Can process mining automatically describe care pathways of patients with long-term conditions in UK primary care? A study protocol

Introduction In the UK, primary care is seen as the optimal context for delivering care to an ageing population with a growing number of long-term conditions. However, if it is to meet these demands effectively and efficiently, a more precise understanding of existing care processes is required to ensure their configuration is based on robust evidence. This need to understand and optimise organisational performance is not unique to healthcare, and in industries such as telecommunications or finance, a methodology known as ‘process mining’ has become an established and successful method to identify how an organisation can best deploy resources to meet the needs of its clients and customers. Here and for the first time in the UK, we will apply it to primary care settings to gain a greater understanding of how patients with two of the most common chronic conditions are managed. Methods and analysis The study will be conducted in three phases; first, we will apply process mining algorithms to the data held on the clinical management system of four practices of varying characteristics in the West Midlands to determine how each interacts with patients with hypertension or type 2 diabetes. Second, we will use traditional process mapping exercises at each practice to manually produce maps of care processes for the selected condition. Third, with the aid of staff and patients at each practice, we will compare and contrast the process models produced by process mining with the process maps produced via manual techniques, review differences and similarities between them and the relative importance of each. The first pilot study will be on hypertension and the second for patients diagnosed with type 2 diabetes

Thirty years of artificial intelligence in medicine (AIME) conferences: A review of research themes

Over the past 30 years, the international conference on Artificial Intelligence in MEdicine (AIME) has been organized at different venues across Europe every 2 years, establishing a forum for scientific exchange and creating an active research community. The Artificial Intelligence in Medicine journal has published theme issues with extended versions of selected AIME papers since 1998

HEALTH INFORMATION STANDARDISATION AS A BASIS FOR LEARNING HEALTH SYSTEMS

PhD ThesisStandardisation of healthcare has been the focus of hospital management and clinicians since the 1990’s. Electronic health records were already intended to provide clinicians with real-time access to clinical knowledge and care plans while also recording and storing vast amounts of patient data. It took more than three decades for electronic health records to start to become ubiquitous in all aspects of healthcare. Learning health systems are the next stage in health information systems whose potential benefits have been promoted for more than a decade - yet few are seen in clinical practice. Clinical care process specifications are a primary form of clinical documentation used in all aspects of healthcare, but they lack standardisation. This thesis contends that this lack of standardisation was inherited by electronic health records and that this is a significant issue holding back the development and adoption of learning health systems. Standardisation of clinical documents is used to mitigate issues in electronic health records as a basis for enabling learning health systems. One type of clinical document, the caremap, is standardised in order to achieve an effective approach to containing resources and ensuring consistency and quality. This led not only to improved clinicians’ comprehension and acceptance of the clinical document, but also to reduced time expended in developing complicated learning health systems built using the input of clinical experts

A Methodological Framework for the Integrated Design of Decision-Intensive Care Pathways\u2014an Application to the Management of COPD Patients

Healthcare processes are by nature complex, mostly due to their multi-disciplinary character that requires continuous coordination between care providers. They encompass both organizational and clinical tasks, the latter ones driven by med- ical knowledge, which is inherently incomplete and distributed among people having different expertise and roles. Care pathways refer to planning and coordination of care processes related to specific groups of patients in a given setting. The goal in defining and following care pathways is to improve the quality of care in terms of patient satisfaction, costs reduction, and medical outcome. Thus, care pathways are a promising methodological tool for standardizing care and decision-making. Business process management techniques can successfully be used for representing organiza- tional aspects of care pathways in a standard, readable, and accessible way, while supporting process development, analysis, and re-engineering. In this paper, we intro- duce a methodological framework that fosters the integrated design, implementation, and enactment of care processes and related decisions, while considering proper rep- resentation and management of organizational and clinical information. We focus here and discuss in detail the design phase, which encompasses the simulation of care pathways. We show how business process model and notation (BPMN) and decision model and notation (DMN) can be combined for supporting intertwined aspects of decision-intensive care pathways. As a proof-of-concept, the proposed methodology has been applied to design care pathways related to chronic obstructive pulmonary disease (COPD) in the region of Veneto, in Italy

