Vojtech Huser: spring AMIA conference: representing clinical processes in XPDL

• 1. Representing clinical processes in XML process definition language (XPDL) Vojtech Huser, MD, PhD Luke Rasmussen Justin Starren, MD, PhD

2. Why represent processes?

• Processes (sequence of events or steps) are important in modeling many healthcare problems

• • Clinical guidelines

• • Quality improvement

• • Research

3. Background

• Workflow patterns 1

• • Evaluation of clinical guidelines formalisms 2

• Reports on use of workflow technology in healthcare 3

• • Administrative processes

• • Clinical processes (QI, DSS)

• Cross-industry use of Business Process Management Systems 4

1 Russel (2006), Wohed (2007) 2 Peleg (2007), Mulyar(2007)3 Haux (2003), Emanuelle (2007), Koetter (2007), Hess (2007), Panzarasa (2007), Quaglini (2000,2001,2008)4 WfMC handbook (2001-2007) ProHealth 2008 ProHealth 2007 4. What is XPDL?

• XPDL= X MLP rocessD efinitionL anguage

• Standard in workflow technology (Business Process Management = BPM)

• Workflow:The automation of a business process where information or tasks are passed from one participant to another for action, according to a set of procedural rules

• Process definition:A network of activities and their relationships, criteria to indicate the start and termination of the process, and information about the individual activities, such as participants, associated IT applications and data, etc.

5. Larger context of our work

• Integrate a workflow engine into an EHR system

• • Customize the functionality using process flowcharts

• • Empower non-programmers to manage knowledge

• RetroGuide project

• • Retrospective analysis of data using executable graphical flowchart

• Process mining research

Huser (2006, 2007, 2008, 2009)Haux(2003) RetroGuide 6. Work presented today

• Key question:

• • How robust are XPDL-compliant workflow editors in modeling clinical processes?

• Specific focus:

• • Representing algorithmic knowledge

• • No human process activities

• • • process consisting of steps for a robot who analyses EHR data

• • Both retrospective and prospective mode

7. 8. Example of execution 0.9% of patients with high risk patients with subsequent MI 9. Example of execution 10. Example of execution 11. Editors tested

• Vendors

• • Enhydra workflow editor

• • Tibco

• • MS Visio with an XPDL plugin (Capevision)

• Features

• • Non-expert view of a process

• • Flowcharting conventions

• • Implementation of the XPDL standard

12. 1. MS Visio 13. 1. MS Visio 14. Two abnormal eGFR at least 90 days apart and no normal ones in between 15. 2. Enhydra Editor Engine 16. 3. Tibco 17. Flowcharting differences Enhydra 18. Flowcharting differences Tibco 19. Results/Conclusions

• Process definition languages represent a valid alternative to healthcare specific standards

• Processes defined in XPDL can be shared across institutions

• • • • WfMC Compatibility levels

• Several competing software workflow suites exist on the market

20. Results/Conclusions

• Differences in graphical representation of different XPDL features

21. Thank you for you attention

• Questions ?

• Additional information:

• • http://healthcareworkflow.wordpress.com

• • Slides:http://www.linkedin.com/in/vojtechhuser

• Our previous related publications:

• • http://healthcareworkflow.wordpress.com/publications