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Beckmann CL, Lodde G, Swoboda J, Livingstone E, Böckmann B. Use of Real-World FHIR Data Combined with Context-Sensitive Decision Modeling to Guide Sentinel Biopsy in Melanoma. J Clin Med 2024; 13:3353. [PMID: 38893064 PMCID: PMC11172530 DOI: 10.3390/jcm13113353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: To support clinical decision-making at the point of care, the "best next step" based on Standard Operating Procedures (SOPs) and actual accurate patient data must be provided. To do this, textual SOPs have to be transformed into operable clinical algorithms and linked to the data of the patient being treated. For this linkage, we need to know exactly which data are needed by clinicians at a certain decision point and whether these data are available. These data might be identical to the data used within the SOP or might integrate a broader view. To address these concerns, we examined if the data used by the SOP is also complete from the point of view of physicians for contextual decision-making. Methods: We selected a cohort of 67 patients with stage III melanoma who had undergone adjuvant treatment and mainly had an indication for a sentinel biopsy. First, we performed a step-by-step simulation of the patient treatment along our clinical algorithm, which is based on a hospital-specific SOP, to validate the algorithm with the given Fast Healthcare Interoperability Resources (FHIR)-based data of our cohort. Second, we presented three different decision situations within our algorithm to 10 dermatooncologists, focusing on the concrete patient data used at this decision point. The results were conducted, analyzed, and compared with those of the pure algorithmic simulation. Results: The treatment paths of patients with melanoma could be retrospectively simulated along the clinical algorithm using data from the patients' electronic health records. The subsequent evaluation by dermatooncologists showed that the data used at the three decision points had a completeness between 84.6% and 100.0% compared with the data used by the SOP. At one decision point, data on "patient age (at primary diagnosis)" and "date of first diagnosis" were missing. Conclusions: The data needed for our decision points are available in the FHIR-based dataset. Furthermore, the data used at decision points by the SOP and hence the clinical algorithm are nearly complete compared with the data required by physicians in clinical practice. This is an important precondition for further research focusing on presenting decision points within a treatment process integrated with the patient data needed.
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Affiliation(s)
- Catharina Lena Beckmann
- Department of Computer Science, University of Applied Sciences and Arts Dortmund (FH Dortmund), 44227 Dortmund, Germany
| | - Georg Lodde
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany
| | - Jessica Swoboda
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Girardetstraße 2, 45131 Essen, Germany;
| | - Elisabeth Livingstone
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany
| | - Britta Böckmann
- Department of Computer Science, University of Applied Sciences and Arts Dortmund (FH Dortmund), 44227 Dortmund, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Girardetstraße 2, 45131 Essen, Germany;
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Martínez-Salvador B, Marcos M, Palau P, Domínguez Mafé E. A model-driven transformation approach for the modelling of processes in clinical practice guidelines. Artif Intell Med 2023; 137:102495. [PMID: 36868689 DOI: 10.1016/j.artmed.2023.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
Clinical Practice Guidelines (CPGs) include recommendations aimed at optimising patient care, informed by a review of the available clinical evidence. To achieve their potential benefits, CPG should be readily available at the point of care. This can be done by translating CPG recommendations into one of the languages for Computer-Interpretable Guidelines (CIGs). This is a difficult task for which the collaboration of clinical and technical staff is crucial. However, in general CIG languages are not accessible to non-technical staff. We propose to support the modelling of CPG processes (and hence the authoring of CIGs) based on a transformation, from a preliminary specification in a more accessible language into an implementation in a CIG language. In this paper, we approach this transformation following the Model-Driven Development (MDD) paradigm, in which models and transformations are key elements for software development. To demonstrate the approach, we implemented and tested an algorithm for the transformation from the BPMN language for business processes to the PROforma CIG language. This implementation uses transformations defined in the ATLAS Transformation Language. Additionally, we conducted a small experiment to assess the hypothesis that a language such as BPMN can facilitate the modelling of CPG processes by clinical and technical staff.
