Modeling Clinical Workflow


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The clinical point of care is a complex area including patients, clinicians, information technology systems and medical devices. Traditionally, these systems have been designed to function individually and have only been integrated by the decision making capability of the clinicians. As clinical environments become more complex, there is increased need to tightly integrate medical devices and information systems in order to support clinicians by providing them with the right information at the right time. Integrated interoperable systems also promise to relieve clinicians’ workload and improve patient safety by reducing nuisance alarms and allowing closed-loop control systems. Supporting these applications requires development of tools with which to model and understand clinical processes. Modeling clinical workflows and decision making can produce systems level requirements that have not been fully understood in the development of point of care systems. In this poster we show the detailed workflow diagrams that can be used in the derivation of systems requirements needed for use in an interoperable clinical environment.

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Modeling Clinical Workflow

  1. 1. Modeling Clinical Workflows<br />By Sean Avery, Michael Sutton, Stephen Foglietta, David Arney, Tracy Rausch, CCE, Julian Goldman, MD<br />DocBox Proprietary Information 2011<br />
  2. 2. Two Views of a Clinical Process<br />X-Ray Ventilator Workflow <br />Business Process Model Notation (BPMN)<br />X-Ray Ventilator Workflow <br />Little-JIL Process Definition Language<br />DocBox Proprietary Information 2011<br />
  3. 3. X-Ray Ventilator – BPMNBenefits and Limitations<br />Benefits:<br /><ul><li>Simple Graphical Key
  4. 4. Easily Trace Process Flow
  5. 5. Industry Standard
  6. 6. Aids in Validation
  7. 7. Extensible to Unified Modeling Language Activity and Class Diagrams</li></ul>Limitations:<br /><ul><li>Ambiguity with Resource Management
  8. 8. No Exception Handling
  9. 9. Representing Process Variation
  10. 10. Property Verification
  11. 11. Process Concurrency
  12. 12. Timing Properties</li></ul>DocBox Proprietary Information 2011<br />
  13. 13. X-Ray Ventilator – Little-JILBenefits and Limitations<br />Benefits:<br /><ul><li>Comprehensive Exception Handling
  14. 14. Resource Management
  15. 15. Concurrency
  16. 16. Built on Formally Defined Semantics
  17. 17. Property Verification
  18. 18. Easy Integration with Related Analysis Tools </li></ul>Limitations:<br /><ul><li>Not in Wide Use
  19. 19. Greater Time Requirement for Modeling Processes
  20. 20. No Easy Conversion to other Modeling Languages
  21. 21. Limited Timing Properties</li></ul>DocBox Proprietary Information 2011<br />Little-JIL, Little-JIL Analyzer, Propel, and FLAVERS software developed by the<br />Laboratory for Advanced Software Engineering Research (LASER) at University of Massachusetts Amherst<br />
  22. 22. Property Verification and Fault-Tree Derivation<br />Here an exception is thrown and handled but the process deviation leads to the property being violated. <br />[This error was seeded to show trace graph]<br />Here we can see depth of safety locks via logic gates, presented here as “OR” (blue ), “AND” (pink ), and “NOT” (green triangles). <br />DocBox Proprietary Information 2011<br />Property Violated<br />Artifact Flow Check<br />Multiple “And” gates showing<br />Process robustness<br />Exception thrown<br />Property violation trace graph – checking “ventilator started after being stopped” property for violations within the process diagram. Property defined with Propel (PROPerty ELucidator), and verified using FLAVERS (FLow Analysis for VERification of Systems) software.<br />Minimal cut set of “Timer-Check” fault-tree – Checking “timer” parameter for correctness during each step presented in the Little-JIL process diagram. Fault-Tree derived directly by mathematical extrapolation done on the Little-JIL process model using Little-JIL Analyzer software.<br />Little-JIL, Little-JIL Analyzer, Propel, and FLAVERS software developed by the<br />Laboratory for Advanced Software Engineering Research (LASER) at University of Massachusetts Amherst<br />