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  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal Get harm’s email address for the end open Tset EAI enteprise application integration Clinical bckground or CS background Researcher vs. production health Have you open ad workflow editor before Have about and any w standartd Are you familiar with Arden syntax or any other CDS paradigms such as GLIF, SAGE, PRoForma, GELLO
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • In spring 2012, the WfMC completed XPDL 2.2 as the fifth revision of this specification. XPDL 2.2 builds on version 2.1 by introducing support for the process modeling extensions added to BPMN 2.0. Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal NOTICE: we can also defin a process where only IT tools play a role. (no humans) bad news: now we became a wheel in an big machine (workers) good news: now we won’t have to remember the order and maintain the record of in which order we run what applications. Executable visio. (managers)
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal system only participants mode retrospective mode real time mode (waiting application for next event) (instead of read next event)
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal Global 360 – wf editor (Process Designer)
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • How do we decide where to place the line? Used best practices. Built in stops – like hand washing. Does it happen? Not sure, but we are trying to focus attention.
  • Opportunities to coach VAP - Oral care every 2 hours. If VAP and check was missed, use as coaching opportunity. Missed opportunity.
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • http://www.xpdl.org/Validate/ValidateXpdl Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • maintenance:      title: Hepatitis A Immunization MLM;;      mlmname: Hep_A_Immunization;;      arden: Version 2.8;;      version: 1.00;;      institution: Intermountain Health Care;;      author: Peter Haug, M.D.;;      specialist: Peter Haug M.D.;;      date: 2011-09-10;;      validation: testing;;  library:      purpose: Suggest initial dose of Hepatitis A vaccine schedule.;;      explanation: ;;      keywords: Hepatitis A; vaccine; immunization;;      citations: to be added. ;;      links: to be added;;  knowledge:  type: data_driven;;  data:      /* text within curly brackets would be replaced with an institution’s own query */     Let PatientIDRecord BE OBJECT [AccountNum, Name, Birthdate, Sex];      LET Patient BE Read As PatientIDRecord Latest {select accountnum, name, dateofbirth, sex from EHR} ;     LET outpatient_visit BE EVENT {storage of ambulatory registration}     LET Medication BE OBJECT [Drug_Name, Form, Dosage, Route, Schedule]      LET VAQTA BE Read As Medication {select med, form, dose, route, schedule from EHR where med = ‘VAQTA’} ;      LET HAVRIX BE Read As Medication {select med, form, dose, route, schedule from EHR where med = ‘HAVRIX’} ;      LET TWINRIX BE Read As Medication {select med, form, dose, route, schedule from EHR where med = ‘TWINRIX’} ;      Let GenericMessage BE OBJECT [MessageID, MessageCode, Message_Text];      Let Vaccine_Message BE New GenericMessage;      ;;  evoke: outpatient_visit;;  logic:      /* Check age */      if          Patient_Age Is Null      then          Patient_Age := Now – Patient.Birthdate;      endif;     if          Patient_Age Less Than 12 months      then          Conclude False ;      endif;      /* Young Patient */             if          Patient_Age Greater Than 12 months and          Patient_Age Less Than or Equal 18 years      then          Apply_young_patient_rules := true;      endif;      /* Older Patient */             if          Patient_Age Greater Than 18 years      then          Apply_older_patient_rules := true;      endif;      /* Rules-no previous