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Affiliation(s)
| | - Mar Marcos
- Department of Computer Engineering and Science, Univ. Jaume I, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Univ. de València, Spain; INCLIVA Instituto de Investigación Sanitaria, Univ. de València, Spain
| | - Eloy Domínguez Mafé
- Cardiology Department, Hospital Clínico Universitario de Valencia, Univ. de València, Spain; Predepartmental Unit of Medicine, Univ. Jaume I, Spain
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Litchfield I, Turner AM, Ferreira Filho JB, Lee M, Weber P. Automated conflict resolution for patients with multiple morbidity being treated using more than one set of single condition clinical guidance: A case study. Comput Biol Med 2022; 144:105381. [DOI: 10.1016/j.compbiomed.2022.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
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Process Mining for Healthcare: Characteristics and Challenges. J Biomed Inform 2022; 127:103994. [DOI: 10.1016/j.jbi.2022.103994] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
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Fuente R, Kattan E, Munoz‐Gama J, Puente I, Navarrete M, Kychenthal C, Fuentes R, Bravo S, Galvez V, Sepúlveda M. Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: A Delphi-based experts consensus. Acta Anaesthesiol Scand 2021; 65:244-256. [PMID: 32997799 DOI: 10.1111/aas.13716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Deconstructing a complex procedure improves skills learning, but no model has covered all relevant Percutaneous Dilatational Tracheostomy (PDT) procedural aspects. Moreover, the heterogeneity of techniques described may hinder trainees' competency acquisition. Our objective was to develop a PDT model for procedural training that includes a comprehensive step-by-step design. METHODS Procedural descriptions were retrieved after a structured search in medical databases. Activities were extracted and the adherence to McKinley's dimensions of procedural competence was analyzed. We developed a comprehensive PDT model, which was further validated through a Delphi-based consensus of Spanish-speaking international experts. RESULTS The 14 descriptions retrieved for analysis presented a median [interquartile range] of 18 [11-22] steps, covering 3 [2-4] of McKinley's dimensions. The Delphi panel's first model included all McKinley's dimensions, and was answered by 25 experts from nine countries, ending in the second round. The final model included 59 activities divided into six stages (51 from the initial model and eight proposed by experts) and performed by two operators (bronchoscopy and tracheostomy). CONCLUSIONS We have presented a PDT model that includes necessary competence dimensions to be considered complete. The model was validated by an experts' consensus, allowing to improve procedural training to promote safer patient care.
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Affiliation(s)
- Rene Fuente
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Jorge Munoz‐Gama
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Ignacio Puente
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Matías Navarrete
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Catalina Kychenthal
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Ricardo Fuentes
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Victor Galvez
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Marcos Sepúlveda
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
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Abstract
Process analysis and process modeling are a current topic that extends to many areas. This trend of using optimization and modeling techniques in various specific areas has led to the question of how widespread these approaches are overall in medical specializations. We compiled a list of 272 medical disciplines that we used as a search string with the Business Process Model and Notation (BPMN) for a Web of Science database search. Thus, we found a total of 485 documents that we subjected to the exclusion criteria. We analyzed the remaining 108 articles using bibliometric and content analyses to find answers to three research questions. This systematic review was carried out using the procedure proposed by Kitchenham and following the Preferred Items of the Systematic Review and Meta-Analysis Report (PRISMA). Due to the broad scope of the medical field, it was no surprise that for almost 85% of the sought-after medical specializations, we could not identify any publications in the given database when applying the BPMN. We analyzed the impact of upgrades to the BPMN on publishing. The keyword analysis showed a diametrical difference between the authors’ keywords and the so-called “Keywords Plus”, and we categorized the publications according to the purpose of applying the BPMN. However, the growing interest in combining BPMN with other approaches brings new challenges in practice.
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de la Fuente R, Fuentes R, Munoz-Gama J, Dagnino J, Sepúlveda M. Delphi Method to Achieve Clinical Consensus for a BPMN Representation of the Central Venous Access Placement for Training Purposes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113889. [PMID: 32486300 PMCID: PMC7312914 DOI: 10.3390/ijerph17113889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022]
Abstract
Proper teaching of the technical skills necessary to perform a medical procedure begins with its breakdown into its constituent steps. Currently available methodologies require substantial resources and their results may be biased. Therefore, it is difficult to generate the necessary breakdown capable of supporting a procedural curriculum. The aim of our work was to breakdown the steps required for ultrasound guided Central Venous Catheter (CVC) placement and represent this procedure graphically using the standard BPMN notation. Methods: We performed the first breakdown based on the activities defined in validated evaluation checklists, which were then graphically represented in BPMN. In order to establish clinical consensus, we used the Delphi method by conducting an online survey in which experts were asked to score the suitability of the proposed activities and eventually propose new activities. Results: Surveys were answered by 13 experts from three medical specialties and eight different institutions in two rounds. The final model included 28 activities proposed in the initial model and four new activities proposed by the experts; seven activities from the initial model were excluded. Conclusions: The proposed methodology proved to be simple and effective, generating a graphic representation to represent activities, decision points, and alternative paths. This approach is complementary to more classical representations for the development of a solid knowledge base that allows the standardization of medical procedures for teaching purposes.
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Affiliation(s)
- Rene de la Fuente
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
| | - Ricardo Fuentes
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
- Correspondence:
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (J.M.-G.); (M.S.)
| | - Jorge Dagnino
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (J.M.-G.); (M.S.)
