Introduction to workflow technology Representation of healthcare processes in a workflow editor and their execution in a workflow engine Vojtech Huser MD PhD AMIA NOW, Small Group session, Tutorial (1hr)Agenda = Part 1: Introduction, history, overview = Part 2: Standards, SDO, related theories = Part 3: Practical tools demonstration = Originally 2 hour workshop = converted to 1 hour tutorial (with focus on introduction and standards) = Accompanying bibliography document ite ee en:Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges ite ee en:Part 2: WT standards, SDOs, related theories = Workflow management coalition’s (WfMC) standards = Definition of WT terms = XML process definition language (XPDL) = Other standardization efforts = Business Process Execution Language (BPEL) = Business Process Modeling Notation (BPMN) = Research-originated WT standards = Petri Nets theory and its relationship to workflows ite ee en:Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: » Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines ite ee en:Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges ite ee en:Workflow technology = BPM = business process management = Adaptive workflow (Adaptive Case Management) = Computer supported collaborative work (CSCW) a Why workflow? = Separation of data into databases = Separation of UI from IT system core = Separation of process knowledge ite ee en:Process Example Ovarrpctn o 8 SB Ye . H wie Yate artes fey ve oonemn eo 8 a) ose ee oll _ Koetter (2007) Las af oa Sea RE aT Fa arom Ea 8 ite ee en:[By experiment out | tata Us| Putcatns loa |G Reger |g? Greunreemace |B ee Home || Users | Groups WEEE | rites | Packs ome » Workflows » Fetch Dragon mages from Biotioby Doone oF ‘Title: Feten Dragon images from BioMoby ‘Type: Tama 1 } @ Preview en Alan Wim (ctocen ne mage gti rat 2c) [namespace © Crodis (1) B tonne © Awibutions (0) None Parse Moby Date iPEGimage SimpleAnaaiaie PEGimage @ Tags() [Clonoina upoaser:an8 images |[amaitiens | y seiven| bioinformatics sereor| XAMPIC | rese miyatd | separ tae 9 i eeWorkflow patterns examples = Parallel Split: When an intrusion alarm is received, trigger the dispatch-patro/ activity and the inform-police activity immediately. = Exclusive Choice: After the review election activity is complete, either the dec/are results or the recount votes activity is undertaken. = Multi Choice: Depending on the nature of the emergency call, one or more of the despatch-police, despatch-fire-engine and despatch-ambulance activities is immediately initiated. 10 ie ee en:WORKFLOW CONTROL-FLOW PATTERNS A Revised View* Nick Russell!, Arthur H.M. ter Hofstede! , ‘Wil MP. van der Aalst!?, Nataliya Mulyar? 1BPM Group, Queensland University of Tochnology — #Department of Technology Management, Eindhoven University of Technolom GPO Box 2434, Brisbane QLD 4001, Australia PO Bor 518, NL-5600 MB Eindhoven, The Netherlands (n.russell,a.terhofstede}¢qut .edu. au {un.p.v.d.aalet,n.mulyar)@ta.tue.a1 Pattern WCP-24 (Per: Description The ability for an activity to be triggered by a signal from another part of the process or from the external environment. These triggers are persistent in form and are retained by the workflow until they can be acted on by the receiving activity. tent Trigger) Examples Start a new instance of the Inspect Vehicle activity for each service overdue signal that is received. Motivation Persistefat triggers are inherently durable in nature, ensuring that they are not lost in transit, and are buffered until they can be dealt with by the target activity. This means that the signalling activity can be certain that the trigger will result in the activity to which they are directed being initiated either immediately (if it already has received the thread of control) or at