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Introduction to workflow technology
   Representation of healthcare processes in a workflow
     editor and their executio...
Agenda
          Part 1: Introduction, history, overview
          Part 2: Standards, SDO, related theories
          P...
Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
Part 2: WT standards, SDOs, related theories
          Workflow management coalition’s (WfMC)
           standards
      ...
Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
Workflow technology
          BPM = business process management
          Adaptive workflow (Adaptive Case
           Ma...
Process Example




                         Koetter (2007)


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Workflow patterns examples
          Parallel Split: When an intrusion alarm is received,
           trigger the dispatch...
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Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
WT development
          1960s
                            Petri Nets (Carl A. Petri PhD work)
          1960s-present
...
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Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
Automating Workflow
          Defined by Workflow Management
           Coalition (WfMC)
                 www.wfmc.org

...
Terms
          Workflow
                 The automation of a business process, in
                  whole or part, duri...
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Humans & machines working together




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Executable flowchart




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Minimum components
                     language                      edito
                                              ...
Interfaces




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Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
WT benefits
          Non-programmers understand processes
          Non-programmers can modify processes
          Ana...
Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
Choice of Wf vendor
          Major player
                 TIBCO
                 BEA
                 Global 360
   ...
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Workflow engine




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Engine




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Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
Use of WT
          Pioneer domains
                 Banking
                 Manufacturing
                 Shipping
...
Examples of WT use in healthcare
    Bed management
                                                        Infections con...
Stroke guideline (WfMS)




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Soarian




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Current Soarian Example




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Use at Marshfield Clinic




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HealthFlow: RetroGuide, FlowGuide


    Workflow                 Workflow
     mining                   editor
      (ProM...
Part 1: Introduction to workflow technology
          Need for specifying workflow within IT systems
          History o...
Future of WT
          Improvements
                 Adoption is growing
                 Software tools sophistication...
Workflow patterns




                          http://
                          workflowpatterns.com/




              ...
Adaptive workflow

              structured                          production workflow
               process


        ...
Part 2: WT standards, SDOs, related theories
          Workflow management coalition’s (WfMC)
           standards
      ...
Part 2: WT standards, SDOs, related theories
          Workflow management coalition’s (WfMC)
           standards
      ...
WfMC
          Started in 1990
          5 interfaces
          XPDL 1.0, 2.0, 2.1
          Yearly Workflow handbook
...
Part 2: WT standards, SDOs, related theories
          Workflow management coalition’s (WfMC)
           standards
      ...
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Workflow Technology
          Business process management system (BPMS)

          Workflow = The automation of a busine...
Part 2: WT standards, SDOs, related theories
          Workflow management coalition’s (WfMC)
           standards
      ...
XPDL
          XML file based on a XSD schema
                 http://wfmc.org/xpdl.html
          First introduced in ...
Standards Timeline




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Example.xpdl




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Process Schema




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Activities




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Part 2: WT standards, SDOs, related theories
          Workflow management coalition’s (WfMC)
           standards
      ...
WT standards
          Historical
                 WSDL
          Current major
                 XPDL, BPMN, BPEL
    ...
Part 2: WT standards, SDOs, related theories
          Workflow management coalition’s (WfMC)
           standards
      ...
Petri Nets
               Mathematical theory
               Basics
                        Petri net consist two types...
Definition of Petri Net
          C = ( P, T, I, O)
                 Places
                  P = { p1, p2, p3, …, pn}
 ...
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Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
Together workflow suite
          Editor
                 JaWE  Together Workflow Editor (TWE)
                 v1.4, ...
Demo




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Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
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Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
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Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
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Log schema




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Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
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Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
Other WT software components
          Editor, engine

          Administration (load a process)
          Monitoring (...
Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
Use case studies
          Marshfield Clinic
          MainLine Health
          U of Pavia
          Einthoven Univer...
Part 3: Practical tools demos
          Demo of an editor and engine
          Example 1:
                 Representing...
WT and DSS
          Clear overlap
                              Many decision support engines have workflow features
  ...
Mulyar at al (2007)
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GLIF
      guideline




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Sage flowchart example
          P. Ram (2004)
                 “Executing Clinical Practice Guidelines
                ...
Summary
          Part 1: Basic terms, history, use
          Part 2: Standards
          Part 3: Tools demonstration

...
Questions ?




          http://healthcareworkflow.wordpress.com
          huser.vojtech@marshfieldclinic.org




     ...
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WT vendors
          Gartner:




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Standards
          Key standards
                 XPDL = XML Process Definition Language
                            D...
Other standards
          BPEL
                        Business process execution language
                        Orig...
Standards Timeline - Releases
  1994       1998        2000   2001    2002   2003    2004   2005    2006   2007   2008    ...
GLIF
      guideline