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Becker M, Böckmann B, Jöckel KH, Stuschke M, Paul A, Kasper S, Virchow I. Mapping Patient Data to Colorectal Cancer Clinical Algorithms for Personalized Guideline-Based Treatment. Appl Clin Inform 2020; 11:200-209. [PMID: 32187632 DOI: 10.1055/s-0040-1705105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Colorectal cancer is the most commonly occurring cancer in Germany, and the second and third most commonly diagnosed cancer in women and men, respectively. In this context, evidence-based guidelines positively impact the quality of treatment processes for cancer patients. However, evidence of their impact on real-world patient care remains unclear. To ensure the success of clinical guidelines, a fast and clear provision of knowledge at the point of care is essential. OBJECTIVES The objectives of this study are to model machine-readable clinical algorithms for colon carcinoma and rectal carcinoma annotated by Unified Medical Language System (UMLS) based on clinical guidelines and the development of an open-source workflow system for mapping clinical algorithms with patient-specific information to identify patient's position on the treatment algorithm for guideline-based therapy recommendations. METHODS This study qualitatively assesses the therapy decision of clinical algorithms as part of a clinical pathway. The solution uses rule-based clinical algorithms, which were developed based on the corresponding guidelines. These algorithms are executed on a newly developed open-source workflow system and are visualized at the point of care. The aim of this approach is to create clinical algorithms based on an established business process standard, the Business Process Model and Notation (BPMN), which is annotated by UMLS terminologies. The gold standard for the validation process was set by manual extraction of clinical datasets from 86 rectal cancer patients and 89 colon cancer patients. RESULTS Using this approach, the algorithm achieved a precision value of 87.64% for colon cancer and 84.70% for rectal cancer with recall values of 87.64 and 83.72%, respectively. CONCLUSION The results indicate that the automatic positioning of a patient on the decision pathway is possible with tumor stages that have a less complex clinical algorithm with fewer decision points reaching a higher accuracy than complex stages.
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Affiliation(s)
- Matthias Becker
- Department of Computer Science, University of Applied Sciences and Arts, Dortmund, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Britta Böckmann
- Department of Computer Science, University of Applied Sciences and Arts, Dortmund, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Radiation and Tumor Clinic, University Hospital Essen, Essen, Germany
| | - Andreas Paul
- Surgical Clinic, University Hospital Essen, Essen, Germany
| | - Stefan Kasper
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Isabel Virchow
- West German Cancer Center, University Hospital Essen, Essen, Germany
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De Ramón Fernández A, Ruiz Fernández D, Sabuco García Y. Business Process Management for optimizing clinical processes: A systematic literature review. Health Informatics J 2019; 26:1305-1320. [PMID: 31581880 DOI: 10.1177/1460458219877092] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Business Process Management is a new strategy for process management that is having a major impact today. Mainly, its use is focused on the industrial, services, and business sector. However, in recent years, it has begun to apply for optimizing clinical processes. So far, no studies that evaluate its true impact on the healthcare sector have been found. This systematic review aims to assess the results of the application of Business Process Management methodology on clinical processes, analyzing whether it can become a useful tool to improve the effectiveness and quality of processes. We conducted a systematic literature review using ScienceDirect, Web of Science, Scopus, PubMed, and Springer databases. After the electronic search process in different databases, 18 articles met the pre-established requirements. The findings support the use of Business Process Management as an effective methodology to optimize clinical processes. Business Process Management has proven to be a feasible and useful methodology to design and optimize clinical processes, as well as to automate tasks. However, a more comprehensive follow-up of this methodology, better technological support, and greater involvement of all the clinical staff are factors that play a key role for the development of its true potential.
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Sooter LJ, Hasley S, Lario R, Rubin KS, Hasić F. Modeling a Clinical Pathway for Contraception. Appl Clin Inform 2019; 10:935-943. [PMID: 31860113 PMCID: PMC6924335 DOI: 10.1055/s-0039-3400749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) produced a 72-page document titled "U.S. Selective Practice Recommendations for Contraceptive Use" in 2016. This document contains the medical eligibility criteria (MEC) for contraceptive initiation or continuation based on a patient's current health status. Notations such as Business Process Model and Notation (BPMN) and Decision Model and Notation (DMN) might be useful to model such recommendations. OBJECTIVE Our objective was to use BPMN and DMN to model and standardize the processes and decisions involved in initiating birth control according to the CDC's MEC for birth control initiation. This model could then be incorporated into an electronic health records system or other digital platform. METHODS Medical terminology, processes, and decisions were modeled in coordination with the CDC to ensure correctness. Challenges in terminology bindings were identified and categorized. RESULTS A model was successfully produced. Integration of clearly defined data elements proved to be the biggest challenge. CONCLUSION BPMN and DMN have strengths and weaknesses when modeling medical processes; however, they can be used to successfully create models for clinical pathways.
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Affiliation(s)
- Letha J. Sooter
- Department of Informatics and Networked Systems, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Steve Hasley
- American College of Obstetricians and Gynecologists, Washington, District of Columbia, United States
| | - Robert Lario
- Veterans Health Administration and University of Utah, Salt Lake City, Utah, United States
| | - Kenneth S. Rubin
- Veterans Health Administration and University of Utah, Salt Lake City, Utah, United States
| | - Faruk Hasić
- Research Centre for Information Systems Engineering, KU Leuven, Leuven, Belgium
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Szelągowski M, Berniak-Woźny J. A Process-Centered Approach to the Description of Clinical Pathways-Forms and Determinants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152638. [PMID: 31344806 PMCID: PMC6695712 DOI: 10.3390/ijerph16152638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022]
Abstract
The aim of the study is to indicate the need for variability in the presentation of clinical pathways, in various phases of their implementation, and to define the forms of presentation of clinical pathways required by physicians in both the Hospital Information Systems (HIS) and Electronic Medical Records (EMR) Systems, as well as the determinants of the selection of the forms of description, in relation to the performed medical actions. The results of the study are a significant lead-in towards further research on the required form of the user interface in systems supporting dynamic business process management (dynamic BPM). The research is a pilot of a survey study, conducted to ascertain the usefulness and feasibility of the adopted methodology, for a wider project on the determinants of the form of description of clinical pathways. An exploratory pilot survey, in a large multi-specialization hospital in Poland, was conducted. The survey sample consisted of 28 purposely selected heads of all hospital departments, and the medical team of the pediatric ward. Descriptive analysis was carried out on the data collected. The results of the study have unambiguously supported the claim that physicians require the form of presentation of clinical pathways to change, depending on the particular phase of the diagnostic–therapeutic process, as well as establishing the main determinants thereof. This pilot study is one of the first attempts to establish the factors determining the choice of clinical pathway presentation in HIS/EMR systems. While not conclusively decisive in terms of the forms of presentation or the determinants of their choice, it indicates the directions of further research, both from the point of view of ergonomics and the usability of HIS/EMR systems, as well as the management of medical knowledge, as part of the dynamic management of clinical pathways.
