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Introduction to workflow technology

Representation of healthcare processes in a workflow editor and their execution in a workflow engine dit d th i ti i kfl i

Vojtech Huser MD PhD

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

Download additional files
Go to: http://healthcareworkflow.wordpress.com http://healthcareworkflow wordpress com post:tutorial Or direct URL: http://healthcareworkflow.wordpress.com/2010/05/21/tutorialintroduction-to-workflow-technology-representation-of-healthcare-processes-in-aworkflow 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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Agenda
Part 1: Introduction, history, overview , y, 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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Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990 p

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 t h l t l Workflow Technology applied industries and healthcare Future development and research challenges
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Part 2: WT standards SDOs related theories standards, SDOs,
Workflow management coalition’s (WfMC) standards Definition of WT terms XML process d f definition l language (XPDL) ( ) Other standardization efforts
Business Process Execution Language B siness P ocess E ec tion Lang age (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards g

Petri Nets theory and its relationship to workflows
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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990 p

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 t h l t l Workflow Technology applied industries and healthcare Future development and research challenges
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Workflow technology
BPM = business process management p g Adaptive workflow (Adaptive Case g ) Management) Computer supported collaborative work ( (CSCW) ) Why workflow?
Sepa at o of Separation o data into databases to Separation of UI from IT system core Separation of process knowledge p p g
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Process Example

Koetter (2007)

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Workflow patterns examples
Parallel Split: When an intrusion alarm is received, trigger the di ti th dispatch-patrol activity and the i f t h t l ti it d th inform-police 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, one or more of the d ll f th despatch-police, t h li despatch-fire-engine and despatch-ambulance activities is immediately initiated.
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Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990 p

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 t h l t l Workflow Technology applied industries and healthcare Future development and research challenges
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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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Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990 p

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 t h l t l Workflow Technology applied industries and healthcare Future development and research challenges
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Automating Workflow
Defined by Workflow Management Coalition (WfMC)
www.wfmc.org

Terminology and Glossary T i l d Gl
http://www.wfmc.org/standards/docs/TC1011_term_glossary_v3.pdf 1011 te m glossa 3 pdf

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Terms
Workflow
The automation of a business process, in whole or part, during which documents, p , g , 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
language

edito r

execution engine

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Interfaces

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Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990 p

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 t h l t l Workflow Technology applied industries and healthcare Future development and research challenges
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WT benefits
Non programmers Non-programmers understand processes Non-programmers can modify processes Analytical tools Faster IT system development (SOA+WT)

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Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990 p

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 kfl t h l t l Workflow Technology applied industries and healthcare Future development and research challenges
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Choice of Wf vendor
Major player
TIBCO BEA Global 360 IBM Fujitsu F jit IBM Oracle Microsoft SAP Lombardi JBOSS Taverna Together Bonita YAWL http://java-source.net/opensource/workflow-engines

Other

Open source

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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 of workflow t h l Hi t f kfl technology Components of workflow t h l C t f kfl technology (process definition, ( d fi iti execution engine, analytical components) Benefits of implementing a workflow server within a generic IT system i t Major workflow vendors and open-source workflow technology tools Workflow Technology applied industries and W kfl T h l li d i d i d healthcare Future development and research challenges
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prior 1960s-1980s development after 1990

Use of WT
Pioneer domains
Banking Manufacturing Shipping Government authorities Pharmaceutical

Healthcare Healthca e
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. 42
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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, FlowGuide RetroGuide

Workflow mining
(ProM)

Workflow editor
(JaWE)

EHR System layer: Notifications Knowledge Base
(workflow process definitions)

Additional Components: Host EHR Passive Interaction Model Host EHR Active Interaction Model

Workflow Execution Engine
(Shark)

Event Listener Actions Data Inquiry

Prospective mode (FlowGuide):

EHR system
Retrospective mode (RetroGuide):

Additional External Services
(Terminology services, NLP services, Statistical Analysis)