Agent-based management of clinical guidelines

Les guies de pràctica clínica (GPC) contenen un conjunt d'accions i dades que ajuden a un metge a prendre decisions sobre el diagnòstic, tractament o qualsevol altre procediment a un pacient i sobre una determinada malaltia. És conegut que l'adopció d'aquestes guies en la vida diària pot millorar l'assistència mèdica als pacients, pel fet que s'estandarditzen les pràctiques. Sistemes computeritzats que utilitzen GPC poden constituir part de sistemes d'ajut a la presa de decisions més complexos amb la finalitat de proporcionar el coneixement adequat a la persona adequada, en un format correcte i en el moment precís. L'automatització de l'execució de les GPC és el primer pas per la seva implantació en els centres mèdics.Per aconseguir aquesta implantació final, hi ha diferents passos que cal solucionar com per exemple, l'adquisició i representació de les GPC, la seva verificació formal, i finalment la seva execució. Aquesta Tesi està dirigida en l'execució de GPC i proposa la implementació d'un sistema multi-agent. En aquest sistema els diferents actors dels centres mèdics coordinen les seves activitats seguint un pla global determinat per una GPC. Un dels principals problemes de qualsevol sistema que treballa en l'àmbit mèdic és el tractament del coneixement. En aquest cas s'han hagut de tractar termes mèdics i organitzatius, que s'ha resolt amb la implementació de diferents ontologies. La separació de la representació del coneixement del seu ús és intencionada i permet que el sistema d'execució de GPC sigui fàcilment adaptable a les circumstàncies concretes dels centres, on varien el personal i els recursos disponibles.En paral·lel a l'execució de GPC, el sistema proposat manega preferències del pacient per tal d'implementar serveis adaptats al pacient. En aquesta àrea concretament, a) s'han definit un conjunt de criteris, b) aquesta informació forma part del perfil de l'usuari i serveix per ordenar les propostes que el sistema li proposa, i c) un algoritme no supervisat d'aprenentatge permet adaptar les preferències del pacient segons triï.Finalment, algunes idees d'aquesta Tesi actualment s'estan aplicant en dos projectes de recerca. Per una banda, l'execució distribuïda de GPC, i per altra banda, la representació del coneixement mèdic i organitzatiu utilitzant ontologies.Clinical guidelines (CGs) contain a set of directions or principles to assist the health care practitioner with patient care decisions about appropriate diagnostic, therapeutic, or other clinical procedures for specific clinical circumstances. It is widely accepted that the adoption of guideline-execution engines in daily practice would improve the patient care, by standardising the care procedures. Guideline-based systems can constitute part of a knowledge-based decision support system in order to deliver the right knowledge to the right people in the right form at the right time. The automation of the guideline execution process is a basic step towards its widespread use in medical centres.To achieve this general goal, different topics should be tackled, such as the acquisition of clinical guidelines, its formal verification, and finally its execution. This dissertation focuses on the execution of CGs and proposes the implementation of an agent-based platform in which the actors involved in health care coordinate their activities to perform the complex task of guideline enactment. The management of medical and organizational knowledge, and the formal representation of the CGs, are two knowledge-related topics addressed in this dissertation and tackled through the design of several application ontologies. The separation of the knowledge from its use is fully intentioned, and allows the CG execution engine to be easily customisable to different medical centres with varying personnel and resources.In parallel with the execution of CGs, the system handles citizen's preferences and uses them to implement patient-centred services. With respect this issue, the following tasks have been developed: a) definition of the user's criteria, b) use of the patient's profile to rank the alternatives presented to him, c) implementation of an unsupervised learning method to adapt dynamically and automatically the user's profile.Finally, several ideas of this dissertation are being directly applied in two ongoing funded research projects, including the agent-based execution of CGs and the ontological management of medical and organizational knowledge