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Affiliation(s)
- Marek Szelągowski
- Systems Research Institute, Polish Academy of Sciences, 00-001 Warsaw, Poland
| | - Justyna Berniak-Woźny
- Faculty of Business and International Relations, Vistula University, 02-787 Warsaw, Poland.
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Litchfield I, Hoye C, Shukla D, Backman R, Turner A, Lee M, Weber P. Can process mining automatically describe care pathways of patients with long-term conditions in UK primary care? A study protocol. BMJ Open 2018; 8:e019947. [PMID: 30518578 PMCID: PMC6286474 DOI: 10.1136/bmjopen-2017-019947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/04/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In the UK, primary care is seen as the optimal context for delivering care to an ageing population with a growing number of long-term conditions. However, if it is to meet these demands effectively and efficiently, a more precise understanding of existing care processes is required to ensure their configuration is based on robust evidence. This need to understand and optimise organisational performance is not unique to healthcare, and in industries such as telecommunications or finance, a methodology known as 'process mining' has become an established and successful method to identify how an organisation can best deploy resources to meet the needs of its clients and customers. Here and for the first time in the UK, we will apply it to primary care settings to gain a greater understanding of how patients with two of the most common chronic conditions are managed. METHODS AND ANALYSIS The study will be conducted in three phases; first, we will apply process mining algorithms to the data held on the clinical management system of four practices of varying characteristics in the West Midlands to determine how each interacts with patients with hypertension or type 2 diabetes. Second, we will use traditional process mapping exercises at each practice to manually produce maps of care processes for the selected condition. Third, with the aid of staff and patients at each practice, we will compare and contrast the process models produced by process mining with the process maps produced via manual techniques, review differences and similarities between them and the relative importance of each. The first pilot study will be on hypertension and the second for patients diagnosed with type 2 diabetes. ETHICS AND DISSEMINATION Ethical approval has been provided by East Midlands-Leicester South Regional Ethics Committee (REC reference 18/EM/0284). Having refined the automated production of maps of care processes, we can explore pinch points and bottlenecks, process variants and unexpected behaviour, and make informed recommendations to improve the quality and efficiency of care. The results of this study will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ciaron Hoye
- Digital Transformation, Birmingham Solihull Clinical Commissioning Group, Birmingham, UK
| | - David Shukla
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruth Backman
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice Turner
- University Hospitals Birmingham NHS Foundation Trust and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Lee
- School of Computer Science, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK
| | - Phil Weber
- School of Engineering and Applied Science, System Analytics for Innovation, Aston University, Birmingham, UK
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Litchfield I, Turner A, Backman R, Bosco Ferreira Filho J, Lee M. Automated conflict resolution between multiple clinical pathways: a technology report. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:142-148. [PMID: 30398456 DOI: 10.14236/jhi.v25i3.986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The number of people in the UK with three or more long-term conditions continues to grow and the management of patients with co-morbidities is complex. In treating patients with multimorbidities, a fundamental problem is understanding and detecting points of conflict between different guidelines which to date has relied on individual clinicians collating disparate information. OBJECTIVE We will develop a framework for modelling a diverse set of care pathways, and investigate how conflicts can be detected and resolved automatically. We will use this knowledge to develop a software tool for use by clinicians that can map guidelines, highlight root causes of conflict between these guidelines and suggest ways they might be resolved. METHOD Our work consists of three phases. First, we will accurately model clinical pathways for six of the most common chronic diseases; second, we will automatically identify and detect sources of conflict across the pathways and howthey might be resolved. Third, we will present a case study to prove the validity of our approach using a team of clinicians to detect and resolve the conflicts in the treatment of a fictional patient with multiple common morbidities and compare their findings and recommendations with those derived automatically using our novel software. DISCUSSION This paper describes the development of an important software-based method for identifying a conflict between clinical guidelines. Our findings will support clinicians treating patients with multimorbidity in both primary and secondary care settings.
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Affiliation(s)
| | - Alice Turner
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham.
| | - Ruth Backman
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham.
| | | | - Mark Lee
- School of Computer Science, College of Engineering and Physical Sciences, University of Birmingham.