vaccine. */      if          Exist(VAQTA) or Exist(HAVRIX) or Exist(TWINRIX)      then          Hepatitis_vaccination:= true;      endif;      if          Apply_young_patient_rules and          Not Hepatitis_vaccination      then          Vaccine_Message.Message_Text := "Give VAQTA vaccine, 25U, IM now and repeat in 6 to 18 months.";          Conclude true;      endif;      if          Apply_older_patient_rules and          Not Hepatitis_vaccination      then          Vaccine_Message.Message_Text := "Give VAQTA vaccine, 50U, IM now and repeat in 6 to 18 months.";          Conclude true;      endif;  /* Rules-one previous vaccination. */      if          Count(VAQTA) + Count(HAVRIX) + Count(TWINRIX) = 1      then          Needs_second_dose := true;      endif;     /* Second dose young people */      if          Apply_young_patient_rules and          Needs_second_dose and          Exist(VAQTA) and          Latest VAQTA Occurred Before 6 months Ago      then          Vaccine_Message.Message_Text := "Give VAQTA vaccine, 25U, IM now. This completes Hepatitis A vaccinations.";          Conclude true;      endif;      if          Apply_young_patient_rules and          Needs_second_dose and          Exist(HAVRIX) and          Latest HAVRIX Occurred Before 6 months Ago      then          Vaccine_Message.Message_Text := "Give HAVRIX vaccine, 720EL.U, IM now. This completes Hepatitis A vaccinations.";          Conclude true;      endif;      if          Apply_young_patient_rules and          Needs_second_dose and          Exist(TWINRIX) and          Latest TWINRIX Occurred Before 1 months Ago      then          Vaccine_Message.Message_Text := "Give TWINRIX vaccine, 720 EL.U/20ug, IM now. This is the second Hepatitis A/B vaccination.";          Conclude true;      endif;     /* Second dose Older people */      if          Apply_older_patient_rules and          Needs_second_dose and          Exist(VAQTA) and          Latest VAQTA Occurred Before 6 months Ago             then          Vaccine_Message.Message_Text := "Give VAQTA vaccine, 50 U, IM now. This completes Hepatitis A vaccinations.";          Conclude true;      endif;      if          Apply_older_patient_rules and          Needs_second_dose and          Exist(HAVRIX) and          Latest HAVRIX Occurred Before 6 months Ago         then          Vaccine_Message.Message_Text := "Give HAVRIX vaccine, 1440 U, IM now. This completes Hepatitis A vaccinations.";          Conclude true;      endif;      if          Apply_older_patient_rules and          Needs_second_dose and          Exist(TWINRIX) and          Latest TWINRIX Occurred Before 1 months Ago             then          Vaccine_Message.Message_Text := "Give TWINRIX vaccine, 720EL.U/20ug, IM now. This is the second Hepatitis A/B vaccination.";          Conclude true;      endif;         /* Third dose of TWINRIX */      if          Exist(TWINRIX) and Count(TWINRIX) = 2 and          Latest(TWINRIX) Occurred Before 5 months Ago      then          Vaccine_Message.Message_Text := "Give TWINRIX vaccine, 720EL.U/20ug, IM now. This completes Hepatitis A/B vaccinations.";          Conclude true;      endif;      ;;  action:      write Vaccine_Message.Message_Text;;  end: Vojtech Huser, Harm Scherpbier: workflow tutorial Morgridge: Project proposal
  • Workflow-technology-tutorial-amia12-vojtech-huser-harm-scherpbier-

    1. 1. Introduction to workflow technology Representation of healthcare processes in a workflow editor and their execution in a workflow engine Vojtech Huser MD PhD Harm Scherpbier, MD, MSAMIA 2012, Tutorial (3hrs)
    2. 2. Agenda  Part 1: Introduction, history, overview  Part 2: Standards, SDO, related theories  Part 3: Practical tools demonstration  Part 4: Conclusion  This presentation is also at this URL http://www.slideshare.net/vojtech_huser/presentations  Accompanying bibliography and other files http://code.google.com/p/healthflow/downloads/list 2Vojtech Huser, Harm Scherpbier: workflow tutorial
