modeling cancer treatment processes with bpmn and hl7 fhir€¦ · hl7 fhir focus on implementers...

A National Comprehensive Cancer Network (NCCN) case study

Lee Surprenant, IBM December 5, 2016

Modeling Cancer Treatment Processes with BPMN and HL7 FHIR

The National Comprehensive Cancer Network (NCCN) The world leader in defining and advancing high-

quality, high-value cancer care Physician Guidelines

Patient Guidelines

Chemotherapy Order Templates

Drugs and Biologics Compendium

Biomarkers Compendium

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The National Comprehensive Cancer Network (NCCN) The world leader in defining and advancing high-

quality, high-value cancer care Physician Guidelines Patient Guidelines

Chemotherapy Order Templates

Drugs and Biologics Compendium

Biomarkers Compendium

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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Guideline

Panel Members Table of Contents Algorithm

Sub-algorithm

Attachment Pages Discussion Pages

Initial focus for our project was on the Algorithm Currently a custom diagram notation distributed via PDF [screenshots

redacted]

https://www.nccn.org/professionals/physician_gls/f_guidelines.asp

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IBM Watson for Oncology Analyzes patient records Identifies potential treatment options Finds and provides supporting evidence

Needs high-quality data sources like the NCCN

Guidelines But diagrams in PDF files are hard to ‘ingest’

How to produce a more machine-friendly version?

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Terminology Guidelines vs Pathways Clinical Practice Guidelines (CPGs)

Typically document-centric

Computer-Interpretable Guidelines (CIGs) Decision trees

Task-network models (TNMs)

Event-condition-action rules

Care Processes vs Care Delivery Processes

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The NCCN Guideline Authoring Tool Custom web-based tool for entering guideline data

Classify nodes into Criteria, Evaluation, Education/Counseling, Treatment (Surgical, Systemic, Radiation, …), etc Break complex logic into smallest units that make sense Different types have different properties

Optionally, tag the nodes with “codeable concepts” Evaluation -> Procedure codes Systemic Therapies -> Chemotherapy agents Criteria Nodes -> Simple attribute-value ‘expressions’

Search and filter by properties and concepts Exports to the BPMN 2.0 Interchange Format

Currently only the ‘semantic’ elements, no visual

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The NCCN Guideline Authoring Tool [screenshot redacted]

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BPMN Extension Example 9

The NCCN Guideline Authoring Tool Open questions

Is BPMN 2.0 the right format for data consumers?

How to synchronize the data with the PDF version?

What expression language to use?

Other interesting use cases?

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Business Process Model and Notation (BPMN)

Positives Well-adopted IT standard for

modeling processes Defined traversal semantics Supports staged approach

Supports the documentation and definition of processes for now

Supports executable processes for the future

Existing tools and process engines

Extensible

Negatives Baggage from Business

Process Management Imperfect semantic fit

Tasks vs Recommendations

Intimidating specification Lots of functionality we don’t

want or need (yet?)

Interoperability issues

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BPMN Interoperability Issues How to support rich text in task documentation /

textAnnotations? How to specify which start event is referenced from a

callActivity? Differing levels of support for custom extensions Differing levels of support for the Diagram Interchange

elements (layout / positioning) For example: support for vertical lanes / milestones

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The National Comprehensive Cancer Network (NCCN) The world leader in defining and advancing high-

quality, high-value cancer care Physician Guidelines

Patient Guidelines

Chemotherapy Order Templates Drugs and Biologics Compendium

Biomarker Compendium

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The NCCN Chemotherapy Order Templates (NCCN Templates®) [screenshot redacted] https://www.nccn.org/ordertemplates/default.asp

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The NCCN Chemotherapy Order Template Tool Custom web-based tool for authoring Order Templates

Integrated with the Guideline Authoring Tool Shared list of diseases / disease sub-types Guideline criteria Template indications

Provide structured data for Chemotherapy Regimens Cost estimation Measure adherence to guidelines Clinical decision support

Exports to HL7 FHIR PlanDefinition / ActivityDefinition

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HL7 FHIR Fast Healthcare Interoperability Resources (FHIR) A ‘fresh take’ on healthcare interoperability Inspired by REST, the architecture of the web Domain modeled as Resources

Foundation Data Types and Conformance Resources Administrative and Financial Resources (Patient, Practitioner, …) Clinical Resources (Condition, Observation, …) Workflow and Clinical Reasoning Resources (Task,

PlanDefinition, …)

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FHIR Workflow Resource Relationships 17

FHIR Resources for the NCCN Order Template Use Case

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PlanDefinition / ActivityDefinition

CarePlan / RequestGroup / MedicationRequest

Medication Administration

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HL7 FHIR PlanDefinition / ActivityDefinition Resources

Positives HL7 FHIR focus on

Implementers Open source availability

Good extensibility Tooling for creating profiles

and implementation guides Growing community

Now is the time to review these resources and get involved

Negatives Nascent and changing

(Maturity Level 0) Intimidating resource

definition Some functionality we don’t

want or need (yet?)

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Thanks! lmsurpre@us.ibm.com

Next Steps

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27 BPMN FHIR PlanDefinition

task actionDefinition

sequenceFlow relatedAction

gateway condition