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Mincarone P, Leo CG, Trujillo-Martín MDM, Manson J, Guarino R, Ponzini G, Sabina S. Standardized languages and notations for graphical modelling of patient care processes: a systematic review. Int J Qual Health Care 2018; 30:169-177. [PMID: 29346638 DOI: 10.1093/intqhc/mzx197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022] Open
Abstract
Purpose The importance of working toward quality improvement in healthcare implies an increasing interest in analysing, understanding and optimizing process logic and sequences of activities embedded in healthcare processes. Their graphical representation promotes faster learning, higher retention and better compliance. The study identifies standardized graphical languages and notations applied to patient care processes and investigates their usefulness in the healthcare setting. Data sources Peer-reviewed literature up to 19 May 2016. Information complemented by a questionnaire sent to the authors of selected studies. Study selection Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data extraction Five authors extracted results of selected studies. Results of data synthesis Ten articles met the inclusion criteria. One notation and language for healthcare process modelling were identified with an application to patient care processes: Business Process Model and Notation and Unified Modeling Language™. One of the authors of every selected study completed the questionnaire. Users' comprehensibility and facilitation of inter-professional analysis of processes have been recognized, in the filled in questionnaires, as major strengths for process modelling in healthcare. Conclusion Both the notation and the language could increase the clarity of presentation thanks to their visual properties, the capacity of easily managing macro and micro scenarios, the possibility of clearly and precisely representing the process logic. Both could increase guidelines/pathways applicability by representing complex scenarios through charts and algorithms hence contributing to reduce unjustified practice variations which negatively impact on quality of care and patient safety.
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Affiliation(s)
- Pierpaolo Mincarone
- National Research Council of Italy, Institute for Research on Population and Social Policies, URT Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy
| | - Carlo Giacomo Leo
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.,Tufts Medical Center, Department of Medicine, 800 Washington Street, Boston, MA 02111, USA
| | - Maria Del Mar Trujillo-Martín
- Canary Foundation of Health Research, Camino Candelaria, 44 C.S. San Isidro-El Chorrillo, 38109 El Rosario, Canary Islands, Spain
| | - Jan Manson
- Scottish Medicines Consortium, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - Roberto Guarino
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy
| | - Giuseppe Ponzini
- National Research Council of Italy, Institute for Research on Population and Social Policies, URT Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy
| | - Saverio Sabina
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy
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16
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Jimenez-Molina A, Gaete-Villegas J, Fuentes J. ProFUSO: Business process and ontology-based framework to develop ubiquitous computing support systems for chronic patients' management. J Biomed Inform 2018; 82:106-127. [PMID: 29627462 DOI: 10.1016/j.jbi.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 01/20/2023]
Abstract
New advances in telemedicine, ubiquitous computing, and artificial intelligence have supported the emergence of more advanced applications and support systems for chronic patients. This trend addresses the important problem of chronic illnesses, highlighted by multiple international organizations as a core issue in future healthcare. Despite the myriad of exciting new developments, each application and system is designed and implemented for specific purposes and lacks the flexibility to support different healthcare concerns. Some of the known problems of such developments are the integration issues between applications and existing healthcare systems, the reusability of technical knowledge in the creation of new and more sophisticated systems and the usage of data gathered from multiple sources in the generation of new knowledge. This paper proposes a framework for the development of chronic disease support systems and applications as an answer to these shortcomings. Through this framework our pursuit is to create a common ground methodology upon which new developments can be created and easily integrated to provide better support to chronic patients, medical staff and other relevant participants. General requirements are inferred for any support system from the primary attention process of chronic patients by the Business Process Management Notation. Numerous technical approaches are proposed to design a general architecture that considers the medical organizational requirements in the treatment of a patient. A framework is presented for any application in support of chronic patients and evaluated by a case study to test the applicability and pertinence of the solution.
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Affiliation(s)
- Angel Jimenez-Molina
- Department of Industrial Engineering, University of Chile, Beauchef 851, Santiago 8370456, Chile.
| | - Jorge Gaete-Villegas
- Department of Industrial Engineering, University of Chile, Beauchef 851, Santiago 8370456, Chile.
| | - Javier Fuentes
- Department of Industrial Engineering, University of Chile, Beauchef 851, Santiago 8370456, Chile.