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Workflow editors and engines
Wofkflow software components
WT software components
          Core components
                 Editor
                 Engine
          Additional ...
Interesting analyses
          Improving processes
                 Allocation of tasks
                        Push (h...
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Computer Supported Collaborative Work




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Workflow mining
          Traditional approach
                 model your process, pilot, deploy

          Alternativ...
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Conclusion
How does it affect my coding ?
          Worklow technology is coming to your desktop
          Code will be split into ...
Summary
          Workflow technology
                 Terms
                 History
                 Software compon...
Questions / Comments




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EXTRA SLIDES
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Workflow / BPM Reference Model




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Workflow / BPM Reference Model
                                BPMN

                                XPDL



             ...
Standards Timeline - Releases
  1994       1998        2000   2001    2002   2003    2004   2005    2006   2007   2008    ...
Timeline
  1993 1994 1995 1996           1997 November     2000     October     May     October
                          ...
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XPDL Support in Market




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Over 70 XPDL Implementations…
         Adobe –                       •   Enhydra JaWE                   •   OpenPages
   ...
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Six Standard BPMN / XPDL
      Examples




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Six Standard BPMN / XPDL
      Examples
          As of Feb 17, 2007, these vendors had
           implemented:




     ...
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Workflow standards
Workflow vs. Java
          Workflow is basically graphical coding
          Workflow language offers contructs for
    ...
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Conditions
          Pre-condition
          Post-condition

          Transition condition




                       ...
Tools
Tools
          Workflow editor

          Workflow Engines
                 Commercial
                        Oracle...
1. Editor - JaWE
          XPDL Editor
                 http://jawe.objectweb.org
          written in Java
          ...
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2. Engine - Shark
          Workflow Engine
          Open Source
          In beta stage
                 http://shar...
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Conclusion/Questions
          How can we best separate logic of a protocol
           from workflow?

          Can Hea...
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Workflow engine project
Agenda
          Workflow project: people contacts, resources

          Fujitsu go/no go criteria
                 abi...
Workflow project
          Phase 1: Research use: BIRC, Vojtech+BIRC is the
           main developer
                   ...
Current status
          Fujitsu’s visit of July 28th
                 Early experiments on VMWare Fujitsu’s image (dev ...
Evaluation
                 See separate document


          Advantages
          Disadvantages




                  ...
Key Benefit of Wf Technology
          Ability for non-expert to review or author
           processes (strong editor)
  ...
Requirements for Wf Editor/Flowchart
          Complexity: Ability to express all my
           processes
               ...
Requirements for the flowchart
          The flowchart can be read without
           additional drill down
             ...
Choice of Wf vendor
          Feature set
          Price
          Special relationship
           (partnership)

    ...
Evaluation perspectives
                data perspective
                        deals with the passing of information ,...
WfMC glossary




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Terms




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Terms




                                 [X]OR or AND split
                                                            ...
Flowchart and execution
          Complexity decision
                 Flowchart will have everything (no drill-downs ne...
Petri Nets (PN)
Screenshots of Wf editor/engine
   (Fujitsu and some TIBCO)


     (will be commented orally)
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Theory
Petri Nets
               Petri net consist two types of nodes:
                places and transitions.
               A...
Definition of Petri Net
          C = ( P, T, I, O)
                 Places
                  P = { p1, p2, p3, …, pn}
 ...
Vector of places’ states
                Below is an example Petri net with two places
                 and one transacti...
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Screenshot tour




  HealthcareWorkflow.wordpress.com
HealthFlow: RetroGuide, FlowGuide

    Workflow                 Workflow
     mining                   editor
      (ProM)...
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Code Layer           (node; right click properties)




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Vo...
code.google.com/p/HealthFlow




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HealthFlow: RetroGuide, FlowGuide

    Workflow                 Workflow
     mining                   editor
      (ProM)...
Together Workflow Engine
      (Community edition)




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Together Workflow Engine
      (Community edition)




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Tutorial: AMIA NOW conference: Introduction to workflow technology: Representation of healthcare processes in a workflow editor and their execution in a workflow engine, Vojtech Huser

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Introduction to workflow technology
Representation of healthcare processes in a workflow editor and their execution in a workflow engine

Vojtech Huser, MD PhD

Marshfield Clinic

Tutorial: AMIA NOW conference: Introduction to workflow technology: Representation of healthcare processes in a workflow editor and their execution in a workflow engine, Vojtech Huser