    3. 3. Part 1: Introduction to workflow technology(WT)  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  Future development and research challenges  Published case studies in Healthcare  Difference: Workflow engine vs. Decision Support engine  WT in healthcare (HS) 3Vojtech Huser, Harm Scherpbier: workflow tutorial
    4. 4. Part 2: WT standards, SDOs, related theories  Workflow management coalition’s (WfMC) standards  Definition of WT terms  XML process definition language  (BPMN 2.0 (stored as XPDL 2.2))  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 4Vojtech Huser, Harm Scherpbier: workflow tutorial
    5. 5. Part 3: Practical tools demos  MainLine Health case study  Demo of an JaWE editor (and engine)  Process mining tool (ProM, Nitro, DISCO) 5Vojtech Huser, Harm Scherpbier: workflow tutorial
    6. 6. Part 4: Conclusion  Momentum behind BPM  Future of workflow technology  Conclusion  Questions & Discussion 6Vojtech Huser, Harm Scherpbier: workflow tutorial
    7. 7. Links  General:  http://wfmc.org  http://en.wikipedia.org/wiki/Xpdl  http://en.wikipedia.org/wiki/BPMN  http://en.wikipedia.org/wiki/Workflow_patterns  http://books.google.com/books?id=I1KOAfiqfxYC  http://books.google.com/books?id=O1xW1_Za-I0C  From tutorial authors  http://healthcareworkflow.wordpress.com  http://code.google.com/p/healthflow/downloads/list  http://code.google.com/p/processmining 7Vojtech Huser, Harm Scherpbier: workflow tutorial
    8. 8. Software  Download the following software:  JaWE Java Workflow Editor  http://sourceforge.net/projects/jawe  Shark Workflow Engine (optional)  http://sourceforge.net/projects/sharkwf 8Vojtech Huser, Harm Scherpbier: workflow tutorial
    9. 9. Part 1 9
    10. 10. 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 10Vojtech Huser, Harm Scherpbier: workflow tutorial
    11. 11. 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 11Vojtech Huser, Harm Scherpbier: workflow tutorial
    12. 12. Process Example Koetter (2007) 12Vojtech Huser, Harm Scherpbier: workflow tutorial
    13. 13. 13Vojtech Huser, Harm Scherpbier: workflow tutorial
    14. 14. 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. 14Vojtech Huser, Harm Scherpbier: workflow tutorial
    15. 15. 15Vojtech Huser, Harm Scherpbier: workflow tutorial
    16. 16. 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 16Vojtech Huser, Harm Scherpbier: workflow tutorial
    17. 17. 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 2010s  BPMN 2.0  XPDL 2.2 17
    18. 18. 18Vojtech Huser, Harm Scherpbier: workflow tutorial
    19. 19. 19Vojtech Huser, Harm Scherpbier: workflow tutorial
    20. 20. 20Vojtech Huser, Harm Scherpbier: workflow tutorial
    21. 21. 21
    22. 22. 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 22
    23. 23. 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 23
    24. 24. 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 24
    25. 25. 25
    26. 26. 26
    27. 27. Humans & machines working together 27
    28. 28. Executable flowchart 28Vojtech Huser, Harm Scherpbier: workflow tutorial
    29. 29. 29
    30. 30. Minimum components editor language execution engine 30
    31. 31. Interfaces 31
    32. 32. 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 32
    33. 33. WT benefits Non-programmers understand processes Non-programmers can modify processes Analytical tools Faster IT system development (SOA+WT) 33
    34. 34. 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 34
    35. 35. Choice of Wf vendor Major player  TIBCO  BEA  Global 360  IBM Other  Fujitsu  IBM  Oracle  Microsoft  SAP  Lombardi Open source  JBOSS  Taverna  Together  Bonita  YAWL  http://java-source.net/open- source/workflow-engines 35
    36. 36. 36Vojtech Huser, Harm Scherpbier: workflow tutorial