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17
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Nan S, Van Gorp P, Lu X, Kaymak U, Korsten H, Vdovjak R, Duan H. A meta-model for computer executable dynamic clinical safety checklists. BMC Med Inform Decis Mak 2017; 17:170. [PMID: 29233155 PMCID: PMC5727863 DOI: 10.1186/s12911-017-0551-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/19/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Safety checklist is a type of cognitive tool enforcing short term memory of medical workers with the purpose of reducing medical errors caused by overlook and ignorance. To facilitate the daily use of safety checklists, computerized systems embedded in the clinical workflow and adapted to patient-context are increasingly developed. However, the current hard-coded approach of implementing checklists in these systems increase the cognitive efforts of clinical experts and coding efforts for informaticists. This is due to the lack of a formal representation format that is both understandable by clinical experts and executable by computer programs. METHODS We developed a dynamic checklist meta-model with a three-step approach. Dynamic checklist modeling requirements were extracted by performing a domain analysis. Then, existing modeling approaches and tools were investigated with the purpose of reusing these languages. Finally, the meta-model was developed by eliciting domain concepts and their hierarchies. The feasibility of using the meta-model was validated by two case studies. The meta-model was mapped to specific modeling languages according to the requirements of hospitals. RESULTS Using the proposed meta-model, a comprehensive coronary artery bypass graft peri-operative checklist set and a percutaneous coronary intervention peri-operative checklist set have been developed in a Dutch hospital and a Chinese hospital, respectively. The result shows that it is feasible to use the meta-model to facilitate the modeling and execution of dynamic checklists. CONCLUSIONS We proposed a novel meta-model for the dynamic checklist with the purpose of facilitating creating dynamic checklists. The meta-model is a framework of reusing existing modeling languages and tools to model dynamic checklists. The feasibility of using the meta-model is validated by implementing a use case in the system.
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Affiliation(s)
- Shan Nan
- School of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China.,School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Pieter Van Gorp
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Xudong Lu
- School of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China. .,School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Uzay Kaymak
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hendrikus Korsten
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Anesthesiology and Intensive Care, Catharina Ziekenhuis in Eindhoven, Eindhoven, The Netherlands
| | | | - Huilong Duan
- School of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
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18
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Combi C, Oliboni B, Zardini A, Zerbato F. A Methodological Framework for the Integrated Design of Decision-Intensive Care Pathways-an Application to the Management of COPD Patients. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2017; 1:157-217. [PMID: 35415395 PMCID: PMC8982764 DOI: 10.1007/s41666-017-0007-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 12/23/2022]
Abstract
Healthcare processes are by nature complex, mostly due to their multidisciplinary character that requires continuous coordination between care providers. They encompass both organizational and clinical tasks, the latter ones driven by medical knowledge, which is inherently incomplete and distributed among people having different expertise and roles. Care pathways refer to planning and coordination of care processes related to specific groups of patients in a given setting. The goal in defining and following care pathways is to improve the quality of care in terms of patient satisfaction, costs reduction, and medical outcome. Thus, care pathways are a promising methodological tool for standardizing care and decision-making. Business process management techniques can successfully be used for representing organizational aspects of care pathways in a standard, readable, and accessible way, while supporting process development, analysis, and re-engineering. In this paper, we introduce a methodological framework that fosters the integrated design, implementation, and enactment of care processes and related decisions, while considering proper representation and management of organizational and clinical information. We focus here and discuss in detail the design phase, which encompasses the simulation of care pathways. We show how business process model and notation (BPMN) and decision model and notation (DMN) can be combined for supporting intertwined aspects of decision-intensive care pathways. As a proof-of-concept, the proposed methodology has been applied to design care pathways related to chronic obstructive pulmonary disease (COPD) in the region of Veneto, in Italy.
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Affiliation(s)
- Carlo Combi
- Department of Computer Science, University of Verona, Strada Le Grazie, 15, 37134 Verona, Italy
| | - Barbara Oliboni
- Department of Computer Science, University of Verona, Strada Le Grazie, 15, 37134 Verona, Italy
| | - Alessandro Zardini
- Department of Business Economics, University of Verona, Via Cantarane, 24, 37129 Verona, Italy
| | - Francesca Zerbato
- Department of Computer Science, University of Verona, Strada Le Grazie, 15, 37134 Verona, Italy
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19
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Ruiz-Fernández D, Marcos-Jorquera D, Gilart-Iglesias V, Vives-Boix V, Ramírez-Navarro J. Empowerment of Patients with Hypertension through BPM, IoT and Remote Sensing. SENSORS 2017; 17:s17102273. [PMID: 28976940 PMCID: PMC5677452 DOI: 10.3390/s17102273] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/28/2017] [Accepted: 10/01/2017] [Indexed: 12/02/2022]
Abstract
Hypertension affects one in five adults worldwide. Healthcare processes require interdisciplinary cooperation and coordination between medical teams, clinical processes, and patients. The lack of patients’ empowerment and adherence to treatment makes necessary to integrate patients, data collecting devices and clinical processes. For this reason, in this paper we propose a model based on Business Process Management paradigm, together with a group of technologies, techniques and IT principles which increase the benefits of the paradigm. To achieve the proposed model, the clinical process of the hypertension is analyzed with the objective of detecting weaknesses and improving the process. Once the process is analyzed, an architecture that joins health devices and environmental sensors, together with an information system, has been developed. To test the architecture, a web system connected with health monitors and environment sensors, and with a mobile app have been implemented.
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Affiliation(s)
| | | | | | - Víctor Vives-Boix
- Department of Computer Technology, University of Alicante, 03690 Alicante, Spain.