  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 AMIA NOW, Small Group session, Tutorial (1hr)
  2. 2. Agenda  Part 1: Introduction, history, overview  Part 2: Standards, SDO, related theories  Part 3: Practical tools demonstration  Originally 2 hour workshop  converted to 1 hour tutorial (with focus on introduction and standards)  Accompanying bibliography document 2 Vojtech Huser, MD, PhD
  3. 3. 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 3 Vojtech Huser, MD, PhD
  4. 4. 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 4 Vojtech Huser, MD, PhD
  5. 5. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 5 Vojtech Huser, MD, PhD
  6. 6. 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 6 Vojtech Huser, MD, PhD
  7. 7. 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 7 Vojtech Huser, MD, PhD
  8. 8. Process Example Koetter (2007) 8 Vojtech Huser, MD, PhD
  9. 9. 9 Vojtech Huser, MD, PhD
  10. 10. 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. 10 Vojtech Huser, MD, PhD
  11. 11. 11 Vojtech Huser, MD, PhD
  12. 12. 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 12 Vojtech Huser, MD, PhD
  13. 13. 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 13 Vojtech Huser, MD, PhD
  14. 14. 14 Vojtech Huser, MD, PhD
  15. 15. 15 Vojtech Huser, MD, PhD
  16. 16. 16 Vojtech Huser, MD, PhD
  17. 17. 17 Vojtech Huser, MD, PhD
  18. 18. 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 18 Vojtech Huser, MD, PhD
  19. 19. 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 19 Vojtech Huser, MD, PhD
  20. 20. 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 20 Vojtech Huser, MD, PhD
  21. 21. 21 Vojtech Huser, MD, PhD
  22. 22. 22 Vojtech Huser, MD, PhD
  23. 23. Humans & machines working together 23 Vojtech Huser, MD, PhD
  24. 24. Executable flowchart 24 Vojtech Huser, MD, PhD
  25. 25. 25 Vojtech Huser, MD, PhD
  26. 26. Minimum components language edito r execution engine 26 Vojtech Huser, MD, PhD
  27. 27. Interfaces 27 Vojtech Huser, MD, PhD
  28. 28. 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 28 Vojtech Huser, MD, PhD
  29. 29. WT benefits  Non-programmers understand processes  Non-programmers can modify processes  Analytical tools  Faster IT system development (SOA+WT) 29 Vojtech Huser, MD, PhD
  30. 30. 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 30 Vojtech Huser, MD, PhD
  31. 31. 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 31 Vojtech Huser, MD, PhD
  32. 32. 32 Vojtech Huser, MD, PhD
  33. 33. 33 Vojtech Huser, MD, PhD
  34. 34. 34 Vojtech Huser, MD, PhD
  35. 35. 35 Vojtech Huser, MD, PhD
  36. 36. 36 Vojtech Huser, MD, PhD
  37. 37. Workflow engine 37 Vojtech Huser, MD, PhD
  38. 38. Engine 38 Vojtech Huser, MD, PhD
  39. 39. 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 39 Vojtech Huser, MD, PhD
  40. 40. Use of WT  Pioneer domains  Banking  Manufacturing  Shipping  Government authorities  Pharmaceutical  Healthcare  Gartner 2008 report: <5% use 40 Vojtech Huser, MD, PhD
  41. 41. Examples of WT use in healthcare Bed management Infections control (MRSA) 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. 41 Vojtech Huser, MD, PhD
  42. 42. Stroke guideline (WfMS) 42 Vojtech Huser, MD, PhD
  43. 43. Soarian 43 Vojtech Huser, MD, PhD
  44. 44. 44 Vojtech Huser, MD, PhD
  45. 45. Current Soarian Example 45 Vojtech Huser, MD, PhD
  46. 46. Use at Marshfield Clinic 46 Vojtech Huser, MD, PhD
  47. 47. HealthFlow: RetroGuide, FlowGuide Workflow Workflow mining editor (ProM) (JaWE) EHR System layer: Additional Components: Notifications Prospective mode Host EHR Passive Knowledge Base Workflow Event (FlowGuide): Interaction Model (workflow process definitions) Execution Listener EHR system Host EHR Active Engine Interaction Model (Shark) Actions Retrospective mode Additional External Services (Terminology services, NLP services, Data Inquiry (RetroGuide): Statistical Analysis) Data Visualization Data Warehouse Event Data Model Workflow log analysis Reports Ontology Model 47 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  48. 48. 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 48 Vojtech Huser, MD, PhD