    37. 37. 37Vojtech Huser, Harm Scherpbier: workflow tutorial
    38. 38. 38Vojtech Huser, Harm Scherpbier: workflow tutorial
    39. 39. 39Vojtech Huser, Harm Scherpbier: workflow tutorial
    40. 40. 40Vojtech Huser, Harm Scherpbier: workflow tutorial
    41. 41. Workflow engine 41Vojtech Huser, Harm Scherpbier: workflow tutorial
    42. 42. Engine 42Vojtech Huser, Harm Scherpbier: workflow tutorial
    43. 43. 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 43Vojtech Huser, Harm Scherpbier: workflow tutorial
    44. 44. Use of WT  Pioneer domains  Banking  Manufacturing  Shipping  Government authorities  Pharmaceutical  Healthcare  Gartner 2008 report: <5% use 44Vojtech Huser, Harm Scherpbier: workflow tutorial
    45. 45. Overview of Healtchare WT articles  Haux R, Seggewies C, Baldauf-Sobez W, Kullmann P, Reichert H, Luedecke L, et al. Soarian - workflow management applied for health care. Methods Inf Med. 2003;42(1):25-36.  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.  Process Mining of Clinical Workflows for Quality and Process Improvement  http://chuckwebster.com/process-mining/HIMSS12/process-mining-clinical- workflows-quality-process-mprovement.pdf  Huser V, Narus SP, Rocha RA. Evaluation of a flowchart-based EHR query system: a case study of RetroGuide. J Biomed Inform 2010;43(1):41-50.   Huser V, Rasmussen LV, Oberg R, Starren JB. Representation and execution of clinical decision support using workflow engine technology. BMC Med Res Methodol  45Vojtech Huser, Harm Scherpbier: workflow tutorial
    46. 46. Process Definition  A process is:  Multiple steps…  For multiple people…  Over time…  To achieve a goal. 46Vojtech Huser, Harm Scherpbier: workflow tutorial
    47. 47. Main Line Health examples Clinical Guidelines and Core Measures Infection Control - e.g. CLABSI Adverse Drug Events prevention Heparin Protocol, Insulin Drip Rate Calculator Research Protocols … and more First: look at the Alerts worklist to see these at work…
    48. 48. Foley Reminders, ADE’s Foley Workflow Goal: Timely removal, reduce risk for UTIs ADE Workflow Goal: Early detection of ADEs, change medications
    49. 49. AMI and CHF Pathways Identify patients, initiate pathway, apply Core Measures AMI: CHF:
    50. 50. Video: CHF pathway  Video of CHF pathway 50Vojtech Huser, Harm Scherpbier: workflow tutorial
    51. 51. Central Line Insertion Checklist Guidance to most preferred line location Guidelines Checklist!!
    52. 52. Central Line Insertion Checklist - continued Checklist!!
    53. 53. Central Line – Procedure Note
    54. 54. Line Follow-up – Removal reminders
    55. 55. Dr. Clark Piatt  Short video – Dr. Clark Piatt on automated Central Line management 55Vojtech Huser, Harm Scherpbier: workflow tutorial
    56. 56. Workflow Engine for Clinical Trials Osteoporosis Research Study - Dr. Matthew DiPaola MD, supported by Sharpe-Strumia Foundation, performed at Lankenau Hospital, with LIMR research staff – 2008 – 2009 Objective: identify patients >65 years old, with hip fracture, and initiate endocrinology management in the acute phase of the care. Identify and treat osteoporosis, by endocrinologist, to prevent future fractures. Identify Candidates – Consent/Enroll – Randomize - Automate Study Protocol – Collect Data
    57. 57. Osteoporosis Research Study Workflow Identify Candidates for Study
    58. 58. Osteoporosis Research Study WorkflowObtain Consent Randomization Study/Control Automate Study Protocol Collect Data
    59. 59. Data Collection Form
    60. 60. Clinical Trial Management Goal: Identify Candidates for Clinical Trials, and Track Enrolled Patients Implement Protocols – including randomization
    61. 61. Heparin Alert Utilization for Sept. 2011 thru Jan. 2012 Percent Alert Utilization Per Site100 90 75  80 74 69 68 67 71 67 70 61 64 60 61 60 54 54 September October 50 November 37 December 40 January 30 17 20 10 0 LMC BMH PH Volume of Alerts Per Site 300 234 200 187 171 173 September October 143 November 113 December January 100 87 69 73 55 50 35 38 24 15 0 LMC BMH PH