some future time. ii ite ee en:Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges 12 ite ee en:WT development = 1960s = Petri Nets (Carl A. Petri PhD work) il = 1960s-present = Workflow components of various systems a 1999 = WfMC: terminology = 2000s = 2002: XPDL 1.0 = 2005 XPDL 2.0 = 2008 XPDL 2.1 = BPMN standard 13 ite ee en:iam Workflow Systems (vam) Cente ama cas oa ar 2000 1985 1990 BS ete te en:ite ee en: ‘Commercial Workflow Systems 15Figure 1. Hype Cycle for Healthcare Provider Technologies and Standards, 2008 visibility ico-womus) corms. [jp pmneer Ok Cie neanentae Beside Muted Bade PC.—Heathcare Providers Medical Device Management HIPAA Gams Ataerments ‘Standard Sece Manapemert Tos | cst Heatmeare Hanayeiing Recogeton Bluetooth Medical Device Profle Diskopvituazaton Caracal Contest Cojo Workroup IT GROM Toots ‘Sine SgTOn Voice Over Intemet Protocol Basic Web Services Protie Nata Pracesin (Gocument Ciaseeston) wos ‘Speech Recognition (Once and Done) Sennce-OnentedAvcetire ‘Strong Authentication for Remote Access ‘Natural Language Processing (Text to Facts) Semantic WebHealtncare. Dalat SOA Application Inigration Tootsets in Healthcare ‘Microscopy ‘Enterprise Access As of June 2008 Peak of ‘Technology Trough of Plateau of Trigger gp Mates Disilusionment Slope of Enlightenment roductivity \ time ‘Years to mainstream adoption: obsolete Oless than 2 years © 2toSyears @5to10years Amorethan 10 years © before plateau ‘Source: Gartnor (June 2008) 10 ite ee en:Figure 2. Priority Matrix for Healthcare Provider Technologies and Standards, 2008 benefit less than 2:years years to mainstream adoption 205 years Sto 10 years ‘more than 10 years. —— a a high moderate nanona rowoerterater ‘As of June 2008 ‘Source: Gartner (June 2008) ite ee en: otutes Aeterna Stem Ertersse PKL Hanaurang Recognton jcoremus) Sexe rents Brentechre teaser ote in Recoonton ns bore) ee Pree! Desktop Vinton ‘Sng Authentcason Enterpree Accost ‘Seng Auenteason or Remo acca cortrun nee = *% cst Hewneare Digtal Meroscony HUT v3 Messages Ingormation Lite Cysie Nanagenert| Ir GROW Tose Rounang Robots Sener Vitetion Service Management tooo 08 Supper From Heathcare Apsicaton User Frowsoring Bede Mute Dewees Buetoon Mec Doves Freie Medical Desce SSancaesnton 17Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges 18 ite ee en:Automating Workflow = Defined by Workflow Management Coalition (WfMC) = www.wfmc.org = Terminology and Glossary » http://www.wfmc.org/standards/docs/TC- 1011_term_glossary_v3.pdf ite ee en:Terms = Workflow = The automation of a business process, in whole or part, during which documents, information or tasks are passed from one participant to another for action, according to a set of procedural rules. » WfMS = Workflow Management System = BPM = Business Proces: 20 ete wnBusiness Process (ie.. what is intended to happen) is defined in a [- — —& Process Definition | (a representation of what \ is intended to happen) Activities which may be nk ies Automated Activities Manual Activ (which are not managed as part of the Workflow System) ete te en: 21Business Process (ie... what is imended to happen) is defined ina ismanaged by a [- — —& Process Definition Workflow Management System | arepresentation of what (controls antomated aspects \ Is intended to happen) used to create af the business process) & manage Sub-Processes via A composed of Process Instances (a representation of what Activities is actually happening) which may be include one or more or Manual Activities Automated Activities > _Activity Instances (which are not managed as during execution which part of the Workflow System) care represented by include Invoked Applications (tasks allocated toa (computer toois/applications workflow participant) used 10 support an activity) 2 we