  49. 49. 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 49 Vojtech Huser, MD, PhD
  50. 50. Workflow patterns http:// workflowpatterns.com/ 50 Vojtech Huser, MD, PhD
  51. 51. Adaptive workflow structured production workflow process ad-hoc workflow unstructured computer-supported process collaborative work information process centric centric 51 Vojtech Huser, MD, PhD
  52. 52. 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 52 Vojtech Huser, MD, PhD
  53. 53. 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 53 Vojtech Huser, MD, PhD
  54. 54. WfMC  Started in 1990  5 interfaces  XPDL 1.0, 2.0, 2.1  Yearly Workflow handbook … 54 Vojtech Huser, MD, PhD
  55. 55. 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 55 Vojtech Huser, MD, PhD
  56. 56. 56 Vojtech Huser, MD, PhD
  57. 57. 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 57 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  58. 58. 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 58 Vojtech Huser, MD, PhD
  59. 59. XPDL  XML file based on a XSD schema  http://wfmc.org/xpdl.html  First introduced in 1999  Conformance testing available  http://www.xpdl.org/Validate/ValidateXpdl  Exchange format  Adoption (70+ products)  http://wfmc.org/xpdl-implementations.html 59 Vojtech Huser, MD, PhD
  60. 60. Standards Timeline 60 Vojtech Huser, MD, PhD
  61. 61. Example.xpdl 61 Vojtech Huser, MD, PhD
  62. 62. Process Schema 62 Vojtech Huser, MD, PhD
  63. 63. Activities 63 Vojtech Huser, MD, PhD
  64. 64. 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 64 Vojtech Huser, MD, PhD
  65. 65. 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 65 Vojtech Huser, MD, PhD
  66. 66. 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 66 Vojtech Huser, MD, PhD
  67. 67. 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 67 Vojtech Huser, MD, PhD
  68. 68. Definition of Petri Net  C = ( P, T, I, O)  Places P = { p1, p2, p3, …, pn}  Transitions T = { t1, t2, t3, …, tn}  Input I : T  Pr (r = number of places)  Output O : T  Pq (q = number of places) 68 Vojtech Huser, MD, PhD
  69. 69. 69 Vojtech Huser, MD, PhD
  70. 70. 70 Vojtech Huser, MD, PhD
  71. 71. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 71 Vojtech Huser, MD, PhD
  72. 72. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 72 Vojtech Huser, MD, PhD
  73. 73. Together workflow suite  Editor  JaWE  Together Workflow Editor (TWE)  v1.4, v2, v3  Engine  Shark  Together Workflow Engine (TWS)  Web-based module  Integration with Outlook 73 Vojtech Huser, MD, PhD
  74. 74. Demo 74 Vojtech Huser, MD, PhD
  75. 75. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 75 Vojtech Huser, MD, PhD
  76. 76. 76 Vojtech Huser, MD, PhD
  77. 77. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 77 Vojtech Huser, MD, PhD
  78. 78. 78 Vojtech Huser, MD, PhD
  79. 79. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 79 Vojtech Huser, MD, PhD
  80. 80. 80 Vojtech Huser, MD, PhD
  81. 81. Log schema 81 Vojtech Huser, MD, PhD
  82. 82. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 82 Vojtech Huser, MD, PhD
  83. 83. 83 Vojtech Huser, MD, PhD
  84. 84. 84 Vojtech Huser, MD, PhD
  85. 85. 85 Vojtech Huser, MD, PhD
  86. 86. 86 Vojtech Huser, MD, PhD
  87. 87. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 87 Vojtech Huser, MD, PhD
  88. 88. Other WT software components  Editor, engine  Administration (load a process)  Monitoring (exception)  Analysis (bottleneck finding)  Workflow simulation  Workflow mining 88 Vojtech Huser, MD, PhD
  89. 89. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 89 Vojtech Huser, MD, PhD
  90. 90. Use case studies  Marshfield Clinic  MainLine Health  U of Pavia  Einthoven University (NL)  Chester County hospital  See bibliography for references 90 Vojtech Huser, MD, PhD
  91. 91. Part 3: Practical tools demos  Demo of an editor and engine  Example 1:  Representing a surgical procedure, discharge and RCT trial enrolment process  Example 2:  Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)  Process mining tool (ProM)  Example 3:  Mining a progression of a chronic kidney disease from EHR data  Brief overview of other workflow technology software  Case studies of use in healthcare/informatics research  Workflow engines and Decision support engines 91 Vojtech Huser, MD, PhD
