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TRANSCRIPT
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! [email protected]
Next Steps
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27 BPMN FHIR PlanDefinition
task actionDefinition
sequenceFlow relatedAction
gateway condition