Ttems ite ee en:Humans & machines working together ite ee en: Business Process Analysis, Modelling & Definition Tools ’ Process Design & Definition Build Time Process Mating TT efinition Process Instanciation erat Workflow Enactment Service Cae tion Tools — Soe cols 23Executable flowchart [ ]] Userintertice & Local Desktop Applications J Process/Activity Met Mh cunt | individual activity 4 —|_+e—_ +e +e +e > 1 ses t Distribution Funetion Business = F een Applications, \* —f | Pats 24 ite ee en:Worklist enerves Process May reference Definition T Interpreted by | fe Organisation mY Ba Administration ‘& Monitoring, (Supervisor ise References — = as Manipulates| ‘Work Work ist Relevant Dats Hl Software component [1 system cont data LB External productidata Workflow Participant Figure 5 Workflow Product Structure 25 ite ee en:ite ee en: Process Definition Process Instance Worklist Ist Process Instance Work List 1 | Work tiem | ro rss deimina | 1 Activity B frctvity A AaiviyD} 2nd Process Instance Work Item 2 7 Work tee Work tem 4 ofets Work Item N Work List 2 Process Definition B it Preiss 5 Work Item 20 * Work Item 21 Work Item 2 >| 2nd Process Instance sci D ° ° mise Work Item N 26Minimum components language 27Administration & Monitoring Tools, ite ee en: Workflow APT fee formats Interface 4 Workflow Enactment Service Workflow Engine(s) Other Workflow Enactment Service(s) Workflow Engine(s) Figure 4 - The Workflow Reference Model 28Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges 29 ite ee en:WT benefits = Non-programmers understand processes = Non-programmers can modify processes = Analytical tools = Faster IT system development (SOA+WT) 30 ite ee en:Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges 31 ete ee en:Choice of Wf vendor = Major player = TIBCO = BEA » Global 360 = IBM = Other « Fujitsu IBM Oracle Microsoft SAP Lombardi ite ee en: 4 abiity to execute challengers leaders niche players ‘visionaries + comaleteness of vison ” As ot Decerber 2007 32Bee en We Se Lord Fo|Se es US OMe eal VRC ie ete te en: 33RB Ole (Cenecasamageemnnrarenneenerse te (|< me mare = [mc crer terme —| Tinea aio |saonin ePerr==— ij [ ieee Ha niacvonencs | By rem tan | lean LS oc na [a comtortnn i ee| lwel @al [= ORs 35fe Boss Eat Yew tho Fmt pins Mon web eri PHIOOs O OS O SA AC AlLOg + «ls)a/-————— eg 8am oy x ‘ Procest td Shama ist) Glemceto ret Ppata Cross Scene Ente: Eek Ea ax a01 (Sa | Decision Antal py etal Tata wore end ‘an RR reer Denson omer Imerapeuic modatty, ps weed ior norapeute mossy used Canies| Pecering| Wat Colton | Cat | Wai tal ute | smut Rost RaCode SYS. Pe s STRING inten ‘Wout Catered endl rode met inc eegenerar sil Ban] Gisuom| Gane] Grennee] iat] —_Yaonmer] —@cmown] E]veubes Mocs) peenaueenormets] ont don| edit] ote Aatnevoacoiie| <@ctnataten| B Gtreonantntes| D ct antes] mi Gti etter] 8. twee] ions] Dea] heater] Der] Oct] ainensmraen| lteter] ite ee en: 38jel @ |G) @\|@a@| & pe (68 | = | & | & [ete |e eee at te ee Process Monitor 622 entnes 123456 & ( ehne@aas {916 modules001_ta! | Id admin 2009-08-10 10:42 - open.cunning aan aa aan = aaeaae a laa aeenuaal: ae 913_modules001_Id! ~) Idi laces 2009-08-10 10:42 ae open.running oe ae SS aaa 7a cen ol) eee te en: 39Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges 40 ite ee en:Use of WT = Pioneer domains = Banking » Manufacturing = Shipping = Government authorities = Pharmaceutical = Healthcare = Gartner 2008 report: <5% use ite ee en: 41Examples of WT use in healthcare Bed management Infections control (MRSA) ett J. Emanuele and L. Koetter, "Workflow Opportunities and Challenges in Healthcare,” in 2007 BPM & Workflow Handbook, 2007. L. Koetter, "MRSA infection control with workflow technology,” Spring AMIA Conference, Orlando, FL, 2007, R. Hess, "The Chester