  92. 92. WT and DSS  Clear overlap  Many decision support engines have workflow features  Many workflow engines have decision support features  Workflow support vs. decision support  What to do and when  Published case studies of use of WT for decision support  Related work  Peleg at al.  Guidelines and workflow models  Design Patterns of Clinical Guidelines (2010) (Bonita wf editor)  Mulyar at al.  Comparison of Guidelines formalisms and workflow patterns 92 Vojtech Huser, MD, PhD
  93. 93. Mulyar at al (2007) 93 Vojtech Huser, MD, PhD
  94. 94. GLIF guideline 94 Vojtech Huser, MD, PhD
  95. 95. 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 95 Vojtech Huser, MD, PhD
  96. 96. Summary  Part 1: Basic terms, history, use  Part 2: Standards  Part 3: Tools demonstration  Cross-industry modeling and execution platform structured process production workflow with growing vendor and tool base and healthcare ad-hoc workflow use examples unstructured computer-supported process collaborative work  http://healthcareworkflow.wordpress.com  huser.vojtech@marshfieldclinic.org information process centric centric 96 Vojtech Huser, MD, PhD
  97. 97. Questions ?  http://healthcareworkflow.wordpress.com  huser.vojtech@marshfieldclinic.org 97 Vojtech Huser, MD, PhD
  98. 98. 98 Vojtech Huser, MD, PhD
  99. 99. 99 Vojtech Huser, MD, PhD
  100. 100. 100 Vojtech Huser, MD, PhD
  101. 101. 101 Vojtech Huser, MD, PhD
  102. 102. 102 Vojtech Huser, MD, PhD
  103. 103. 103 Vojtech Huser, MD, PhD
  104. 104. 104 Vojtech Huser, MD, PhD
  105. 105. WT vendors  Gartner: 105 Vojtech Huser, MD, PhD
  106. 106. Standards  Key standards  XPDL = XML Process Definition Language  Delivered as: XSD file  BPMN = Business Process Modeling Notation  Delivered as: PDF file  Key organizations  Workflow Management Coalition  www.wfmc.org  Object Management Group  www.omg.org (www.bpmn.org) 106 Vojtech Huser, MD, PhD
  107. 107. Other standards  BPEL  Business process execution language  Origins: XLANG (Microsoft) + WSFL (IBM) = BPEL4WS  Also known as WS-BPEL  Efforts to link BPEL to BPMN  YAWL  Yet another workflow language  Research project 107 Vojtech Huser, MD, PhD
  108. 108. Standards Timeline - Releases 1994 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 WfMC Ref Wf-XML 1.0 Wf-XML 1.1 Wf-XML-R Model WPDL XPDL 1.0 XPDL 2.0 XPDL 2.1 XPDL 3.0 BPMI BPAF BPMN 1.0 XML OMG BPMN BPMN BPMN BPMN 1.0 1.1 1.2 2.0 OASIS BPEL BPEL4People 108 Vojtech Huser, MD, PhD
  109. 109. GLIF guideline 109 Vojtech Huser, MD, PhD
  110. 110. Workflow editors and engines
  111. 111. Wofkflow software components
  112. 112. WT software components  Core components  Editor  Engine  Additional components  Administration application (deplay, terminate, versioning)  Worklist handler  User management (LDAP, MS, other)  Organizational roles  Monitoring/Analytical application  Simulation tools  Worfklow mining 112 Vojtech Huser, MD, PhD
  113. 113. Interesting analyses  Improving processes  Allocation of tasks  Push (human decides)/pull (machine) strategy  (push to all or to one and then escalate)  Earliest due date, first-in first-out  Rules: (1)let a resource practice its specialty; (2) do similar task in succession; (3) flexibility of staff (“save the generalist”)  Bottlenecks  Number of cases in progress  Case completion time  Level of service (customers)  Resource based indicators  BPR = business process re-engineering 114 Vojtech Huser, MD, PhD
  114. 114. 115 Vojtech Huser, MD, PhD
  115. 115. 116 Vojtech Huser, MD, PhD
  116. 116. 117 Vojtech Huser, MD, PhD
  117. 117. Computer Supported Collaborative Work 118 Vojtech Huser, MD, PhD
  118. 118. 119 Vojtech Huser, MD, PhD
  119. 119. Workflow mining  Traditional approach  model your process, pilot, deploy  Alternative  Take existing event data  Mine process definition  Delta analysis  Discovered process (current) vs. Human modelled process (goal, dream design)  Migration strategy www.processmining.org 120 Vojtech Huser, MD, PhD
  120. 120. 121 Vojtech Huser, MD, PhD
  121. 121. 122 Vojtech Huser, MD, PhD