Combining ontologies and rules with clinical archetypes

Al igual que otros campos que dependen en gran medida de las funcionalidades ofrecidas por las tecnologías de la información y las comunicaciones (IT), la biomedicina y la salud necesitan cada vez más la implantación de normas y mecanismos ampliamente aceptados para el intercambio de datos, información y conocimiento. Dicha necesidad de compatibilidad e interoperabilidad va más allá de las cuestiones sintácticas y estructurales, pues la interoperabilidad semántica es también requerida. La interoperabilidad a nivel semántico es esencial para el soporte computarizado de alertas, flujos de trabajo y de la medicina basada en evidencia cuando contamos con la presencia de sistemas heterogéneos de Historia Clínica Electrónica (EHR). El modelo de arquetipos clínicos respaldado por el estándar CEN/ISO EN13606 y la fundación openEHR ofrece un mecanismo para expresar las estructuras de datos clínicos de manera compartida e interoperable. El modelo ha ido ganando aceptación en los últimos años por su capacidad para definir conceptos clínicos basados en un Modelo de Referencia común. Dicha separación a dos capas permite conservar la heterogeneidad de las implementaciones de almacenamiento a bajo nivel, presentes en los diferentes sistemas de EHR. Sin embargo, los lenguajes de arquetipos no soportan la representación de reglas clínicas ni el mapeo a ontologías formales, ambos elementos fundamentales para alcanzar la interoperabilidad semántica completa pues permiten llevar a cabo el razonamiento y la inferencia a partir del conocimiento clínico existente. Paralelamente, es reconocido el hecho de que la World Wide Web presenta requisitos análogos a los descritos anteriormente, lo cual ha fomentado el desarrollo de la Web Semántica. El progreso alcanzado en este terreno, con respecto a la representación del conocimiento y al razonamiento sobre el mismo, es combinado en esta tesis con los modelos de EHR con el objetivo de mejorar el enfoque de los arquetipos clínicos y ofrecer funcionalidades que se corresponden con nivel más alto de interoperabilidad semántica. Concretamente, la investigación que se describe a continuación presenta y evalúa un enfoque para traducir automáticamente las definiciones expresadas en el lenguaje de definición de arquetipos de openEHR (ADL) a una representación formal basada en lenguajes de ontologías. El método se implementa en la plataforma ArchOnt, que también es descrita. A continuación se estudia la integración de dichas representaciones formales con reglas clínicas, ofreciéndose un enfoque para reutilizar el razonamiento con instancias concretas de datos clínicos. Es importante ver como el acto de compartir el conocimiento clínico expresado a través de reglas es coherente con la filosofía de intercambio abierto fomentada por los arquetipos, a la vez que se extiende la reutilización a proposiciones de conocimiento declarativo como las utilizadas en las guías de práctica clínica. De esta manera, la tesis describe una técnica de mapeo de arquetipos a ontologías, para luego asociar reglas clínicas a la representación resultante. La traducción automática también permite la conexión formal de los elementos especificados en los arquetipos con conceptos clínicos equivalentes provenientes de otras fuentes como son las terminologías clínicas. Dichos enlaces fomentan la reutilización del conocimiento clínico ya representado, así como el razonamiento y la navegación a través de distintas ontologías clínicas. Otra contribución significativa de la tesis es la aplicación del enfoque mencionado en dos proyectos de investigación y desarrollo clínico, llevados a cabo en combinación con hospitales universitarios de Madrid. En la explicación se incluyen ejemplos de las aplicaciones más representativas del enfoque como es el caso del desarrollo de sistemas de alertas orientados a mejorar la seguridad del paciente. No obstante, la traducción automática de arquetipos clínicos a lenguajes de ontologías constituye una base común para la implementación de una amplia gama de actividades semánticas, razonamiento y validación, evitándose así la necesidad de aplicar distintos enfoques ad-hoc directamente sobre los arquetipos para poder satisfacer las condiciones de cada contexto

Exploring the use of routine healthcare data through process mining to inform the management of musculoskeletal diseases

Healthcare informatics can help address some of the challenges faced by both healthcare providers and patients. The medical domain is characterised by inherently complex and intricate issues, data can often be of poor quality and novel techniques are required. Process mining is a discipline that uses techniques to extract insights from event data, generated during the execution of processes. It has had good results in various branches of medical science but applications to musculoskeletal diseases remain largely unexplored. This research commenced with a review of the healthcare and technical literature and applied a variety of process mining techniques in order to investigate approaches to the healthcare plans of patients with musculoskeletal conditions. The analysis involved three datasets from: 1) a private hospital in Boston, US, where data was used to create disease trajectory models. Results suggest the method may be of interest to healthcare researchers, as it enables a more rapid modelling and visualisation; 2) a mobile healthcare application for patients receiving physiotherapy in Sheffield, UK, where data was used to identify possible indicators for health outcomes. After evaluation of the results, it was found that the indicators identified may be down to chance; and 3) the population of Wales to explore knee pain surgery pathways. Results suggest that process mining is an effective technique. This work demonstrates how routine healthcare data can be analysed using process mining techniques to provide insights that may benefit patients suffering with musculoskeletal conditions. This thesis explores how strict criteria for analysis can be performed. The work is intended to expand the breadth of process mining methods available to the data science community and has contributed by making recommendations for service utilisation within physiotherapy at Sheffield Hospital and helped to define a roadmap for a leading healthcare software company