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Introduction to workflow technology

Representation of healthcare processes in a workflow


editor
dit andd their
th i execution
ti ini a workflow
kfl engine
i

Vojtech Huser MD PhD

AMIA NOW, Small Group session, Tutorial (1hr)


Download additional files
Go to:
http://healthcareworkflow wordpress com post:tutorial
http://healthcareworkflow.wordpress.com

Or direct URL: http://healthcareworkflow.wordpress.com/2010/05/21/tutorial-


introduction-to-workflow-technology-representation-of-healthcare-processes-in-a-
workflow editor and their execution in a workflow engine/
workflow-editor-and-their-execution-in-a-workflow-engine/

Download the bibliography document for all references mentioned in the presentation (at
the link above)

(In the workflow editor: use Shark view (Settings -> Configuration -> Shark))

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Vojtech Huser, MD, PhD
Agenda
Part 1: Introduction,, history,
y, 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

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Vojtech Huser, MD, PhD
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
t h l
technology tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d f llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows

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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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

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Vojtech Huser, MD, PhD
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
t h l
technology tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
Workflow technology
BPM = business pprocess management
g
Adaptive workflow (Adaptive Case
g
Management) )
Computer supported collaborative work
(
(CSCW))
Why workflow?
Sepa at o o
Separation of data into
to databases
Separation of UI from IT system core
Separation
p of process
p knowledge
g

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Process Example

Koetter (2007)

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Workflow patterns examples
Parallel Split: When an intrusion alarm is received,
ti
trigger th dispatch-patrol
the di t h t l activity
ti it and th inform-police
d the i f li
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, th despatch-police
ll one or more off the d t h li ,
despatch-fire-engine and despatch-ambulance activities
is immediately initiated.

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Vojtech Huser, MD, PhD
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
t h l
technology tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
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

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Vojtech Huser, MD, PhD
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Vojtech Huser, MD, PhD
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
t h l
technology tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
Automating Workflow
Defined by Workflow Management
Coalition (WfMC)
www.wfmc.org

T
Terminology
i l and
d Glossary
Gl
http://www.wfmc.org/standards/docs/TC-
1011 te m glossa
1011_term_glossary_v3.pdf
3 pdf

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Vojtech Huser, MD, PhD
Terms
Workflow
The automation of a business process, in
whole or ppart,, during
g 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

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Humans & machines working together

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Executable flowchart

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Minimum components
edito
language
r

execution engine

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Interfaces

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Vojtech Huser, MD, PhD
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
t h l
technology tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
WT benefits
Non programmers understand processes
Non-programmers
Non-programmers can modify processes
Analytical tools
Faster IT system development (SOA+WT)

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Vojtech Huser, MD, PhD
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
kfl technology
t h l tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
Choice of Wf vendor
Major player
TIBCO
BEA
Global 360
IBM
Other
Fujitsu
F jit
IBM
Oracle
Microsoft
SAP
Lombardi
Open source
JBOSS
Taverna
Together
Bonita
YAWL
http://java-source.net/open-
source/workflow-engines

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Workflow engine

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Engine

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Vojtech Huser, MD, PhD
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
Hi t
History off workflow
kfl ttechnology
h l
prior 1960s-1980s
development after 1990
Components
C t off workflow
kfl ttechnology
h l (process
( definition,
d fi iti
execution engine, analytical components)
Benefits of implementing a workflow server within a
generic
i IT system
t
Major workflow vendors and open-source workflow
technology tools
W kfl
Workflow Technology
T h l applied
li d industries
i d i and d
healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
Use of WT
Pioneer domains
Banking
Manufacturing
Shipping
Government authorities
Pharmaceutical
Healthca e
Healthcare
Gartner 2008 report: <5% use

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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.
FL, 2007
R. Hess, "The Chester County Hospital: Case Study," in 2007 Excellence in Practice: Moving the
Goalposts., 2007.
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Stroke guideline (WfMS)

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Soarian

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Use at Marshfield Clinic

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HealthFlow: RetroGuide,
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

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Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
t h l
technology tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges

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Vojtech Huser, MD, PhD
Future of WT
Improvements
Adoption is growing
Software tools sophistication is improving
Competition, consolidation
Future similar to a database server inclusion in
IT systems
St d d consolidation
Standards lid ti
Research challenges
Process model visualization challenges
Process model cross-vendor portability
Adaptive workflow

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Workflow patterns

http://
workflowpatterns.com/

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Adaptive workflow

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Vojtech Huser, MD, PhD
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d f llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows

52
Vojtech Huser, MD, PhD
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d f llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows

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WfMC
Started in 1990
5 interfaces
XPDL 1.0,
1 0 2.0,
2 0 2.1
21
Yearly Workflow handbook

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Vojtech Huser, MD, PhD
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d f llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows

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Vojtech Huser, MD, PhD
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
rules.