  122. 122. Conclusion
  123. 123. How does it affect my coding ?  Worklow technology is coming to your desktop  Code will be split into small pieces (SOA)  Manipulation / customization via flowchart  CSCW vs. Structured processes  WT future  similar impact to IT as database technology in 1980s  Worklow enabled IT system  Ability to send and receive data to a worklow server  Worklist handler rather then full system  No need for designated monitoring pieces 124 Vojtech Huser, MD, PhD
  124. 124. Summary  Workflow technology  Terms  History  Software components  Theory  Future of WT  Bright (IT users will require it, ipod generation)  Gradual adoption  Maturation of standards, software  WT here in Marshfield  Phase 1: research use  Phase 2: dev use within IT (provisioning, QI, CDSS)  Phase 3: production use within Cattails sw 125 Vojtech Huser, MD, PhD
  125. 125. Questions / Comments 126 Vojtech Huser, MD, PhD
  126. 126. EXTRA SLIDES
  127. 127. 128 Vojtech Huser, MD, PhD
  128. 128. Workflow / BPM Reference Model 129 Vojtech Huser, MD, PhD
  129. 129. Workflow / BPM Reference Model BPMN XPDL BPAF Wf-XML BPEL SOAP REST 130 Vojtech Huser, MD, PhD
  130. 130. Standards Timeline - Releases 1994 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 WfMC Ref Wf-XML 1.0 Wf-XML 1.1 Wf-XML-R Model WPDL XPDL 1.0 XPDL 2.0 XPDL 2.1 XPDL 3.0 BPMI BPAF BPMN 1.0 XML OMG BPMN BPMN BPMN BPMN 1.0 1.1 1.2 2.0 OASIS BPEL BPEL4People 131 Vojtech Huser, MD, PhD
  131. 131. Timeline 1993 1994 1995 1996 1997 November 2000 October May October 1998 2002 2004 2005 WFMC Glossary Reference Wf-XML Wf-XML 2.0 Model WPDL XPDL 1.0 XPDL 2.0 BPMI OMG XML BPMN 1.0 OASIS BPEL ASAP 132 Vojtech Huser, MD, PhD
  132. 132. 133 Vojtech Huser, MD, PhD
  133. 133. XPDL Support in Market 134 Vojtech Huser, MD, PhD
  134. 134. Over 70 XPDL Implementations…  Adobe – • Enhydra JaWE • OpenPages Adobe LiveCycle Workflow • Finantix Studio (FXS) • Oracle - 9i Warehouse Builder  ADVANTYS - WorkflowGen • Fujitsu - Interstage BPM • Pentaho  Amazonas Workflow • Projekty Bankowe Polsoft – • FileNet - Process Manager  Appian - Enterprise BPB Workflow • GA Communications  Arachnea - EverSuite • Proforma Corporation - ProVision • Global 360 –  Ascentn - AgilePoint Server Business Optimzation Server • Rodan Systems - OfficeObjects®  Aspose Pty Ltd - • HOGA.PL Workflow Aspose.Workflow • Simprocess • IBM - FileNet  BOC - ADONIS 3.7 • Software AG- crossvision BPM • IDS Scheer –  BEA - Fuego Business Architect • SpeechCycle - LevelOne  Brein BV - InProces • Integic – • TIBCO iProcess™ Suite  Bonita v2.0 e.POWER WorkManager • Together Workflow Editor  Box UK - Amaxus • Interwoven - WorkRoute MP • Transware - Ambassador  Canto - CanFlow • Infor - SSA Baan, SSA BPCS, • Vignette –  CapeVisions SSA MANMAN, SSA Process Workflow Modeler  CARNOT - Process Engine • Masterpiece • W4 - BPM Suite  CHALEX - BPM Framework • ITP-Commerce – • WfMOpen  ComActivity Process Modeler Professional • Workflow::Wfmc  Cubetto Toolset • IT Pearls • Workflow4r  Dessault Systems - ENOVIA • jawFlow • ZAPLET 3 - PROCESS BUILDER  Eclaire Group – • Jenz & Partner GmbH • Zynium - Byzio Lynx Flow Designer • Kaisha-Tec - Avantage  EMC Documentum - • Metoda S.p.A - OpenMet ApplicationXtender Workflow BPMF  Empresa Solutions - Kinnosa • Mindfire Solutions Workflow • Nautica  Enhydra Shark • Open Business Engine 135 Vojtech Huser, MD, PhD
  135. 135. 136 Vojtech Huser, MD, PhD
  136. 136. 137 Vojtech Huser, MD, PhD
  137. 137. Six Standard BPMN / XPDL Examples 138 Vojtech Huser, MD, PhD
  138. 138. Six Standard BPMN / XPDL Examples  As of Feb 17, 2007, these vendors had implemented: 139 Vojtech Huser, MD, PhD
  139. 139. 140 Vojtech Huser, MD, PhD
  140. 140. 141 Vojtech Huser, MD, PhD
  141. 141. Workflow standards
  142. 142. Workflow vs. Java  Workflow is basically graphical coding  Workflow language offers contructs for branching  AND split  AND joint  OR split  OR joint 143 Vojtech Huser, MD, PhD
  143. 143. 144 Vojtech Huser, MD, PhD
  144. 144. 145 Vojtech Huser, MD, PhD
  145. 145. 146 Vojtech Huser, MD, PhD
  146. 146. 147 Vojtech Huser, MD, PhD
  147. 147. 148 Vojtech Huser, MD, PhD
