Post on 16-Jan-2016
Introduction to workflow technology Representation of healthcare
processes in a workflow editor and their execution in a workflow engine
Vojtech Huser MD PhD
AMIA NOW, Small Group session, Tutorial (1hr)
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Agenda Part 1: Introduction, history, overview Part 2: Standards, SDO, related
theories Part 3: Practical tools demonstration
Originally 2 hour workshop converted to 1 hour tutorial (with focus on introduction and
standards) Accompanying bibliography document
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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
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB
screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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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
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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Workflow technology BPM = business process management Adaptive workflow (Adaptive Case
Management) Computer supported collaborative
work (CSCW) Why workflow?
Separation of data into databases Separation of UI from IT system core Separation of process knowledge
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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 dispatch-patrol activity and the inform-police activity immediately.
Exclusive Choice: After the review election activity is complete, either the declare results or the recount votes activity is undertaken.
Multi Choice: Depending on the nature of the emergency call, one or more of the despatch-police, despatch-fire-engine and despatch-ambulance activities is immediately initiated.
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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
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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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
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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Automating Workflow Defined by Workflow Management
Coalition (WfMC) www.wfmc.org
Terminology and Glossary http://www.wfmc.org/standards/docs/TC-
1011_term_glossary_v3.pdf
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Terms Workflow
The automation of a business process, in whole or part, during which documents, information or tasks are passed from one participant to another for action, according to a set of procedural rules.
WfMS = Workflow Management System
BPM = Business Process Management BPMS = Business Process Management System
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Humans & machines working together
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Executable flowchart
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Worklist
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Minimum componentslanguage 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
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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WT benefits 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
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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Choice of Wf vendor Major player
TIBCO BEA Global 360 IBM
Other Fujitsu IBM Oracle Microsoft SAP Lombardi
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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 technology
prior 1960s-1980s development after 1990
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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Use of WT Pioneer domains
Banking Manufacturing Shipping Government authorities Pharmaceutical
Healthcare Gartner 2008 report: <5% use
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Examples of WT use in healthcare
Bed managementInfections control (MRSA)
J. Emanuele and L. Koetter, "Workflow Opportunities and Challenges in Healthcare," in 2007 BPM & Workflow Handbook, 2007.
L. Koetter, "MRSA infection control with workflow technology," Spring AMIA Conference, Orlando, FL, 2007.
R. Hess, "The Chester County Hospital: Case Study," in 2007 Excellence in Practice: Moving the Goalposts., 2007.
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Stroke guideline (WfMS)
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Soarian
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Current Soarian Example
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Use at Marshfield Clinic
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HealthFlow: RetroGuide, FlowGuide
HealthcareWorkflow.wordpress.com
EHR system
Event Listener
Notifications
Actions
Knowledge Base(workflow process
definitions)
Data Inquiry
Workflow Execution
Engine(Shark)
EHR System layer:
Prospective mode (FlowGuide):
Retrospective mode(RetroGuide):
Reports
Data Warehouse
Workflow mining(ProM)
Workflow editor(JaWE)
Data Visualization
Additional Components:
Event Data Model
Ontology Model
Host EHR Passive Interaction Model
Host EHR Active Interaction Model
Additional External Services(Terminology services, NLP services,
Statistical Analysis)
Workflow log analysis
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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
Components of workflow technology (process definition, execution engine, analytical components)
Benefits of implementing a workflow server within a generic IT system
Major workflow vendors and open-source workflow technology tools
Workflow Technology applied industries and healthcare
Future development and research challenges
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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 consolidation 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
informationcentric
process centric
structuredprocess
unstructuredprocess
computer-supported collaborative work
ad-hoc workflow
production workflow
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Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
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Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
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WfMC Started in 1990 5 interfaces XPDL 1.0, 2.0, 2.1 Yearly Workflow handbook
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Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
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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.