    62. 62. Workflow Engine vs. RulesEngineWorkflow Engine with Rules Engine Rules Engine Process Automation / Business  Rule-based Clinical Decision Process Management Support Multiple steps, over time, for  Single decision point for single multiple users user State-aware: keeps track of point in time and waits (listens) for  Not State-aware – runs at trigger next event to happen event Asynchronous Plug-in services (EAI)  Synchronous Graphical programming
    63. 63. 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 63Vojtech Huser, Harm Scherpbier: workflow tutorial
    64. 64. 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 64Vojtech Huser, Harm Scherpbier: workflow tutorial
    65. 65. Workflow patterns http:// workflowpatterns.com/ 65Vojtech Huser, Harm Scherpbier: workflow tutorial
    66. 66. Adaptive workflow 66Vojtech Huser, Harm Scherpbier: workflow tutorial
    67. 67. Part 2 67
    68. 68. 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 68Vojtech Huser, Harm Scherpbier: workflow tutorial
    69. 69. 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 69Vojtech Huser, Harm Scherpbier: workflow tutorial
    70. 70. WfMC  Started in 1990  5 interfaces  XPDL 1.0, 2.0, 2.1,2.2  Yearly Workflow handbook … 70Vojtech Huser, Harm Scherpbier: workflow tutorial
    71. 71. 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 71Vojtech Huser, Harm Scherpbier: workflow tutorial
    72. 72. 72Vojtech Huser, Harm Scherpbier: workflow tutorial
    73. 73. 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 73Vojtech Huser, Harm Scherpbier: workflow tutorial
    74. 74. 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 74Vojtech Huser, Harm Scherpbier: workflow tutorial
    75. 75. XPDL  XML file based on a XSD schema  http://wfmc.org/xpdl.html  http://www.xpdl.org/standards/xpdl-2.2/bpmnxpdl_40a.xsd  First introduced in 1999  Conformance testing available  http://www.xpdl.org/cloudapps.html  Exchange format  Adoption (70+ products)  http://wfmc.org/xpdl-implementations.html 75Vojtech Huser, Harm Scherpbier: workflow tutorial
    76. 76. Standards Timeline 76Vojtech Huser, Harm Scherpbier: workflow tutorial
    77. 77. Example.xpdl 77Vojtech Huser, Harm Scherpbier: workflow tutorial
    78. 78. Process Schema 78Vojtech Huser, Harm Scherpbier: workflow tutorial
    79. 79. Activities 79Vojtech Huser, Harm Scherpbier: workflow tutorial
    80. 80. 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 80Vojtech Huser, Harm Scherpbier: workflow tutorial
    81. 81. WT standards  Historical  WSDL  Current major  XPDL, BPMN, BPEL  Proprietary (vendor specific):  JBPM (JBoss)  Win Workflow Foundation (Microsoft)  T2Flow->SCUFL2 (Taverna)  internal format (Weka)  Research ones  YAWL 81Vojtech Huser, Harm Scherpbier: workflow tutorial
    82. 82. Standards trending 82Vojtech Huser, Harm Scherpbier: workflow tutorial
    83. 83. 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 83Vojtech Huser, Harm Scherpbier: workflow tutorial
    84. 84. Petri Nets  Mathematical theory  Basics  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) p1 t1 p2 84Vojtech Huser, Harm Scherpbier: workflow tutorial
    85. 85. Definition of Petri Net  C = ( P, T, F)  Places (circles)  P = { p1, p2, p3, …, pn}  Transitions (bars)  T = { t1, t2, t3, …, tn}  Flow relations (arcs)  F ⊂ (P × T ) ∪ (T × P )  Extensions  Hierarchical Petri Netns  Coloured Petri Nets 85Vojtech Huser, Harm Scherpbier: workflow tutorial
    86. 86. 86Vojtech Huser, Harm Scherpbier: workflow tutorial
    87. 87. Petri Net for Math lovers 87Vojtech Huser, Harm Scherpbier: workflow tutorial
    88. 88. Part 3 - DEMOS 88Vojtech Huser, Harm Scherpbier: workflow tutorial