County Hospital Goalposts., 2007. ‘ase Study," in 2007 Excellence in Practice: Moving the 42 ite ee en:Stroke guideline (WfMS)Soarian Soorian™ — Workflow Management Applied for Health Care t ton Seggewies?, W. Baldauf-Sobez*, P Kullmonn’, H. Reichert’, L. Luedecke?, bol ‘Univesity for Health Informatics and Technology Tyrol (UMIT), Institute for Health Information Systems, Innsbruck, Austia “Aivesty of Eranger-Nuremberg, Ved, Erlangen, Germany Siemens Medical Soltions Health Services, Clinical Systems, Mover, A, USA Siemens Medical Solutions Heolth Service, Clinical Systems, Oslo, Norway “Siemens Medical Solutions Health Sevices, Clinical Systems, Eslangen, Gemony 1. Introduction Summary, To dese ond camer on fcnnly and cite ofthe sofware product Soi Aeveloped by Sims, to ent key detent toro roduc, nit comment on predecessor systems and beta vasons.Tis has ben dane nthe fru ofo conference on beth information systems ofthe IAUA. ‘Methods: Anayzing existing Inertue. Site iit of ite ee en: 1.1 From Hospital Information ‘Systems to Health Information Systems Today information processing is. usually ‘Methods Inf Med 2003; 42: 25-36 One of the outcomes was summarized in the statement: “Whereas the preceding” .. “conferences considered the scope of the Hospital Information Systems (HIS) to be restricted fo the information systems within the borders ofthe institution, this confer ‘ence was of the opinion that functions out- side the hospital also need to be included in the definition, ie. HIS broadens its mea- 441 toni EBS ORD 15 baie TERED 7 Sa tear % nie wenow con a Sane Deere A = ete ee en:Current Soarian Example 46 ite ie en:Use at Marshfield Clinic ite ee en:HealthFlow: RetroGuide, FlowGuide Workflow ‘mining Workflow Additional External Services| (Temrotgy sovioes, NLP services, ‘Steel Ana) ite ee en: Notifications Workflow ian Execution Listener Engine (Shark) ‘actions Data Inquiry, Workilow log analysis. EHR System layer: Prospeciive mode (FlonGuide): EHR system Retrospective mods (RetroGuide): Data Warehouse HealthcareWorkflow.wordpress.com A Marshfield Clinic ‘Additional Components: Host EHR Passive Interaction Modal Host EHR Active Interaction Medel Data Visualization [ontario ee i2b2 48Part 1: Introduction to workflow technology = Need for specifying workflow within IT systems = History of workflow technology = prior 1960s-1980s = development after 1990 = Components of workflow technology (process definition, execution engine, analytical components) = Benefits of implementing a workflow server within a generic IT system = Major workflow vendors and open-source workflow technology tools = Workflow Technology applied industries and healthcare = Future development and research challenges 49 ite ee en:Future of WT = Improvements » Adoption is growing = Software tools sophistication is improving = Competition, consolidation = Future similar to a database server inclusion in IT systems = Standards consolidation = Research challenges = Process model visualization challenges = Process model cross-vendor portability = Adaptive workflow 50 ite ee en:Workflow patterns Basic Control-flow 1. Sequence 2. Paratel Spit 3. Synchronization 4. Exclusive Choice 5. Simple Merge Advanced Synchronization 6. Muttiple Choice 7. Str Synchronizing Merge 8. Multiple Merge 9. Structured Discriminator 28. Blocking Discriminator 29. Canceling Discriminator 30. Structured Partial Join 31. Blocking Partial Join 32. Canceling Partial Join 33. Generalized AND Join 37. Local Sync. Merge 38. General Sync. Merge 41. Thread Merge 42. Thread Spit Iteration 10. Atbirary Cycles 21. Structured Loop 22. Recursion ite ee en: Termination 11. Implicit Termination 43. Explicit Termination Multiple Instances 12. Ml without Synchronization 43. Miwith apri. Design Time Knl 