Francesca Zerbato

Seamless Design of Decision-Intensive Care Pathways

Healthcare processes are intrinsically complex and multidisciplinary. In order to maintain acceptable levels of assistance quality, reduce costs and limit the variability of medical practice outcomes, care provision plans must rely on structured and standard procedures. Business process modeling suitably responds to the need for a clear, iterative and comprehensible design approach for care assistance paths, as it fosters workload organization, coordination among participants and resource sharing. Moreover, the integrated modeling of process-related decisions enhances flexible information management, improving re-engineering and adaptability of healthcare delivery plans. In this paper, we propose an integrated approach to deal with healthcare processes and related decision-making design, in order to support the development and re-engineering of diagnostic-therapeutic care pathways and to enhance the (re)-use of clinical information. Such approach is based on BPMN 2.0 and the new DMN 1.0 formalism, developed under the OMG umbrella. Moreover, we apply the proposed methodology to the management of patients affected by Chronic Obstructive Pulmonary Disease in the region of Veneto, in north-eastern Italy.

BPMN-Based Representation and Comparison of Clinical Pathways for Catheter-Related Bloodstream Infections

Healthcare processes require continuous support in order to face the increasing demand for optimal quality of care and to provide a sound basis for integrating different sources of medical knowledge. A very important issue to consider in the medical domain is the fact that clinical process activities intertwine with data, and thus, process-oriented information systems play a crucial role in healthcare management. Business-process modeling techniques can successfully be applied in order to represent clinical pathways and guidelines in a standardized way, by giving a more understandable high-level description of evidence-based medical practice. In this paper, we address (i) the representation of clinical pathways by means of conceptual process models, and (ii) by considering process-related information. Moreover, (iii) we apply our methodology to the modeling of two clinical pathways for catheter-related bloodstream infections adopted in two different hospitals in Europe and U.S., respectively, and (iv) we take advantage of the application of our approach for comparing the resulting processes at a higher level of abstraction.

Modeling and handling duration constraints in BPMN 2.0

When dealing with business processes, modeling and managing temporal aspects, either properties or constraints, is crucial. In this paper, we propose a set of structured BPMN process diagrams for specifying duration constraints at different levels of abstraction, starting from BPMN atomic tasks and up to consider the duration of selected process sub-regions. Moreover, we suggest suitable techniques for addressing their violation at process run-time.

Conceptual modeling of inter-dependencies between processes and data

The connection between business processes and data has drawn the attention of many research efforts within the community of business process management. In traditional activity-centric process models, representing how process activities access the information organized in a data model is a challenging task. Accordingly, a conceptual model that combines process and data aspects is still missing. In this paper, we propose an approach for supporting the integrated conceptual modeling of business processes and related data. We devise the concept of activity view to capture relevant aspects of data operations performed by process activities. Then, we show how such new representation allows the evaluation of consistency between different data operations, with the goal of detecting possible data modeling flaws at design time.

A Process-Oriented Approach for Supporting Clinical Decisions for Infection Management

Clinical practice guidelines have proven to be a powerful means for improving and standardizing healthcare assistance and patient outcome. Despite the recent increase in their diffusion and the advances made towards their automation, most clinicians do not use guidelines at the point of care in their daily practice. Indeed, clinical decision support systems are often retrospective and complicated to use. To promote the extraction and use of the process-oriented knowledge encoded in clinical guidelines, we propose to seamlessly integrate different techniques in order to incorporate procedural and medical knowledge into an existing clinical decision support system. In detail, we employ the BPMN and DMN process and decision modeling standards to model certain critical parts of selected guidelines. The obtained diagrams are combined with production rules to measure the current progress of clinical practice with respect to the steps outlined in the guideline and to provide contextualized clinical decision support. Moreover, we introduce a timeline view of medical activities to foster both the planning of future care steps and the adaptation of the guideline to the needs of an individual patient. In this paper, we describe the novelties introduced in a clinical decision support system capable of visualizing guideline progress and of supporting clinical decisions in the context of antimicrobial stewardship programs.

Towards Dynamic Duration Constraints for Therapy and Monitoring Tasks

Duration constraints are among the most subtle and important aspects of clinical practice. When designing healthcare processes, it is important to incorporate such constraints into process diagrams and to provide suitable mechanisms for managing their violations during process run-time. Nonetheless, the Business Process Model and Notation (BPMN 2.0) fails in providing proper support for duration constraint modeling. In this paper, we propose a set of BPMN patterns to foster the modeling and management of shifted duration, that constitutes an unexplored kind of duration constraints, recurrent in medical practice. Specifically, this constraint is suitable for dealing with the real-time adjustments required by pharmacological therapies and monitoring tasks.

A Logical Formalization of Time-Critical Processes with Resources

Checking time-critical properties of concurrent process instances having a finite amount of allocated resources is a challenging task. Modelling and understanding at design time the interactions of concurrent activities along the time line can become quite cumbersome, even for expert designers. In this paper, we consider processes that are composed of activities having a constrained duration and a bounded number of allocated resources, and we rely on a well-studied first order formalism, called Open image in new window , to model and verify the interdependencies among multiple and concurrent process instances. Then, we show the expressiveness of our approach by describing the temporal properties that may be expressed through it. Throughout all the paper, we refer to a real clinical scenario to motivate our approach and showcase its expressiveness.

Conceptual Modeling of Processes and Data: Connecting Different Perspectives

Business processes constantly generate, manipulate, and consume data that are managed by organizational databases. Despite being central to process modeling and execution, the link between processes and data is often handled by developers when the process is implemented, thus leaving the connection unexplored during the conceptual design. In this paper, we introduce, formalize, and evaluate a novel conceptual view that bridges the gap between process and data models, and show some kinds of interesting insights that can be derived from this novel proposal.

A Decision Support Visualization Tool for Infection Management Based on BMPN and DMN

The interdisciplinary team of an Antimicrobial Stewardship Program is indispensable to preserve the antibiotic utility and avoid resistance in a hospital. One key duty of this team is the administration behaviour surveillance, which is a complex and tedious issue.