  148. 148. Conditions  Pre-condition  Post-condition  Transition condition 149 Vojtech Huser, MD, PhD
  149. 149. Tools
  150. 150. Tools  Workflow editor  Workflow Engines  Commercial  Oracle Workflow  Open Source  Shark  OpenWFE (does not use XPDL, but it’s own format) 151 Vojtech Huser, MD, PhD
  151. 151. 1. Editor - JaWE  XPDL Editor  http://jawe.objectweb.org  written in Java  Open Source 152 Vojtech Huser, MD, PhD
  152. 152. 153 Vojtech Huser, MD, PhD
  153. 153. 2. Engine - Shark  Workflow Engine  Open Source  In beta stage  http://shark.objectweb.org/ 154 Vojtech Huser, MD, PhD
  154. 154. 155 Vojtech Huser, MD, PhD
  155. 155. Conclusion/Questions  How can we best separate logic of a protocol from workflow?  Can HealthCare be automated using same approach as Business Processes?  Are the workflow standards and tools mature enough? 156 Vojtech Huser, MD, PhD
  156. 156. 157 Vojtech Huser, MD, PhD
  157. 157. 158 Vojtech Huser, MD, PhD
  158. 158. 159 Vojtech Huser, MD, PhD
  159. 159. 160 Vojtech Huser, MD, PhD
  160. 160. Workflow engine project
  161. 161. Agenda  Workflow project: people contacts, resources  Fujitsu go/no go criteria  ability of Fujitsu to acknowledge current limitations  Improvements to the editor (close collaboration vs. one-of-many- customer)  Long term plan (phase 2, phase 3)  If Fujitsu is chosen  If other vendor is chosen  Small items  Longer workflow technology talk (taped)  (scientific seminar (Wed), grand rounds (Fri), IT brown bags)  Shadowing 162 Vojtech Huser, MD, PhD
  162. 162. Workflow project  Phase 1: Research use: BIRC, Vojtech+BIRC is the main developer  Scenarios: clinical scenarios based on Vojtech’s work on RetroGuide (e.g., osteoporosis, diabetes, chronic kidney disease)  Phase 2: dev use in IT within CattailsMD suite, Vojtech + IT workflow person/team  Scenarios: Provisioning (assigning user rightes, managing users), Decision Support (JohnF), Ancilarry services (TammyF), Radiology (preping prior imaging studies)  Phase 3: production use in IT, many IT developers/managers involved  Transforming dev processes to production systems 163 Vojtech Huser, MD, PhD
  163. 163. Current status  Fujitsu’s visit of July 28th  Early experiments on VMWare Fujitsu’s image (dev image)  Focus on breath of features (rather then full working scenario)  Counting with future support  MC’s server full install only finished on the last day at noon  After the visit  MC server  Transport of tested features from dev image to MC’s server  Demo access  Mike’s flowchart  Workflow follow-up meeting #1 (Aug 1st)  Rule systems in current CattailsMD suite ( 164 Vojtech Huser, MD, PhD
  164. 164. Evaluation  See separate document  Advantages  Disadvantages 165 Vojtech Huser, MD, PhD
  165. 165. Key Benefit of Wf Technology  Ability for non-expert to review or author processes (strong editor)  Level 1: processes developed via consulting  Level 2: processes developed by MC’s workflow person  Level 3: processes developed by chief of Pediatrics  Using Wf Engine will decrease development cost  Basic functions (no need to develop them)  Advanced analytical/monitoring functions 166 Vojtech Huser, MD, PhD
  166. 166. Requirements for Wf Editor/Flowchart  Complexity: Ability to express all my processes  Complexity (it can support MC’s business, clinical processes (DSS, QI), daily administrative processes (coordinating staff and clinicians, departments)  User-friendliness: Ability to express them in a level 3 friendly way  User-friendliness (buy in of MC’s users) 167 Vojtech Huser, MD, PhD
  167. 167. Requirements for the flowchart  The flowchart can be read without additional drill down  Can become quite complex and have many extra nodes (split, join, conditions)  Readability of the flowchart is most important.  Certain elements are hidden to improve readability  Mousing-over, drill-down click reveals additional detail 168 Vojtech Huser, MD, PhD
  168. 168. Choice of Wf vendor  Feature set  Price  Special relationship (partnership)  TIBCO  Fujitsu  Lombardi  BEA  Global 360 169 Vojtech Huser, MD, PhD