Workflow Process = A set of one or more linked procedures or


activities which collectivelyy realize a business objective
j or policy
p y goal,
g ,
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,DocumentNumberWFMCTC1011,Feb99
http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74
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Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d fi i i llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows

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XPDL
XML file based on a XSD schema
http://wfmc.org/xpdl.html
First introduced in 1999
Conformance testing available
h
http://www.xpdl.org/Validate/ValidateXpdl
// dl / ld / ld dl
Exchange format
Adoption (70+ products)
http://wfmc.org/xpdl-implementations.html
p // g/ p p

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Standards Timeline

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Example xpdl
Example.xpdl

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Process Schema

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Activities

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Vojtech Huser, MD, PhD
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d f llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows

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Vojtech Huser, MD, PhD
WT standards
Historical
WSDL
Current major
j
XPDL, BPMN, BPEL
Proprietary (vendor specific):
JBPM (JBoss)
(JB )
Win Workflow Foundation (Microsoft)
T2Flow->SCUFL2 (Taverna)
internal format (Weka)

Research ones
YAWL

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Vojtech Huser, MD, PhD
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d f llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows

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Petri Nets
Mathematical theory
Basics
Petri net consist two types of nodes: places
andd transitions.
t iti
A place may have zero or more tokens.
G aphic representations
Graphic ep esentations :Places
Places (ci
(circles),
cles)
transitions (bars), arcs (arrows), and
tokens ((dots))

p1 t1 p2

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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)

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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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

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Vojtech Huser, MD, PhD
Together workflow suite
Editor
JaWE Together Workflow Editor (TWE)
v1 4 v2,
v1.4, v2 v3
Engine
Shark Together Workflow Engine (TWS)
Web-based module
I t
Integration
ti with
ith O
Outlook
tl k

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Demo

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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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

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Vojtech Huser, MD, PhD
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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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
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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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

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Log schema

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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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

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http://www.marshfieldclinic.org/birc/pages/default.aspx?page=mcrf_birc_pubs_presentations 86
Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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
W kfl
Workflow engines
i andd Decision
D i i supportt engines
i
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Vojtech Huser, MD, PhD
Other WT software components
Editor, engine

Administration (load a process)


Monitoring (exception)
Analysis (bottleneck finding)

Workflow simulation
Workflow mining

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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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
W kfl
Workflow engines
i and
d Decision
D i i supportt engines
i
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Use case studies
Marshfield Clinic
MainLine Health
U of Pavia
Einthoven University (NL)
Chester County hospital

See bibliography for references

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Vojtech Huser, MD, PhD
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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

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Vojtech Huser, MD, PhD
WT and DSS
Clear overlap
Many decision support engines have workflow features
Many workflow engines have decision support features
Workflow support vs. decision support
Wh to do
What d and
d when
h
Published case studies of use of WT for decision support
Related
e ated work
o
Peleg at al.
Guidelines and workflow models
Design
g Patterns of Clinical Guidelines (2010)
( ) ((Bonita wf editor))
Mulyar at al.
Comparison of Guidelines formalisms and workflow patterns

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Mulyar at al (2007)
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GLIF
guideline
id li

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Sage flowchart example
P. Ram (2004)
Executing Clinical Practice Guidelines
Using the SAGE Execution Engine,
Medinfo, pp. 251-5, 2004

SAGEs decision maps


subflows.
Rule-in and Rule-out
contructs
Linking workflow engine
with a rule engine

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Summary
Part 1: Basic terms,, history,
y, use
Part 2: Standards
Part 3: Tools demonstration

Cross-industry modeling
and execution platform
with growing vendor and
tool base and healthcare
use examples
l

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

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Questions ?

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

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