Data Warehouse
Workflow log analysis Reports

Data Visualization Event Data Model Ontology Model

Vojtech Huser, MD, PhD

HealthcareWorkflow.wordpress.com

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Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems History of workflow technology
prior 1960s-1980s development after 1990 p

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 t h l t l Workflow Technology applied industries and healthcare Future development and research challenges
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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 St d d consolidation 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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Part 2: WT standards SDOs related theories standards, SDOs,
Workflow management coalition’s (WfMC) standards Definition of WT terms XML process d f definition l language (XPDL) ( ) Other standardization efforts
Business Process Execution Language B siness P ocess E ec tion Lang age (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards g

Petri Nets theory and its relationship to workflows
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Vojtech Huser, MD, PhD

Part 2: WT standards SDOs related theories standards, SDOs,
Workflow management coalition’s (WfMC) standards Definition of WT terms XML process d f definition l language (XPDL) ( ) Other standardization efforts
Business Process Execution Language B siness P ocess E ec tion Lang age (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards g

Petri Nets theory and its relationship to workflows
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WfMC
Started in 1990 5 interfaces XPDL 1.0, 2.0, 2.1 10 20 21 Yearly Workflow handbook

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Part 2: WT standards SDOs related theories standards, SDOs,
Workflow management coalition’s (WfMC) standards Definition of WT terms XML process d f definition l language (XPDL) ( ) Other standardization efforts
Business Process Execution Language B siness P ocess E ec tion Lang age (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards g

Petri Nets theory and its relationship to workflows
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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 y j p yg , 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 Vojtech Huser, MD, PhD

HealthcareWorkflow.wordpress.com

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Part 2: WT standards SDOs related theories standards, SDOs,
Workflow management coalition’s (WfMC) standards Definition of WT terms XML process d fi i i definition l language (XPDL) ( ) Other standardization efforts
Business Process Execution Language B siness P ocess E ec tion Lang age (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards g

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
http://www.xpdl.org/Validate/ValidateXpdl h // 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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Part 2: WT standards SDOs related theories standards, SDOs,
Workflow management coalition’s (WfMC) standards Definition of WT terms XML process d f definition l language (XPDL) ( ) Other standardization efforts
Business Process Execution Language B siness P ocess E ec tion Lang age (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards g

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

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 and transitions. dt iti A place may have zero or more tokens. Graphic ep esentations Places (circles), G aphic representations :Places (ci 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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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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Vojtech Huser, MD, PhD

Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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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 Integration with O tl k I t ti ith Outlook

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Demo

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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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Vojtech Huser, MD, PhD

Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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Log schema

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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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http://www.marshfieldclinic.org/birc/pages/default.aspx?page=mcrf_birc_pubs_presentations Vojtech Huser, MD, PhD

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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines W kfl i dD i i t i
Vojtech Huser, MD, PhD

Mining a progression of a chronic kidney disease from EHR data

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Other WT software components
Editor, engine Administration (load a process) Monitoring (exception) Analysis (bottleneck finding) Workflow simulation
Workflow mining
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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines W kfl i dD i i t i
Vojtech Huser, MD, PhD

Mining a progression of a chronic kidney disease from EHR data

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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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Part 3: Practical tools demos
Demo of an editor and engine Example 1: E l 1 Example 2:
Representing a surgical procedure, discharge and RCT trial enrolment process Two rheumatology decision support processes (TB screening, Pneumococcal vaccine)

Process mining tool (ProM) Example 3:

Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines

Mining a progression of a chronic kidney disease from EHR data

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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 Wh to do and when d d h

Published case studies of use of WT for decision support Related work e ated o
Peleg at al.
Guidelines and workflow models Design Patterns of Clinical Guidelines (2010) (Bonita wf editor) g ( )( )

Mulyar at al.
Comparison of Guidelines formalisms and workflow patterns

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Mulyar at al (2007) 93
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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

SAGE’s 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, use , y, 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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