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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- Workflow-technology-tutorial-amia12-vojtech-huser-harm-scherpbier- Presentation Transcript

  • 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)
  • 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
  • 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
  • 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
  • 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
  • Part 4: Conclusion  Momentum behind BPM  Future of workflow technology  Conclusion  Questions & Discussion 6Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • Part 1 9
  • 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
  • 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
  • Process Example Koetter (2007) 12Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 13Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 15Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • 18Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 19Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 20Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 21
  • 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
  • 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
  • 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
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  • Humans & machines working together 27
  • Executable flowchart 28Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 29
  • Minimum components editor language execution engine 30
  • Interfaces 31
  • 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
  • WT benefits Non-programmers understand processes Non-programmers can modify processes Analytical tools Faster IT system development (SOA+WT) 33
  • 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
  • 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
  • 36Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 37Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 38Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 39Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 40Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Workflow engine 41Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Engine 42Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • Use of WT  Pioneer domains  Banking  Manufacturing  Shipping  Government authorities  Pharmaceutical  Healthcare  Gartner 2008 report: <5% use 44Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • Process Definition  A process is:  Multiple steps…  For multiple people…  Over time…  To achieve a goal. 46Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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…
  • Foley Reminders, ADE’s Foley Workflow Goal: Timely removal, reduce risk for UTIs ADE Workflow Goal: Early detection of ADEs, change medications
  • AMI and CHF Pathways Identify patients, initiate pathway, apply Core Measures AMI: CHF:
  • Video: CHF pathway  Video of CHF pathway 50Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Central Line Insertion Checklist Guidance to most preferred line location Guidelines Checklist!!
  • Central Line Insertion Checklist - continued Checklist!!
  • Central Line – Procedure Note
  • Line Follow-up – Removal reminders
  • Dr. Clark Piatt  Short video – Dr. Clark Piatt on automated Central Line management 55Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • Osteoporosis Research Study Workflow Identify Candidates for Study
  • Osteoporosis Research Study WorkflowObtain Consent Randomization Study/Control Automate Study Protocol Collect Data
  • Data Collection Form
  • Clinical Trial Management Goal: Identify Candidates for Clinical Trials, and Track Enrolled Patients Implement Protocols – including randomization
  • 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
  • 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
  • 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
  • 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
  • Workflow patterns http:// workflowpatterns.com/ 65Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Adaptive workflow 66Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Part 2 67
  • 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
  • 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
  • WfMC  Started in 1990  5 interfaces  XPDL 1.0, 2.0, 2.1,2.2  Yearly Workflow handbook … 70Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 72Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • 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
  • Standards Timeline 76Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Example.xpdl 77Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Process Schema 78Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Activities 79Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • Standards trending 82Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • 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
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  • Petri Net for Math lovers 87Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Part 3 - DEMOS 88Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • VH Demo part (30 min)  Screenshot tour of editor, processes and process mining  editor  process mining tool 91Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
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  • More CDS examplesWorkflow mining tour Vojtech Huser, Harm Scherpbier: workflow tutorial 95
  • Log schema 96Vojtech Huser, Harm Scherpbier: workflow tutorial
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  • 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
  • Editor live demo Vojtech Huser, Harm Scherpbier: workflow tutorial 102
  • Part 4: Conclusion 103Vojtech Huser, Harm Scherpbier: workflow tutorial
  • Agenda for part 4  Vojtech’s points  Harm’s points 104Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • Healthcare is different  Current workflow standards  YAWL  Current workflow vendors implementations  Complexity of medicine 106Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • 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
  • Mulyar at al (2007) 110Vojtech Huser, MD, PhD
  • GLIF guideline 111Vojtech Huser, MD, PhD
  • 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
  • Splitting the CDS representation format 113Vojtech Huser, MD, PhD
  •  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
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  • Approach comparison 116Vojtech Huser, MD, PhD
  • 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
  • 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
  • Harm Sherpbier’s conclusion 119Vojtech Huser, Harm Scherpbier: workflow tutorial
  • 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
  • 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
  • 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
  • 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
  • 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
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