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20
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Yan H, Van Gorp P, Kaymak U, Lu X, Ji L, Chiau CC, Korsten HHM, Duan H. Aligning Event Logs to Task-Time Matrix Clinical Pathways in BPMN for Variance Analysis. IEEE J Biomed Health Inform 2017; 22:311-317. [PMID: 28922133 DOI: 10.1109/jbhi.2017.2753827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical pathways (CPs) are popular healthcare management tools to standardize care and ensure quality. Analyzing CP compliance levels and variances is known to be useful for training and CP redesign purposes. Flexible semantics of the business process model and notation (BPMN) language has been shown to be useful for the modeling and analysis of complex protocols. However, in practical cases one may want to exploit that CPs often have the form of task-time matrices. This paper presents a new method parsing complex BPMN models and aligning traces to the models heuristically. A case study on variance analysis is undertaken, where a CP from the practice and two large sets of patients data from an electronic medical record (EMR) database are used. The results demonstrate that automated variance analysis between BPMN task-time models and real-life EMR data are feasible, whereas that was not the case for the existing analysis techniques. We also provide meaningful insights for further improvement.
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21
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Kriegel J, Tuttle-Weidinger L, Schiefer L, Schwarz S. Management of support processes in Austrian hospitals: Integrated network of primary care processes and support processes. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1343759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johannes Kriegel
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Linda Tuttle-Weidinger
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Lisa Schiefer
- Department of Anesthesiology and Perioperative Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Stefan Schwarz
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
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22
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Supporting the Refinement of Clinical Process Models to Computer-Interpretable Guideline Models. BUSINESS & INFORMATION SYSTEMS ENGINEERING 2016. [DOI: 10.1007/s12599-016-0443-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Percival J, McGregor C. An Evaluation of Understandability of Patient Journey Models in Mental Health. JMIR Hum Factors 2016; 3:e20. [PMID: 27471006 PMCID: PMC4981695 DOI: 10.2196/humanfactors.5640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/01/2016] [Accepted: 07/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. OBJECTIVES This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. METHOD Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. RESULTS The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. CONCLUSIONS The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot case study to a more diversified group of clinicians and health care support workers.
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Affiliation(s)
- Jennifer Percival
- University of Ontario Institute of Technology, Faculty of Business and Information Technology, Oshawa, ON, Canada.
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24
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Kaiser K, Marcos M. Leveraging workflow control patterns in the domain of clinical practice guidelines. BMC Med Inform Decis Mak 2016; 16:20. [PMID: 26863868 PMCID: PMC4748513 DOI: 10.1186/s12911-016-0253-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) include recommendations describing appropriate care for the management of patients with a specific clinical condition. A number of representation languages have been developed to support executable CPGs, with associated authoring/editing tools. Even with tool assistance, authoring of CPG models is a labor-intensive task. We aim at facilitating the early stages of CPG modeling task. In this context, we propose to support the authoring of CPG models based on a set of suitable procedural patterns described in an implementation-independent notation that can be then semi-automatically transformed into one of the alternative executable CPG languages. METHODS We have started with the workflow control patterns which have been identified in the fields of workflow systems and business process management. We have analyzed the suitability of these patterns by means of a qualitative analysis of CPG texts. Following our analysis we have implemented a selection of workflow patterns in the Asbru and PROforma CPG languages. As implementation-independent notation for the description of patterns we have chosen BPMN 2.0. Finally, we have developed XSLT transformations to convert the BPMN 2.0 version of the patterns into the Asbru and PROforma languages. RESULTS We showed that although a significant number of workflow control patterns are suitable to describe CPG procedural knowledge, not all of them are applicable in the context of CPGs due to their focus on single-patient care. Moreover, CPGs may require additional patterns not included in the set of workflow control patterns. We also showed that nearly all the CPG-suitable patterns can be conveniently implemented in the Asbru and PROforma languages. Finally, we demonstrated that individual patterns can be semi-automatically transformed from a process specification in BPMN 2.0 to executable implementations in these languages. CONCLUSIONS We propose a pattern and transformation-based approach for the development of CPG models. Such an approach can form the basis of a valid framework for the authoring of CPG models. The identification of adequate patterns and the implementation of transformations to convert patterns from a process specification into different executable implementations are the first necessary steps for our approach.
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Affiliation(s)
- Katharina Kaiser
- Institute of Creative Media Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
- Institute of Software Technology & Interactive Systems, Vienna University of Technology, Vienna, Austria
| | - Mar Marcos
- Department of Computer Engineering and Science, Universitat Jaume I, Castellón, Spain
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25
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Using Semantic Components to Represent Dynamics of an Interdisciplinary Healthcare Team in a Multi-Agent Decision Support System. J Med Syst 2015; 40:42. [DOI: 10.1007/s10916-015-0375-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
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26
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Perer A, Wang F, Hu J. Mining and exploring care pathways from electronic medical records with visual analytics. J Biomed Inform 2015; 56:369-78. [PMID: 26146159 DOI: 10.1016/j.jbi.2015.06.020] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/13/2015] [Accepted: 06/26/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In order to derive data-driven insights, we develop Care Pathway Explorer, a system that mines and visualizes a set of frequent event sequences from patient EMR data. The goal is to utilize historical EMR data to extract common sequences of medical events such as diagnoses and treatments, and investigate how these sequences correlate with patient outcome. MATERIALS AND METHODS The Care Pathway Explorer uses a frequent sequence mining algorithm adapted to handle the real-world properties of EMR data, including techniques for handling event concurrency, multiple levels-of-detail, temporal context, and outcome. The mined patterns are then visualized in an interactive user interface consisting of novel overview and flow visualizations. RESULTS We use the proposed system to analyze the diagnoses and treatments of a cohort of hyperlipidemic patients with hypertension and diabetes pre-conditions, and demonstrate the clinical relevance of patterns mined from EMR data. The patterns that were identified corresponded to clinical and published knowledge, some of it unknown to the physician at the time of discovery. CONCLUSION Care Pathway Explorer, which combines frequent sequence mining techniques with advanced visualizations supports the integration of data-driven insights into care pathway discovery.
