areas requiring explicit collaboration support. In our opinion, guidelines for subsystem level design are rarely given most guidelines currently given apply to the programming language level. We extract guidelines from a case study of the redesign and extension of an advanced commercial workflow management system and place them into the context of existing software engineering research. The guidelines are then validated against the design decisions made in the construction of a widely used web-based groupware system. Our approach is based on the well-known distinction between essential (logical) and physical architectures. We show how essential architecture design can be based on a direct mapping of abstract functional concepts as found in general-purpose systems to modules in the essential architecture. The essential architecture is next mapped to a physical architecture by applying software clustering and replication to achieve the required distribution and performance characteristics

Reproducible computational biology experiments with SED-ML - The Simulation Experiment Description Markup Language

Background: The increasing use of computational simulation experiments to inform modern biological research creates new challenges to annotate, archive, share and reproduce such experiments. The recently published Minimum Information About a Simulation Experiment (MIASE) proposes a minimal set of information that should be provided to allow the reproduction of simulation experiments among users and software tools. Results: In this article, we present the Simulation Experiment Description Markup Language (SED-ML). SED-ML encodes in a computer-readable exchange format the information required by MIASE to enable reproduction of simulation experiments. It has been developed as a community project and it is defined in a detailed technical specification and additionally provides an XML schema. The version of SED-ML described in this publication is Level 1 Version 1. It covers the description of the most frequent type of simulation experiments in the area, namely time course simulations. SED-ML documents specify which models to use in an experiment, modifications to apply on the models before using them, which simulation procedures to run on each model, what analysis results to output, and how the results should be presented. These descriptions are independent of the underlying model implementation. SED-ML is a software-independent format for encoding the description of simulation experiments; it is not specific to particular simulation tools. Here, we demonstrate that with the growing software support for SED-ML we can effectively exchange executable simulation descriptions. Conclusions: With SED-ML, software can exchange simulation experiment descriptions, enabling the validation and reuse of simulation experiments in different tools. Authors of papers reporting simulation experiments can make their simulation protocols available for other scientists to reproduce the results. Because SED-ML is agnostic about exact modeling language(s) used, experiments covering models from different fields of research can be accurately described and combined

A Consent-based Workflow System for Healthcare Systems

In this paper, we describe a new framework for healthcare systems where patients are able to control the disclosure of their medical data. In our framework, the patient's consent has a pivotal role in granting or removing access rights to subjects accessing patient's medical data. Depending on the context in which the access is being executed, different consent policies can be applied. Context is expressed in terms of workflows. The execution of a task in a given workflow carries the necessary information to infer whether the consent can be implicitly retrieved or should be explicitly requested from a patient. However, patients are always able to enforce their own decisions and withdraw consent if necessary. Additionally, the use of workflows enables us to apply the need-to-know principle. Even when the patient's consent is obtained, a subject should access medical data only if it is required by the actual situation. For example, if the subject is assigned to the execution of a medical diagnosis workflow requiring access to the patient's medical record. We also provide a complex medical case study to highlight the design principles behind our framework. Finally, the implementation of the framework is outlined