    89. 89. HS Demo (30 min)  Editor and EMR portions  Activy example  Basic editing  Roundtrip between editor and EMR (changes)  MLM logic vs. flowchart logic 89Vojtech Huser, Harm Scherpbier: workflow tutorial
    90. 90. Main Line Health Demo Integration points to EMR via services:  Events  Decision Rules  Tasks, messages, actions Wait-steps Nesting Workflow Engine Demonstration: http://intranet/Soarian/Support/Links.htm
    91. 91. VH Demo part (30 min)  Screenshot tour of editor, processes and process mining  editor  process mining tool 91Vojtech Huser, Harm Scherpbier: workflow tutorial
    92. 92. Software shown  Editor  JaWE  Together Workflow Editor (TWE)  v1.4, v2, v3, v4.3  Engine  Shark  Together Workflow Engine (TWS)  Web-based module  Integration with Outlook  ProM (processmining.org)  V5.2, V6  Fluxicon (www.fluxicon.com)  Nitro  Disco 92Vojtech Huser, Harm Scherpbier: workflow tutorial
    93. 93. 93Vojtech Huser, Harm Scherpbier: workflow tutorial
    94. 94. 94Vojtech Huser, Harm Scherpbier: workflow tutorial
    95. 95. More CDS examplesWorkflow mining tour Vojtech Huser, Harm Scherpbier: workflow tutorial 95
    96. 96. Log schema 96Vojtech Huser, Harm Scherpbier: workflow tutorial
    97. 97. 97Vojtech Huser, Harm Scherpbier: workflow tutorial
    98. 98. 98Vojtech Huser, Harm Scherpbier: workflow tutorial
    99. 99. 99Vojtech Huser, Harm Scherpbier: workflow tutorial
    100. 100. 100Vojtech Huser, Harm Scherpbier: workflow tutorial
    101. 101. 2012: Mercy Health case study  Process Mining of Clinical Workflows for Quality and Process Improvement  http://chuckwebster.com/process-mining/HIMSS12/process-mining-clinical-workflows- quality-process-mprovement.pdf 101Vojtech Huser, Harm Scherpbier: workflow tutorial
    102. 102. Editor live demo Vojtech Huser, Harm Scherpbier: workflow tutorial 102
    103. 103. Part 4: Conclusion 103Vojtech Huser, Harm Scherpbier: workflow tutorial
    104. 104. Agenda for part 4  Vojtech’s points  Harm’s points 104Vojtech Huser, Harm Scherpbier: workflow tutorial
    105. 105. Modelling paradigm  Flowcharts  Several historical revisions  Different vendors used different paradigm  Standardization (BPMN)  Swim lanes example  Split/Join example  Annotation elements  Complex flowcharts  Flowchart can’t remove it  different views, hierarchical layers  Exception handling  General standards (XPDL) vs. medicine specific standards (GLIF, SAGE) 105Vojtech Huser, Harm Scherpbier: workflow tutorial
    106. 106. Healthcare is different  Current workflow standards  YAWL  Current workflow vendors implementations  Complexity of medicine 106Vojtech Huser, Harm Scherpbier: workflow tutorial
    107. 107. WT and EHR vendors  Current status  One vendor uses a third party workflow engine  Variable support for workflow constructs  Work list (push [single clinician, team], pull)  Obtain current performer of a certain role  Obtain patient data  Maintain process state  Limited or now workflow features 107Vojtech Huser, Harm Scherpbier: workflow tutorial
    108. 108. WT and EHR vendors  Future state  Status quo stays  More vendors adopt 3rd party workflow engine  Internal “CDS [rule] engines” gain more workflow features  New CDS standard with workflow components  HL7 DSS 108Vojtech Huser, Harm Scherpbier: workflow tutorial
    109. 109. 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 109Vojtech Huser, MD, PhD
    110. 110. Mulyar at al (2007) 110Vojtech Huser, MD, PhD
    111. 111. GLIF guideline 111Vojtech Huser, MD, PhD
    112. 112. Sharing CDS content  MLM content (code logic)  Workflow content (flowchart + code logic)  2 levels of sharing (WT)  Share complete process definition  Share only the flowchart (description)  http://healthcareworkflow.wordpress.com/2012/02/09/healtflow- hepatitis-a-scenario/ 112Vojtech Huser, Harm Scherpbier: workflow tutorial
