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

Toward the automation of business process ontology generation

Semantic Business Process Management (SBPM) utilises semantic technologies (e.g., ontology) to model and query process representations. There are times in which such models must be reconstructed from existing textual documentation. In this scenario the automated generation of ontological models would be preferable, however current methods and technology are still not capable of automatically generating accurate semantic process models from textual descriptions. This research attempts to automate the process as much as possible by proposing a method that drives the transformation through the joint use of a foundational ontology and lexico-semantic analysis. The method is presented, demonstrated and evaluated. The original dataset represents 150 business activities related to the procurement processes of a case study company. As the evaluation shows, the proposed method can accurately map the linguistic patterns of the process descriptions to semantic patterns of the foundational ontology to a high level of accuracy, however further research is required in order to reduce the level of human intervention, expand the method so as to recognise further patterns of the foundational ontology and develop a tool to assist the business process modeller in the semi-automated generation of process models

Identifying and Modelling Complex Workflow Requirements in Web Applications

Workflow plays a major role in nowadays business and therefore its requirement elicitation must be accurate and clear for achieving the solution closest to business’s needs. Due to Web applications popularity, the Web is becoming the standard platform for implementing business workflows. In this context, Web applications and their workflows must be adapted to market demands in such a way that time and effort are minimize. As they get more popular, they must give support to different functional requirements but also they contain tangled and scattered behaviour. In this work we present a model-driven approach for modelling workflows using a Domain Specific Language for Web application requirement called WebSpec. We present an extension to WebSpec based on Pattern Specifications for modelling crosscutting workflow requirements identifying tangled and scattered behaviour and reducing inconsistencies early in the cycle

A linked data approach to publishing complex scientific workflows

Past data management practices in many fields of natural science, including climate research, have focused primarily on the final research output - the research publication - with less attention paid to the chain of intermediate data results and their associated metadata, including provenance. Data were often regarded merely as an adjunct to the publication, rather than a scientific resource in their own right. In this paper, we attempt to address the issues of capturing and publishing detailed workflows associated with the climate/research datasets held by the Climatic Research Unit (CRU) at the University of East Anglia. To this end, we present a customisable approach to exposing climate research workflows for the effective re-use of the associated data, through the adoption of linked-data principles, existing widely adopted citation techniques (Digital Object Identifier) and data exchange mechanisms (Open Archives Initiative Object Reuse and Exchange)

APQL: A process-model query language

As business process management technology matures, organisations acquire more and more business process models. The management of the resulting collections of process models poses real challenges. One of these challenges concerns model retrieval where support should be provided for the formulation and efficient execution of business process model queries. As queries based on only structural information cannot deal with all querying requirements in practice, there should be support for queries that require knowledge of process model semantics. In this paper we formally define a process model query language that is based on semantic relationships between tasks in process models and is independent of any particular process modelling notation

Interaction-driven definition of e-business processes

Business-to-business interaction (B2Bi) is the next step for corporate IT [1]. Business relationships become increasingly dynamic, and new requirements emerge for data and process management. Standardisation initiatives are successfully targeting business ontology [4]. Still, business agility mainly depends on the flexibility of the business processes of a company. In the B2B space, traditional approaches to process modelling and management are inadequate. Today more than ever, traditional workflow management is crucial for the internal effectiveness of a company. Internal efficiency is a prerequisite for external agility. From both a technical and a business perspective, internal workflow management relies on specific assumptions in terms of resources involved in the process, as well as the process itself [2]. Level of control, availability, reliability, and cost stability are parameters that traditional process models and technology can almost take for granted. A single authority ruling on the process definition and the total control over process execution are also basic concepts for internal workflows. From a business perspective, a big upfront investment is put in the complete definition of process specifications. A different conceptual framework is required for the definition and management of e-business processes [3, 5]. The intrinsic capability to adapt to rapidly changing business requirements becomes crucial. The line of research explored in this paper derives from an approach to process modelling and management that explicitly targets the peculiarities and dynamics of B2Bi. In the model we propose, the upfront specification of the interaction logic of a company can be limited to partially specified processes and basic interaction rules. Specific information is then gathered from the observation of actual instances of business interaction, and used to refine and extend the initial model. In addition to the enforcement of explicit business requirement, the goal is to capture and leverage implicit operational knowledge. In the following sections, we present an overview of the methodology we are currently experimenting with for the inference of complex processes from business interaction flows. For our initial experiments, we focus on business messages compliant with the RosettaNet standard [4]

A System for Deduction-based Formal Verification of Workflow-oriented Software Models

The work concerns formal verification of workflow-oriented software models using deductive approach. The formal correctness of a model's behaviour is considered. Manually building logical specifications, which are considered as a set of temporal logic formulas, seems to be the significant obstacle for an inexperienced user when applying the deductive approach. A system, and its architecture, for the deduction-based verification of workflow-oriented models is proposed. The process of inference is based on the semantic tableaux method which has some advantages when compared to traditional deduction strategies. The algorithm for an automatic generation of logical specifications is proposed. The generation procedure is based on the predefined workflow patterns for BPMN, which is a standard and dominant notation for the modeling of business processes. The main idea for the approach is to consider patterns, defined in terms of temporal logic,as a kind of (logical) primitives which enable the transformation of models to temporal logic formulas constituting a logical specification. Automation of the generation process is crucial for bridging the gap between intuitiveness of the deductive reasoning and the difficulty of its practical application in the case when logical specifications are built manually. This approach has gone some way towards supporting, hopefully enhancing our understanding of, the deduction-based formal verification of workflow-oriented models.Comment: International Journal of Applied Mathematics and Computer Scienc

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