introduction to workflow technology representation of healthcare processes in a workflow editor and...

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)

Vojtech Huser, MD, PhDVojtech Huser, MD, PhD

2

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


3

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


4

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


5

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


6










7

Workflow technology BPM = business process management Adaptive workflow (Adaptive Case

Management) Computer supported collaborative

work (CSCW) Why workflow?

Separation of data into databases Separation of UI from IT system core Separation of process knowledge


8

Process Example

Koetter (2007)


9


10

Workflow patterns examples Parallel Split: When an intrusion alarm is

received, trigger the dispatch-patrol activity and the inform-police activity immediately.

Exclusive Choice: After the review election activity is complete, either the declare 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.


11


12










13

WT development 1960s

Petri Nets (Carl A. Petri PhD work)

1960s-present Workflow components of various systems

1999 WfMC: terminology

2000s 2002: XPDL 1.0 2005 XPDL 2.0 2008 XPDL 2.1 BPMN standard


14


15


16


17


18










19

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


20

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 Process Management BPMS = Business Process Management System


21


22


23

Humans & machines working together


24

Executable flowchart


25

Worklist


26


27

Minimum componentslanguage edito

r

execution engine


28

Interfaces


29










30

WT benefits Non-programmers understand

processes Non-programmers can modify

processes Analytical tools Faster IT system development

(SOA+WT)


31










32

Choice of Wf vendor Major player

TIBCO BEA Global 360 IBM

Other Fujitsu IBM Oracle Microsoft SAP Lombardi


33


34


35


36


37


38

Workflow engine


39

Engine


40










41

Use of WT Pioneer domains

Banking Manufacturing Shipping Government authorities Pharmaceutical

Healthcare Gartner 2008 report: <5% use


42

Examples of WT use in healthcare

Bed managementInfections control (MRSA)

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: Case Study," in 2007 Excellence in Practice: Moving the Goalposts., 2007.


43

Stroke guideline (WfMS)


44

Soarian


45


46

Current Soarian Example


47

Use at Marshfield Clinic


48

HealthFlow: RetroGuide, FlowGuide

HealthcareWorkflow.wordpress.com

EHR system

Event Listener

Notifications

Actions

Knowledge Base(workflow process

definitions)

Data Inquiry

Workflow Execution

Engine(Shark)

EHR System layer:

Prospective mode (FlowGuide):

Retrospective mode(RetroGuide):

Reports

Data Warehouse

Workflow mining(ProM)

Workflow editor(JaWE)

Data Visualization

Additional Components:

Event Data Model

Ontology Model

Host EHR Passive Interaction Model

Host EHR Active Interaction Model

Additional External Services(Terminology services, NLP services,

Statistical Analysis)

Workflow log analysis


49










50

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


51

Workflow patterns

http://

workflowpatterns.com/


52

Adaptive workflow

informationcentric

process centric

structuredprocess

unstructuredprocess

computer-supported collaborative work

ad-hoc workflow

production workflow


53







54







55

WfMC Started in 1990 5 interfaces XPDL 1.0, 2.0, 2.1 Yearly Workflow handbook


56







57


58

Workflow Technology Business process management system (BPMS)

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.

Workflow Process = A set of one or more linked procedures or activities which collectively realize a business objective or policy goal, normally within the context of an organizational structure defining functional roles and relationships (definition vs. instance)

Worklist Handler = A software component that manages the interaction between the user and the worklist maintained by a workflow engine (task display, completion, acceptance, referral)

WfMC: Terminology & Glossary, Document Number WFMC-TC-1011, Feb 99 http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74

HealthcareWorkflow.wordpress.com

http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74


59



Definition of WT terms XML process definition language

(XPDL) Other standardization efforts




60

XPDL XML file based on a XSD schema

http://wfmc.org/xpdl.html First introduced in 1999 Conformance testing available

http://www.xpdl.org/Validate/ValidateXpdl

Exchange format links

http://wfmc.org/xpdl.html




61

Standards Timeline


62

Example.xpdl


63

Process Schema


64

Activities


65

Activities


66







67

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


68







69

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)

p2 p1

t1

Petri Nets


70

Definition of Petri Net C = ( P, T, I, O)

PlacesP = { p1, p2, p3, …, pn}

TransitionsT = { t1, t2, t3, …, tn}

Input I : T Pr (r = number of places)

OutputO : T Pq (q = number of places)


71

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

state transition of form (1, 0) (0, 1)p1 : input place p2: output place

p2 p1

t1


72

Properties of PNs Sequential

Execution

Synchronization two tokens needed

Merging two tokens reduce to one

p2

t1

p1 p3

t2

t1


73

Properties of Petri Nets

Conflictt1 and t2 are both ready to fire but the firing of any leads to the disabling of the other transitions.

t1

t2

t1

t2


74









75









76

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


77

Demo


78









79


80









81


82









83


84

Log schema


85









86


87


88


89


90



Example 2: Two rheumatology decision support processes (TB screening,

Pneumococcal vaccine) Process mining tool (ProM) Example 3:


Brief overview of other workflow technology software

Case studies of use in healthcare/informatics research Workflow engines and Decision support engines


91

Other WT software components Editor, engine

Administration (load a process) Monitoring (exception) Analysis (bottleneck finding)

Workflow simulation Workflow mining


92









93

Use case studies Marshfield Clinic MainLine Health U of Pavia Einthoven University (NL)


94





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


95

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


96

GLIF guideline


97

Sage flowchart example P. Ram (2004)

“Executing Clinical Practice Guidelines Using the SAGE Execution Engine,” Medinfo, pp. 251-5, 2004

SAGE’s decision maps subflows.

Rule-in and Rule-out contructs

Linking workflow engine with a rule engine


98

Summary Part 1: Basic terms, history, use Part 2: Standards Part 3: Tools demonstration

Cross-industry modeling and execution platformwith growing vendor and tool base and healthcare use examples

http://healthcareworkflow.wordpress.com [email protected]

informationcentric

process centric

structuredprocess

unstructuredprocess

computer-supported collaborative work

ad-hoc workflow

production workflow

http://healthcareworkflow.wordpress.com/

mailto:[email protected]


99

Questions ?

http://healthcareworkflow.wordpress.com [email protected]

http://healthcareworkflow.wordpress.com/

mailto:[email protected]


100


101


102


103


104

introduction to workflow technology representation of healthcare processes in a workflow editor and...

Documents