Workflow Process = A set of one or more linked procedures or activities which collectively realize a business objective or policy goal, normally within the context of an organizational structure defining functional roles and relationships (definition vs. instance)
Worklist Handler = A software component that manages the interaction between the user and the worklist maintained by a workflow engine (task display, completion, acceptance, referral)
WfMC: Terminology & Glossary, Document Number WFMC-TC-1011, Feb 99 http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74
HealthcareWorkflow.wordpress.com
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Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language
(XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
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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
Exchange format links
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Standards Timeline
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Example.xpdl
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Process Schema
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Activities
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Activities
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Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
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WT standards Historical
BPEL, WSDL Current major
XPDL, BPMN, BPEL Proprietary (vendor specific):
JBPM (JBoss) T2Flow->SCUFL2 (Taverna), internal format (Weka) Win Workflow Foundation (Microsoft)
Research ones YAWL
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Part 2: WT standards, SDOs, related theories
Workflow management coalition’s (WfMC) standards
Definition of WT terms XML process definition language (XPDL) Other standardization efforts
Business Process Execution Language (BPEL) Business Process Modeling Notation (BPMN) Research-originated WT standards
Petri Nets theory and its relationship to workflows
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Petri net consist two types of nodes: places and transitions.
A place may have zero or more tokens.
Graphic representations :Places (circles), transitions (bars), arcs (arrows), and tokens (dots)
p2 p1
t1
Petri Nets
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Definition of Petri Net C = ( P, T, I, O)
PlacesP = { p1, p2, p3, …, pn}
TransitionsT = { t1, t2, t3, …, tn}
Input I : T Pr (r = number of places)
OutputO : T Pq (q = number of places)
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Vector of places’ states Below is an example Petri net with two
places and one transaction. Transition node is ready to fire if and
only if there is at least one token at each of its input places
state transition of form (1, 0) (0, 1)p1 : input place p2: output place
p2 p1
t1
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Properties of PNs Sequential
Execution
Synchronization two tokens needed
Merging two tokens reduce to one
p2
t1
p1 p3
t2
t1
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Properties of Petri Nets
Conflictt1 and t2 are both ready to fire but the firing of any leads to the disabling of the other transitions.
t1
t2
t1
t2
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB
screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB
screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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Together workflow suite Editor
JaWE Together Workflow Editor (TWE) v1.4, v2, v3
Engine Shark Together Workflow Engine
(TWS) Web-based module Integration with Outlook
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Demo
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB
screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB
screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB
screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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Log schema
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB
screening, Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software
Case studies of use in healthcare/informatics research Workflow engines and Decision support engines
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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:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data
Brief overview of other workflow technology software Case studies of use in healthcare/informatics
research Workflow engines and Decision support engines
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Use case studies Marshfield Clinic MainLine Health U of Pavia Einthoven University (NL)
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Part 3: Practical tools demos Demo of an editor and engine Example 1:
Representing a surgical procedure, discharge and RCT trial enrolment process
Example 2: Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine) Process mining tool (ProM) Example 3:
Mining a progression of a chronic kidney disease from EHR data Brief overview of other workflow technology software Case studies of use in healthcare/informatics research Workflow engines and Decision support engines
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WT and DSS Clear overlap
Many decision support engines have workflow features Many workflow engines have decision support features
Published case studies of use of WT for decision support
Related work Peleg at al.
Guidelines and workflow models Design Patterns of Clinical Guidelines (2010) (Bonita wf
editor) Mulyar at al.
Comparison of Guidelines formalisms and workflow patterns
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GLIF guideline
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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 Part 2: Standards Part 3: Tools demonstration
Cross-industry modeling and execution platformwith growing vendor and tool base and healthcare use examples
http://healthcareworkflow.wordpress.com huser.vojtech@marshfieldclinic.org
informationcentric
process centric
structuredprocess
unstructuredprocess
computer-supported collaborative work
ad-hoc workflow
production workflow
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Questions ?
http://healthcareworkflow.wordpress.com huser.vojtech@marshfieldclinic.org
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