    113. 113. Splitting the CDS representation format 113Vojtech Huser, MD, PhD
    114. 114.  maintenance:      title: Hepatitis A Immunization MLM;;  library:      links: to be added;;  knowledge:  type: data_driven;;  data:      /* text within curly brackets would be replaced with an institution’s own query */      Let PatientIDRecord BE OBJECT [AccountNum, Name, Birthdate, Sex];      LET Patient BE Read As PatientIDRecord Latest {select accountnum, name, dateofbirth, sex from EHR} ;      LET HAVRIX BE Read As Medication {select med, form, dose, route, schedule from EHR where med = ‘HAVRIX’} ;      LET TWINRIX BE Read As Medication {select med, form, dose, route, schedule from EHR where med = ‘TWINRIX’} ;      Let GenericMessage BE OBJECT [MessageID, MessageCode, Message_Text];      Let Vaccine_Message BE New GenericMessage;      ;;  evoke: outpatient_visit;;  logic:      /* Check age */      if          Patient_Age Is Null      then  /* Rules-one previous vaccination. */      if          Count(VAQTA) + Count(HAVRIX) + Count(TWINRIX) = 1      then          Needs_second_dose := true;      endif;      /* Second dose young people */      if          Apply_young_patient_rules and          Needs_second_dose and          Exist(VAQTA) and          Latest VAQTA Occurred Before 6 months Ago      then          Vaccine_Message.Message_Text := "Give VAQTA vaccine, 25U, IM now. This completes Hepatitis A vaccinations.";          Conclude true;      endif;  114     if Vojtech Huser, Harm Scherpbier: workflow tutorial
    115. 115. 115Vojtech Huser, Harm Scherpbier: workflow tutorial
    116. 116. Approach comparison 116Vojtech Huser, MD, PhD
    117. 117. WT and healthcare institutions  Current status  No adoption (majority, Gartner report)  EHR vendor supports WT  3rd party engine implementation  (Marshfield Clinic)  Different institutions are at different stages 117Vojtech Huser, Harm Scherpbier: workflow tutorial
    118. 118. WT future (software components)  Core components  Editor  Engine  Additional components  Administration application (deplay, terminate, versioning)  Work list handler  User management (LDAP, MS, other)  Organizational roles  Monitoring/Analytical application  Simulation tools  Worfklow mining 118Vojtech Huser, MD, PhD
    119. 119. Harm Sherpbier’s conclusion 119Vojtech Huser, Harm Scherpbier: workflow tutorial
    120. 120. Learnings  Powerful  Complex  Importance of integration to EMR  EMR represents the users, the data, and the transactions  Need for services: events, work-lists, tasks and notifications, actions (e.g. orders), EAI 120Vojtech Huser, Harm Scherpbier: workflow tutorial
    121. 121. Healthcare Processes  Healthcare Processes waiting to be automated:  Clinical Pathways, Care Management  Transitions and Discharges  Surveillance and monitoring  Administrative processes  … and many more  Many opportunities for use of BPM technology in healthcare 121Vojtech Huser, Harm Scherpbier: workflow tutorial
    122. 122. Platform for outsourced knowledge  Currently: managing decision rules internally, linked into the workflows  Future: opportunity to call outside knowledge sources  HL7 DSS, OpenCDS standards 122Vojtech Huser, Harm Scherpbier: workflow tutorial
    123. 123. Future of BPM in Healthcare?  Opportunity, processes to be automated? Yes!  Technology available? Yes!  Advantage of BPM over other decision support and process management tools? Yes!  Can healthcare organizations manage the complexity (build and maintain)? Maybe… 123Vojtech Huser, Harm Scherpbier: workflow tutorial
    124. 124. Questions ?  Covered topics  Introduction to workflow technology  WT standards  Examples  WT and healthcare  Contact us  vojtech.huser at nih.gov 124Vojtech Huser, Harm Scherpbier: workflow tutorial
    125. 125. 125Vojtech Huser, Harm Scherpbier: workflow tutorial

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