14, Mlwth apr. Runtime Knl 15. MI without a pri Runtime Kni. 27. Complete Ml Activity 34. Static Partial Join for MI 35. Static Canc. Partial Join for MI 36. Dynamic Partial Join for MI State-Based 16. Deferred Choice 39. Critical Section 17. Interleaved Parallel Routing 40. Interleaved Routing 48. Milestone Cancellation 49. Cancel Activity 20. Cancel Case http:// 25, Cancel Region skoemnowpareernswoniy 26. Cancel Ml Activity Trigger 23. Transient Trigger 24, Persistent Trigger 51Adaptive workflow structured production workflow process ad-hoc workflow unstructured computer-supported process collaborative work Yt information process centric centric 52 ite ee en:Part 2: WT standards, SDOs, related theories = Workflow management coalition’s (WfMC) standards = Definition of WT terms = XML process definition language (XPDL) = Other standardization efforts = Business Process Execution Language (BPEL) = Business Process Modeling Notation (BPMN) = Research-originated WT standards = Petri Nets theory and its relationship to workflows 53 ite ee en:Part 2: WT standards, SDOs, related theories « Workflow management coalition’s (WfMC) standards = Definition of WT terms = XML process definition language (XPDL) = Other standardization efforts = Business Process Execution Language (BPEL) = Business Process Modeling Notation (BPMN) = Research-originated WT standards = Petri Nets theory and its relationship to workflows 54 ite ee en:WfMC = Started in 1990 = 5 interfaces = XPDL 1.0, 2.0, 2.1 = Yearly Workflow handbook 55 ite ee en:Part 2: WT standards, SDOs, related theories = Workflow management coalition’s (WfMC) standards = Definition of WT terms = XML process definition language (XPDL) = Other standardization efforts = Business Process Execution Language (BPEL) = Business Process Modeling Notation (BPMN) = Research-originated WT standards = Petri Nets theory and its relationship to workflows 56 ite ee en:Business Process (ie... what is imended to happen) is defined ina ismanaged by a [- — —& Process Definition Workflow Management System | arepresentation of what (controls antomated aspects \ Is intended to happen) used to create af the business process) & manage Sub-Processes via A composed of Process Instances (a representation of what Activities is actually happening) which may be include one or more or Manual Activities Automated Activities > _Activity Instances (which are not managed as during execution which part of the Workflow System) care represented by include Invoked Applications (tasks allocated toa (computer toois/applications workflow participant) used 10 support an activity) 7 we Ttems ite ee en:WA Workflow Technology ) We-xML 4.1 XPDL 1.0 XPDL20 XPDL 24 =p BPM a] BPNIN 1.0 omc BPMN }. BP BPMN 1.0 14 (oasis BPEL OF 61Example.xpdl «Script Type="text/ javascript" /> 1 ++ l+eee MadeBy" Valu; Version” Value: Ja We" /> 2" [>63 ite ee en:Activities a a >Activities Incoming Incoming Incomit i ing Transitions ranejigns eae (doin (Join (bin Element) Element) Element) Activity Body Null Null (Split (Split (Split Element) Element) Element) Outgoing Outgoing Outgoing Transitions Transitions Transitions Generic ROUTE BLOCK Activity Activity Activity ActivitySet Incoming ‘Transitions (Join Element) Activity Body (Split Element) ryt Outgoing Transitions SUBFLOW Activity Figure 7-1: Acttvity Structures & Transition Conditions ite ee en:Part 2: WT standards, SDOs, related theories = Workflow management coalition’s (WfMC) standards = Definition of WT terms = XML process definition language (XPDL) = Other standardization efforts = Business Process Execution Language (BPEL) = Business Process Modeling Notation (BPMN) = Research-originated WT standards = Petri Nets theory and its relationship to workflows 66 ite ee ee:WT standards = Historical » BPEL, WSDL = Current major = XPDL, BPMN, BPEL = Proprietary (vendor specific): = JBPM (JBoss) « T2Flow->SCUFL2 (Taverna), internal format (Weka) » Win Workflow Foundation (Microsoft) = Research ones = YAWL OMO0R® 67 ite ee en:Part 2: WT standards, SDOs, related theories = Workflow management coalition’s (WfMC) standards = Definition of WT terms = XML process definition language (XPDL) = Other standardization efforts = Business Process Execution Language (BPEL) = Business Process Modeling Notation (BPMN) = Research-originated WT standards = Petri Nets theory and its relationship to workflows 68 ite ee en:Petri Nets = Petri net consist two types of nodes: places and transitions. = A place may have zero or more tokens. = Graphic representations :Places (circles), transitions (bars), arcs (arrows), and tokens (dots) ° t Po 69 ite ee en:Definition of Petri Net »C=(P,T,1, 0) = Places P={ pl, p2, p3, ..., pn} = Transitions T={t1, t2, t3, ..., tn} = Input 1: T > Pr (r = number of places) = Output 0: T > Pq (q = number of places) 70 ite ee en:Vector of places’ states = Below is an example Petri net with two places and one transaction. = Transition node is ready to fire if and only if there is at least one token at each of its input places i t P2 state transition of forn] (1, 0) > (0, 1) pl : input place p2: output place 7 ite ee en:Properties of PNs = Sequential Execution = Synchronization = two tokens needed « Merging = two tokens reduce to one ite ee en: @ FOO PG P2 & P3Properties of Petri Nets = Conflict t1 and t2 are both ready to fire but the firing of any leads to the disabling of the other transitions. ite ee en: ot x or t t, 73Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: « Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 74 nite ee en:Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: « Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 75 ite ee en:Together workflow suite = Editor = JaWE > Together Workflow Editor (TWE) = V1.4, v2, v3 » Engine = Shark > Together Workflow Engine (TWS) = Web-based module = Integration with Outlook 76 ite ee en:Demo ite ee en: 7Part 3: Practical tools demos = Demo of an editor and engine = Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: » Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 78 ite ee en:Ce aie ceed (Shark configuration File Edit Search Package Process ExtemalPackages Setings Help (DOERR AB BCS +9 TBF wetness (@ modulesoo1 =§ dsimpieo2 - |___Eternal package relations | Overview | Transient package poo! | Graph | xPDL View BAD AXA FP CORR FF 2a ch BSR PE Rete TAL Top_note "i e+ 5 ¥ 3 Leaiseh_note "i Lunenrot "i Navigator | Package ree) g = ae 2 = == 2 notity | Complete 79Part 3: Practical tools demos Demo of an editor and engine = Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: « Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 80 ite ee en:cr Eee Els ot Sea favape Peres ENMAPSOES SONNE HCP DdsG mu Boe +sax cae ~340@ See aval Gaaae TmehQaaseoe x a Bro ae mote 81 ite ee en:Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3: « Mining a progression of a chronic kidney disease from EHR data Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines 82 ite ee en:Moe) Caen ot) Y fe Q Ee CORT cg Sealand elec rae Pre Cee SST ea MinesPlagin ee TeeLog schema ite ee en: 84Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: « Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 85 ite ee en:ce (Semis et eon ey Sane cont 00,0) oe) sexresaeTo8eo baw cesar som ‘sesearoeomo08 | =m pe er ‘srenearTosto00 =a{D Rowunsneutstes miner on Fred chd07_12_Dam (Spt er) aa eae 0 ena Dee sah ina Fania a aha) sn rae ite ee en:E) Resuts - Association Rusle Miner on Filtered ckd_07_13_D.xml (Simple filter) (3) ‘Predictive Apri Association Rules 8. Kidney Transplant (first fw