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Affiliation(s)
- Adam Perer
- IBM T.J. Watson Research Center, 1101 Kitchawan Road, P.O. Box 218, Yorktown Heights, NY 10598, USA.
| | - Fei Wang
- University of Connecticut, Storrs, CT, USA
| | - Jianying Hu
- IBM T.J. Watson Research Center, 1101 Kitchawan Road, P.O. Box 218, Yorktown Heights, NY 10598, USA
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27
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Kenngott HG, Wagner M, Nickel F, Wekerle AL, Preukschas A, Apitz M, Schulte T, Rempel R, Mietkowski P, Wagner F, Termer A, Müller-Stich BP. Computer-assisted abdominal surgery: new technologies. Langenbecks Arch Surg 2015; 400:273-81. [PMID: 25701196 DOI: 10.1007/s00423-015-1289-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Computer-assisted surgery is a wide field of technologies with the potential to enable the surgeon to improve efficiency and efficacy of diagnosis, treatment, and clinical management. PURPOSE This review provides an overview of the most important new technologies and their applications. METHODS A MEDLINE database search was performed revealing a total of 1702 references. All references were considered for information on six main topics, namely image guidance and navigation, robot-assisted surgery, human-machine interface, surgical processes and clinical pathways, computer-assisted surgical training, and clinical decision support. Further references were obtained through cross-referencing the bibliography cited in each work. Based on their respective field of expertise, the authors chose 64 publications relevant for the purpose of this review. CONCLUSION Computer-assisted systems are increasingly used not only in experimental studies but also in clinical studies. Although computer-assisted abdominal surgery is still in its infancy, the number of studies is constantly increasing, and clinical studies start showing the benefits of computers used not only as tools of documentation and accounting but also for directly assisting surgeons during diagnosis and treatment of patients. Further developments in the field of clinical decision support even have the potential of causing a paradigm shift in how patients are diagnosed and treated.
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Affiliation(s)
- H G Kenngott
- Department of General, Abdominal and Transplant Surgery, Ruprecht-Karls-University, Heidelberg, Germany
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Barzdins J, Barzdins J, Rencis E, Sostaks A. Graphical modeling and query language for hospitals. Health Inf Sci Syst 2013; 1:14. [PMID: 25825664 PMCID: PMC4340803 DOI: 10.1186/2047-2501-1-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND So far there has been little evidence that implementation of the health information technologies (HIT) is leading to health care cost savings. One of the reasons for this lack of impact by the HIT likely lies in the complexity of the business process ownership in the hospitals. The goal of our research is to develop a business model-based method for hospital use which would allow doctors to retrieve directly the ad-hoc information from various hospital databases. METHODS We have developed a special domain-specific process modelling language called the MedMod. Formally, we define the MedMod language as a profile on UML Class diagrams, but we also demonstrate it on examples, where we explain the semantics of all its elements informally. Moreover, we have developed the Process Query Language (PQL) that is based on MedMod process definition language. The purpose of PQL is to allow a doctor querying (filtering) runtime data of hospital's processes described using MedMod. RESULTS The MedMod language tries to overcome deficiencies in existing process modeling languages, allowing to specify the loosely-defined sequence of the steps to be performed in the clinical process. The main advantages of PQL are in two main areas - usability and efficiency. They are: 1) the view on data through "glasses" of familiar process, 2) the simple and easy-to-perceive means of setting filtering conditions require no more expertise than using spreadsheet applications, 3) the dynamic response to each step in construction of the complete query that shortens the learning curve greatly and reduces the error rate, and 4) the selected means of filtering and data retrieving allows to execute queries in O(n) time regarding the size of the dataset. CONCLUSIONS We are about to continue developing this project with three further steps. First, we are planning to develop user-friendly graphical editors for the MedMod process modeling and query languages. The second step is to do evaluation of usability the proposed language and tool involving the physicians from several hospitals in Latvia and working with real data from these hospitals. Our third step is to develop an efficient implementation of the query language.
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Affiliation(s)
- Janis Barzdins
- Institute of Mathematics and Computer Science, University of Latvia, Riga, Latvia
| | - Juris Barzdins
- Institute of Mathematics and Computer Science, University of Latvia, Riga, Latvia ; Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Edgars Rencis
- Institute of Mathematics and Computer Science, University of Latvia, Riga, Latvia
| | - Agris Sostaks
- Institute of Mathematics and Computer Science, University of Latvia, Riga, Latvia
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