  169. 169. Evaluation perspectives  data perspective  deals with the passing of information , scoping of variables  resource perspective  deals with resource to task allocation, delegation  exception handling perspective  deal with the various causes of exceptions and the various actions that need to be taken as a result of exceptions occurring 170 Vojtech Huser, MD, PhD
  170. 170. WfMC glossary 171 Vojtech Huser, MD, PhD
  171. 171. Terms 172 Vojtech Huser, MD, PhD
  172. 172. Terms [X]OR or AND split Always or if not (A or B or C) If A If B If C “Otherwise” route Route A Route B Route C 173 Vojtech Huser, MD, PhD
  173. 173. Flowchart and execution  Complexity decision  Flowchart will have everything (no drill-downs necessary)  Flowchart will be a simplified view  Type of process specific knowledge  Design time  Run time  Deadlock situation (how bullet-proof is your process definition)  Flowchart level  Engine level (default behavior) (simpler flowchart) 174 Vojtech Huser, MD, PhD
  174. 174. Petri Nets (PN)
  175. 175. Screenshots of Wf editor/engine (Fujitsu and some TIBCO) (will be commented orally)
  176. 176. 177 Vojtech Huser, MD, PhD
  177. 177. 178 Vojtech Huser, MD, PhD
  178. 178. 179 Vojtech Huser, MD, PhD
  179. 179. 180 Vojtech Huser, MD, PhD
  180. 180. 181 Vojtech Huser, MD, PhD
  181. 181. 182 Vojtech Huser, MD, PhD
  182. 182. 183 Vojtech Huser, MD, PhD
  183. 183. Theory
  184. 184. Petri Nets  Petri net consist two types of nodes: places and transitions.  A place may have zero or more tokens.  Graphically, places, transitions, arcs, and tokens are represented respectively by: circles, bars, arrows, and dots. p1 t1 p2 185 Vojtech Huser, MD, PhD
  185. 185. Definition of Petri Net  C = ( P, T, I, O)  Places P = { p1, p2, p3, …, pn}  Transitions T = { t1, t2, t3, …, tn}  Input I : T  Pr (r = number of places)  Output O : T  Pq (q = number of places) 186 Vojtech Huser, MD, PhD
  186. 186. Vector of places’ states  Below is an example Petri net with two places and one transaction.  Transition node is ready to fire if and only if there is at least one token at each of its input places p1 t1 p2 state transition of form (1, 0)  (0, 1) p1 : input place p2: output place 187 Vojtech Huser, MD, PhD
  187. 187. 188 Vojtech Huser, MD, PhD
  188. 188. 189 Vojtech Huser, MD, PhD
  189. 189. Screenshot tour HealthcareWorkflow.wordpress.com
  190. 190. HealthFlow: RetroGuide, FlowGuide Workflow Workflow mining editor (ProM) (JaWE) EHR System layer: Additional Components: Notifications Prospective mode Host EHR Passive Knowledge Base Workflow Event (FlowGuide): Interaction Model (workflow process definitions) Execution Listener EHR system Host EHR Active Engine Interaction Model (Shark) Actions Retrospective mode Additional External Services (Terminology services, NLP services, Data Inquiry (RetroGuide): Statistical Analysis) Data Visualization Data Warehouse Event Data Model Workflow log analysis Reports Ontology Model 191 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  191. 191. 192 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  192. 192. 193 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  193. 193. Code Layer (node; right click properties) 194 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  194. 194. code.google.com/p/HealthFlow 195 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  195. 195. HealthFlow: RetroGuide, FlowGuide Workflow Workflow mining editor (ProM) (JaWE) EHR System layer: Additional Components: Notifications Prospective mode Host EHR Passive Knowledge Base Workflow Event (FlowGuide): Interaction Model (workflow process definitions) Execution Listener EHR system Host EHR Active Engine Interaction Model (Shark) Actions Retrospective mode Additional External Services (Terminology services, NLP services, Data Inquiry (RetroGuide): Statistical Analysis) Data Visualization Data Warehouse Event Data Model Workflow log analysis Reports Ontology Model 196 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  196. 196. Together Workflow Engine (Community edition) 197 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
  197. 197. Together Workflow Engine (Community edition) 198 Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com

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