after tt O)=>Hypertension (onset(RF2) (first, global), OM (onseh(RF 1) dirst, global) (a4 Fy ©. Kidney Transplant (ist fv ater 11O}=*Ch. Kidney disease onset (t10_CKD_onset, DM (onset\RF') rst, globad| 10, Death (frst globa=Hypertension (onseD(RF2) (st, global), DM (onseWMRFI) (st, global (accuracy: 0.247% 11 Hypertension (onsen(RF2) cst, sloba)=>Ch. Kianey disease onset (10_CKD_onse), DM (onsen F1) cst, 12. Ch. kidney disease onset 10_CKD_onset)=+Hypertension (onseb(RF2) (irs, loba), DM (onseh(RF1) dirt 13, Regular Dialysis (rst ater 1}>Hypertension (onseO(RF2) (ist, glob), Kidney Transplant (rst after 19 14 Regular Dialysis (rst fw afer t1}>Ch. kidney disease onset 1 0_CKD_onsed, Kidney Transplant rst fw at 16 Kidnoy Trancplant (est 4 ator 1 0)=>Hypartonsion (onseh(RF2) (rs, globab, Regular Dialysls (st tw aftortt9 16 Kidney Transplant rst Ww atert10)=»Ch, kidney disaase onset @40_CKD_onsed, Regular Dialysis rst fw ate « i a 4. Kidney Transplant (rst fw ater {10)=>Hiypertension (onset(RF2) (rst, global, 88 ite ee en:EHR Data Pre-processing Facilitating Process Mining: an Application to Chronic Kidney Disease Vojtech Huser, MD, PhD'?, Justin B. Starren, MD, PhO! "Biomedical Research Center, Marshfield Clinic, Marshfield, Institute for Research, Madison, Wi Me poe teh peel ata a Discussion os ieee i singe ora ca ite ee en:Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: » Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technolo software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 90 ite ee en:Other WT software components « Editor, engine = Administration (load a process) = Monitoring (exception) = Analysis (bottleneck finding) = Workflow simulation = Workflow mining 91 ite ee en:Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: « Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 92 ite ee en:Use case studies = Marshfield Clinic = MainLine Health = U of Pavia = Einthoven University (NL) 93 ite ee en:Part 3: Practical tools demos Demo of an editor and engine Example 1: « Representing a surgical procedure, discharge and RCT trial enrolment process = Example 2: = Two rheumatology decision support processes (TB screening, Pneumococcal vaccine) = Process mining tool (ProM) = Example 3: « Mining a progression of a chronic kidney disease from EHR data = Brief overview of other workflow technology software = Case studies of use in healthcare/informatics research = Workflow engines and Decision support engines 94 ite ee en:WT and DSS = Clear overlap = Many decision support engines have workflow features = Many workflow engines have decision support features = Published case studies of use of WT for decision support = Related work = Peleg at al. » Guidelines and workflow models » Design Patterns of Clinical Guidelines (2010) (Bonita wf editor) = Mulyar at al. » Comparison of Guidelines formalisms and workflow patterns 95 ite ee en:GLIF guideline ite ee en: 96Sage flowchart example Daemne | [oar — = P. Ram (2004) emseee|-fmmanen| -< oc = “Executing Clinical Practice Guidelines Using the SAGE Execution Engine,” Medinfo, pp. 251-5, 2004 femora = SAGE's decision maps = subflows. ve = Rule-in and Rule-out contructs a » Linking workflow engine with a rule engine eeeert 7 ite ee en:Summary = Part 1: Basic terms, history, use = Part 2: Standards = Part 3: Tools demonstration = Cross-industry modeling and execution platform sates with growing vendor and tool base and healthcare <> use examples unsiuctred| | /Computer-supported = http://healthcareworkflow.wordpress.com pees Seem = — huser.vojtecht ifieldclinic.< information process conte ‘centie ite ee en:Questions ? = _ http://healthcareworkflow.wordpress.com = huser. marshfieldclinic. ite ee en: 99100 ete ee en:101 ite ee en:102 ite ee en:103 eee ee ee:104 ite ee en: