Workflow Process Management and Enterprise Application Integration in Healthcare


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Amit Sheth, Keynote Address at HEALTHCOM99, Sydney, Australia, Jan.11, 1999.

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Workflow Process Management and Enterprise Application Integration in Healthcare

  1. 1. Large Scale Distributed Information Systems Lab at University of Georgia Requirements, Applications, Technology and Research Amit Sheth Keynote Address HEALTHCOM99 Sydney, AU Jan.11, 1999 Enterprise Application Integration in Healthcare Thanks: > Krys Kochut, John Miller and METEOR Team > NIST-ATP, IONA Technologies, Informix, ...
  2. 2. Introduction <ul><li>Comprehensive Healthcare IT solutions require </li></ul><ul><li>broad variety of process management applications, and </li></ul><ul><li>enterprise application integration </li></ul><ul><li>in a rapidly changing, distributed, and heterogeneous computing environments. </li></ul>
  3. 3. Reprsentative Healthcare Applications for which the METEOR EAppS has been used <ul><li>Application </li></ul><ul><li>NeoNatal Clinical PathWays </li></ul><ul><li>Genome Sequencing </li></ul><ul><li>Eligibility-Referral </li></ul><ul><li>Immunization Tracking </li></ul><ul><li>Key Characteristics </li></ul><ul><li>Clinical, single site/server </li></ul><ul><li>Non-medical, multiple user organizations, two servers </li></ul><ul><li>Administrative, two participating organizations </li></ul><ul><li>Clinical and Administrative, multiple servers, multiple organizations </li></ul>
  4. 4. Neonatal Clinical Pathways Server Nurse Nurse Coordinator Neonatologist
  5. 5. Neonatal Clinical Pathways <ul><li>Multiple inter-related clinical pathways or treatment plans for premature, underweight babies (head ultrasound, metabolic screen, nutrition, immunizations, etc.) </li></ul><ul><li>Alert on test to be ordered, enter tests and review results, update database, print reports </li></ul><ul><li>Users: nurse coordinator, nurse, neonatologist </li></ul><ul><li>single server, Web-based clients </li></ul>
  6. 6. Head Ultrasound Workflow
  7. 8. Multi-institutional Genome Sequencing Solaris Server Users in different labs worldwide SGI Server Legacy App Legacy App Georgia
  8. 9. Data Analysis in a Multi-institution Genome Sequencing Enterprise Raw output from DNA sequencing machines from multiple institutions Fully sequenced and annotated genome Task 1 Task 2 Task i ... Automatic and human-computer data analysis tasks running on heterogeneous servers
  9. 10. Characteristics of Data Analysis Tasks <ul><li>Many existing legacy data analysis applications and new applications running </li></ul><ul><li>different servers (SGI and Solaris) </li></ul><ul><li>Each human-computer task performed by an expert who specializes in that task; experts are located at different institutions throughout the world </li></ul>
  10. 11. Eligibility and Referral Sending organization Receiving organization Insurance company
  11. 12. Eligibility and Referral (i.e., “patient dumping”) <ul><li>Sending Organization -- Receiving Organization -- (optionally insurance company and ambulance services) </li></ul><ul><li>Two independent workflows with interoperability , optionally EDI with other organizations </li></ul>
  12. 13. Sending Organization Receiving Organization
  13. 14. An Example of Mission-critical Enterprise Application Developed using METEOR EAppS
  14. 15. Schematic of Immunization Tracking CLINICAL SUBSYSTEM <ul><li>Generates: </li></ul><ul><li>Alerts to identify patient’s needs. </li></ul><ul><li>Contraindications to caution providers . </li></ul>SDOH and CHREF maintain databases, support EDI transactions Hospitals and clinics update central databases after encounters Health providers can obtain up-to-date clinical and eligibility information TRACKING SUBSYSTEM State and HMO’s can update patient’s eligibility data Health agencies can use reports generated to track population’s needs CT Hospitals and case workers can reach out to the population HMOs can keep track of performance Reports to state Reminders to parents
  15. 16. Implementation Testbed: Immunization Tracking Demo ask us for a demo CORBA DBMS Immunization Database Web Server (Solaris) Administrator Case Worker Admit Clerk Triage Nurse Doctor/ NP Maternity Ward (Solaris) Encounter Database Hospital CHREF Admit Clerk Triage Nurse Doctor/ NP Encounter Files/Databases Office Practice Mgmt System Clinic CHREF/SDOH Insurance Eligibility Database (Solaris) EDI (Solaris) MPI MEI Web Server Web Server DBMS DBMS (Windows NT) Hospital Info System
  16. 17. Web-based Implementation Start . . . . Start PULL CGI N N N N N CGI CGI CGI CGI CGI CGI Enter Patient Generate Alerts Update Personal Data Check Eligibility Update Local Database HTTP Worklist File Generate Triage Nurse’s Page Display Worklist Generate Alerts Enter Patient Info. Update Personal Data Check Eligibility Update Local Database Stop Implementation Triage Nurse Task Submit Button Alert Results Eligibility Results Admit Clerk Task Workflow Design Machine Boundary Collect Vitals Add to Worklist Web Page DBMS Updated Results WORKLIST HANDLER N Enter Patient Info. N Enter Patient Info. N Enter Patient Info.
  17. 18. Start . . . . Start PULL CGI N N N N CGI CGI CGI CGI CGI CGI Enter Patient Generate Alerts Update Personal Data Check Eligibility Update Local Database HTTP Generate Triage Nurse’s Page Display Worklist Generate Alerts Enter Patient Info. Update Personal Data Check Eligibility Update Local Database Stop Implementation Triage Nurse Task Submit Button Alert Results Eligibility Results Admit Clerk Task Workflow Design Machine Boundary Collect Vitals Add to Worklist Web Page DBMS Updated Results Web-based Implementation N Enter Patient Info. N Worklist File WORKLIST HANDLER N Worklist File WORKLIST HANDLER N Worklist File WORKLIST HANDLER
  18. 19. Provider Interface: Immunization Reco’s List of overdue vaccinations Link to contraindication info obtained from the Internet Clinical update to “ administer vaccination”
  19. 20. CORBA-based Implementation Check Eligibility . . . . Workflow Design Generate Alerts Enter Patient Info. Update Personal Data Check Eligibility Update Local Database Start Stop Triage Nurse Task Start Admit Clerk Task Collect Vitals Enter Patient Generate Alerts Update Personal Data Check Eligibility Update Local Database HTTP Worklist Handler Enter Patient Info. Implementation Submit Button Alert Results Eligibility Results Machine Boundary CORBA CORBA CORBA CORBA CORBA N Add to Worklist N Web Page DBMS Updated Results N N N CORBA Patient Data (CORBA) Control Flow
  20. 21. Requirements of mission-critical healthcare applications that METEOR supports <ul><li>Some of the important requirements for this application include: </li></ul><ul><li>Support for a distributed architecture in a heterogeneous computing environment. At the level of any user of the system, this distribution should be transparent </li></ul><ul><li>Support for inter- and intra-enterprise wide coordination of tasks </li></ul><ul><li>Provision of a standard user-friendly interface to all users of the system </li></ul><ul><li>Support for a variety of tasks: transactional and non-transactional, user and application </li></ul>
  21. 22. Requirements of mission-critical healthcare applications that METEOR supports <ul><li>Capability of using existing DBMS infrastructure and databases across organizations </li></ul><ul><li>Low cost of system for the providers and user organizations </li></ul><ul><li>Ease of modification (re-design), scalability, extensibility and fast design-to-implementation </li></ul><ul><li>Open architecture, use of standards (e.g., CORBA, CORBAmed, OMG WF, WfMC, SWAP) and middleware (JDBC) </li></ul><ul><li>Security authorization for users and secure communication (required as patient data is typically confidential) </li></ul>
  22. 23. Adaptive Workflow Example 1 <ul><li>If initial exam identifies needs for additional procedure in the blood test, the task/subprocess component is obtained from the repository and added to the subprocess </li></ul>get blood standard test write report This example is from Han et al. Workflow Component Repos. special test
  23. 24. Adaptive Workflow Example 2 <ul><li>Comorbidity: new lab result identifies previously unknown illness or health condition that requires additional health management in addition to the current condition. </li></ul><ul><li>New related workflow (or subworkflow) is kicked off. </li></ul>
  24. 25. State of the art technology, products and research
  25. 26. Market Approaches to Workflow e-mail document mgmt. workgroup/ collaborative imaging Internet ORB database TP-monitoring
  26. 27. Key conclusion from DocuLab’s workflow product comparison study <ul><li>Products that allow development of complex applications, provide flexibility and support integration are very hard to use, take too long and require experience programmers (and are still not quite comprehensive) </li></ul><ul><li>Easy to use products are too restrictive -- and are useful for small or standard applications only </li></ul><ul><li>METEOR’s objective is to avoid significant compromise. </li></ul>
  27. 28. What is lacking from state of the art in Workflow Technology <ul><li>Primarily centralized, client/server architectures </li></ul><ul><li>Difficulty in integrating with existing applications and databases, not meant for heterogeneous, multi-server environments </li></ul><ul><li>Static workflows that can be fully defined before enactment starts </li></ul><ul><li>Focus on repetitive processes </li></ul><ul><li>Most products are, however, suitable for many office automation and other human oriented processes. </li></ul>
  28. 29. Research Disciplines Contributing to to Workflow Management Quantitative and Formal Methods/Modeling Software Engineering, HCI, etc. Organizational Science CSCW Database Management/ Information Systems Distributed Computing/Systems MIS/ Reengineering/ Methodology Software Process
  29. 30. Enterprise Application Integration [EAI] <ul><li>The average Fortune 2000 company relies on 49 enterprise-level applications to run its business and spends 25 to 33 percent of its IT budget just to get tem to talk to each other [Dan Sholler, Meta Group] </li></ul><ul><li>Systems integration costs in many cases amount of 40 percent of IT costs </li></ul>
  30. 31. Messaging/Persistent Queue Middleware Distributed Object Management (ORB) Enterprise Java Beans DCOM Publish/Subscribe; event-based messaging Broker METEOR Component HOST 1 HOST 2 HOST 3 HOST 4 Application Database Transaction EDI User Task METEOR Component METEOR Component METEOR Component METEOR Component Services and Business Objects Message/Data Tools/Architecture of current EAI products/solutions Business Object/Process Tool/Architecture of the METEOR Enterprise Application Development & Integration Adapter Adapter Adapter Adapter Packaged App User Task App App Legacy App
  31. 32. METEOR EAppS [Enterprise Application Suite of Services and Tools] CORBA Java Internet/Web database middleware Enterprise Application Integration Adaptive and Scalable Workflow E-Commerce
  33. 34. METEOR 2 EAppS [Enterprise Application Suite of Tools and Services] End Users
  34. 35. METEOR Model <ul><li>Integral support for human and application tasks </li></ul><ul><ul><li>transactional and non-transactional tasks </li></ul></ul><ul><ul><li>human tasks: forms, collaborative tasks </li></ul></ul><ul><ul><li>automated tasks: database access, legacy applications </li></ul></ul><ul><li>Complex control and data dependencies </li></ul><ul><li>much more </li></ul>
  35. 37. METEOR Workflow Builder Service <ul><li>Comprehensive set of graphical tools for building workflow process applications </li></ul><ul><li>Map Designer </li></ul><ul><li>Data Designer </li></ul><ul><li>Task Designer </li></ul><ul><li>Web Form Designer </li></ul><ul><li>Exception Designer </li></ul>
  36. 40. WebWork Application Development Workflow Designer Task Customizer Workflow Generator Application Prototype Page Customizer Specification Customizer Workflow Application .wil .spec source .spec .html .cc
  37. 42. Web Enabled and Web Based Engines Web Enabled Web Based Centralized Distributed Vendor1 Vendor2 Vendor3 OzWeb Endeavors WebWork Distributed Scheduling Error handling Recovery (Transactional Support) CGI Tcl, Java, XML Front End Enactment, monitoring, administration EJB
  38. 45. Workflow Monitor GRM Object Request Broker (CORBA) TTM LRM LPS Application Task Web Server GPS Web Workflow Administrator Database Task User Task DBMS Host E Host D Host C Host A Host B UTM LPS LRM NtTM GPS Global Persistence Store GRM Global Recovery Manager LPS Local Persistence Store LRM Local Recovery Manager NtTM Non-transactional Task Manager TM Task Manager TTM Transactional Task Manger UTM User Task Manager Cleanup Task Watchdog Data Object Activate Message LRM OVERVIEW LPS
  39. 46. ORBWork Enactment Service <ul><li>Designed to address a variety of shortcomings found in today’s component middleware, enterprise integration, and workflow process management systems, it supports the following capabilities: </li></ul><ul><ul><li>Integration of application components and databases on disparate distributed and heterogeneous computing environments across enterprise intranet and extranet boundaries </li></ul></ul><ul><ul><li>A fully distributed and highly scalable enterprise application process enactment system capable of supporting dynamic business processes </li></ul></ul>
  40. 47. ORBWork (continued) <ul><ul><li>Utilization of open and industry standards such as CORBA/IIOP, Java, JDBC, HTTP, and OMG Workflow Facility for developing open, distributed, object-based, interoperable enterprise applications </li></ul></ul><ul><ul><li>Support for cross-platform portability of tasks in business processes (by exclusively developing them in Java) </li></ul></ul><ul><ul><li>Provision for a browser-based Web user interface for the end-users and the administrators. </li></ul></ul>
  41. 48. Schedulers and Task Managers <ul><li>Activation (scheduling): start, termination </li></ul><ul><li>Error Handling </li></ul><ul><li>Recovery </li></ul><ul><li>Task (Application) Invocation </li></ul><ul><li>Note that automatic code generation means all task managers are automatically generated! At run-time, they are started when needed. </li></ul>
  42. 49. Task Schedulers <ul><li>A Task Scheduler performs the scheduling of all workflow instances “flowing” through it. </li></ul><ul><li>Task schedulers differ, depending on the type of task they manage. </li></ul><ul><li>Task schedulers form a hierarchy. </li></ul>
  43. 50. Task Schedulers (continued) <ul><li>Upon detecting an enabled task: </li></ul><ul><ul><li>an AutoTaskScheduler activates an associated Task Manager to oversee the execution of the task; </li></ul></ul><ul><ul><li>a UserTaskManager prepares a form with the instance-specific data and places the task on the worklist. </li></ul></ul><ul><li>The worklist is managed by the scheduler. </li></ul><ul><li>The next task (instance) is then picked up by the end-user from a Web browser. </li></ul>
  44. 51. Task Scheduler Details AND OR Transition 1 Transition 2 Transition 3 Task Output Dependency Input Dependency Task invocation Recovery System Monitor Task Scheduler Data Objects Data Objects Task Manager
  45. 52. Task Scheduler Managing Multiple Workflow Instances Task invocation AND Transition 1 Transition 2 Task Recovery System Monitor Task Scheduler Data Objects Task Manager Task Manager Task Manager Task Manager ... ... Task Manager Done Pending Task Task Manager Running
  46. 53. Task Managers <ul><li>A Task Manager oversees the execution of an automatic task in the workflow. </li></ul><ul><li>Task Managers differ, depending on the type of task they manage. </li></ul><ul><li>Task Managers form a hierarchy. </li></ul>
  47. 54. Handling of Automated Tasks <ul><li>Newly developed tasks </li></ul><ul><ul><li>typically implemented as CORBA objects </li></ul></ul><ul><li>Existing (legacy) tasks </li></ul><ul><ul><li>wrapped as CORBA objects </li></ul></ul><ul><ul><li>invoked directly by the task manager which prepares the input data and handles the results </li></ul></ul>
  48. 55. Handling of User Tasks <ul><li>User tasks use a Web browser and an HTML form. </li></ul><ul><li>Communication between a CORBA task scheduler and the browser: </li></ul><ul><ul><li>access data objects to retrieve necessary attribute values; </li></ul></ul><ul><ul><li>generate a form instance (for the current workflow instance); </li></ul></ul><ul><ul><li>place the form on the worklist. </li></ul></ul>
  49. 56. Handling of User Tasks <ul><li>The scheduler provides a rudimentary implementation of the HTTP protocol. </li></ul><ul><li>The end-user’s browser connects directly to the task scheduler. </li></ul><ul><li>The scheduler receives the GET method from the browser. </li></ul><ul><li>The task scheduler sends to the browser the worklist with the enabled task instances and/or the individual task forms. </li></ul>
  50. 57. ORBWork’s fully distributed scheduling and flexible placement
  51. 58. Achieving Scalability <ul><li>Use of a fully distributed scheduler. </li></ul><ul><li>Component task schedulers “mirror” the workflow map design. </li></ul><ul><li>Natural distribution of scheduling and task activation functions among participating hosts. </li></ul><ul><li>Task schedulers can be replicated to increase the load handling potential. </li></ul><ul><li>Task managers can be distributed among many hosts to balance the load. </li></ul>
  52. 59. Dynamic Changes <ul><li>Dynamic changes both to the enterprise application or workflow process schema and to the individual workflow process instances. </li></ul><ul><li>Administrator can easily modify the schema at runtime by acquiring the new information from the repository, or even by modifying the specification by HTTP-based direct interaction with the scheduler. </li></ul>
  53. 60. ORBWork implementation: Utilizing ORBIX’s features
  54. 61. Why METEOR? <ul><li>Generation shift (from first generation to second) and high-end market needs </li></ul><ul><ul><li>client-server to distributed and network-centric (trend, scalability, flexibility, robustness requirement) </li></ul></ul><ul><ul><li>new generation of distributed computing infrastructure (WWW, CORBA and Java) and new standards: some companies are going for CORBA standard (E.g. various CORBAmed and defense companies) </li></ul></ul><ul><ul><li>new standards: OMG Workflow Facility is being proposed with METEOR as the prime example </li></ul></ul>
  55. 62. Why METEOR? <ul><li>Workflow management system can become an enterprise-wide and inter-enterprise application integration platform if it is open and standards-based; most products do nothing to deal with heterogeneity commonly found in most enterprises </li></ul><ul><ul><li>METEOR is the first and currently only implementation using distributed Web and CORBA infrastructures, and Java </li></ul></ul>
  56. 63. Why METEOR? <ul><li>Many products are seen as consultant-ware with complex toolkits </li></ul><ul><ul><li>METEOR offers advanced code generation capability which can provide 60% to 80% saving in generating distributed workflow application in heterogeneous environments </li></ul></ul><ul><ul><li>METEOR has a significant edge in ease of use, deployment and management </li></ul></ul>
  57. 64. Features, capabilities and benefits
  58. 65. Emergent New Market for Enterprise Application Development EAI Workflow E-Commerce
  59. 66. Summary <ul><li>Enterprise Healthcare applications need more than what most workflow products and “consultantware” systems have to offer. </li></ul><ul><li>METEOR EAppS uses CORBA, Web, and Java offers unique solutions to realize the promise of recent advances in distributed computing infrastructure, middleware and Web, by quickly integrating applications and information systems, to support complex and dynamic business process management . </li></ul>
  60. 67. Additional information (METEOR Research) Infocosm, Inc. METEOR EAppS (Technology/ Product Licensing)