A UML Approach to Process Modelling of Clinical Practice Guidelines for Enactment

1
A UML Approach to Process Modelling of Clinical
Practice Guidelinesfor Enactment
HISI Annual Conference, Stillorgan, 14. November
2002.
2
What is this presentation about?

• Use of the Unified Modelling Language (UML)
• Why? widely accepted within IT industry,
  supports process modelling
• Standardised and maintained by independent body
  (OMG)

A UML Approachto Process Modelling
of Clinical Practice Guidelinesfor
Enactment

• Why? - Guidelines are considered as
  recommendations
• for repeating processes in clinical settings
• Access to experience of process modelling
  research
• community business process modelling and
• reengineering

• Enactable Clinical Practice Guidelines (eCPGs)
• Enactment is execution of process steps
  according to the process
• model instance
• eCPGs combine clinical knowledge from guidelines
  with
• organisational knowledge

3
2 Phases of Guideline Enactment
Execution of Guideline Processes in
WMS (Enactment)
Design of Formal Guideline Process Models
Prototype demonstration in workshop yesterday
Focus of this presentation
WMS Workflow Management System
4
Outline

• Introduction
• - Motivation for Guidelines
• - Different Modelling Methodologies for
  Guidelines
• Concept of Workflow
• Different Stages in Modelling eCPGs
• Modelling of eCPGs
• - Requirements of eCPGs
• - Requirements of a Modelling Language
• - UML
• - Business Process Modelling
• - Process Modelling Elements
• Sample eCPG on Diabetes Mellitus
• Summary

5
Introduction Motivation for Guidelines
Clinical Practice Guidelines can

• Ensure and improve quality of healthcare
• Recommended strategies for managing healthcare in
  specific clinical circumstances
• Evidence-based best practice
• Reduce inappropriate variations in clinical
  practice,
• Medical education

Enacted automated Clinical Guidelines
additionally can

• Reduce healthcare costs
• Business Process (BP) optimisation through
  automation (improve process efficiency)
• Alerts and reminders
• Automated case management

However

• Healthcare organisations typically pay more
  attention to guideline development than to
  guideline implementation for routine use in
  clinical settings
• (Audet, A., Greenfield, S., Field, M. Medical
  Practice Guidelines, 1990)

6
Introduction Different Modelling Methodologies
for Guidelines

• Different Ways to Modelling Processes of CPGs
• Disease state maps
• Plans
• Workflow specifications
• MediLink Objective
• Coordination of tasks that occur in clinical
  environments by process modelling and enactment
  and using knowledge about clinical processes
  encapsulated in CPGs (use of workflow technology)
• Allow clinicians to author guideline process in a
  high-level graphical notation

7
What is Workflow? (1/2)
Source Leymann, Production Workflow, 2000.

• A workflow is a business process in execution (an
  instance of a process model) in a computing
  environment

8
What is Workflow? (2/2)

• Order of process steps is managed by control flow
  (sequencing of actions)
• Information resources for activities is provided
  by data flow
• Both data flow and control flow need to be
  modelled in a process model !!!
• Furthermore
• Overall Process Monitoring/Management

9
Is Workflow the Solution for all Situations?

• No
• Only if there are
• Highly structured activities
• Determining rules, logical transactions between
  activities
• Digital information resources
• if explicit control of allocation of work is
  reqd (best practice, repeating procedures)

10
Different Stages in Modelling eCPGs
Kind of CPG representation
Formal Graphical
Formal Textual
Formal Rules
Narrative
XMI Format
Plain English on paper or electronic file
UML Notation
XML Format
Format
UML Tool e.g. Poseidon (free) Rose
(commercial) TogetherJ (commercial)
Transformation Tool e.g. Xalan (free)
Necessary software
Flowchart (clinician) UML (developer)
XSLT- programming (developer)
Necessary skills
11
Requirements of eCPGs

• Must have a formal model (precise and
  unambiguous)
• Must include explicit control and data flow
• Human readable
• Sharable
• Adaptable to different settings (with use of
  organisational knowledge)
• integrable

12
Requirements of a Modelling Language for eCPGs

• Support 4 main primitives
• Actions
• Decisions
• Patient states
• Execution states
• Scheduling constraints
• Sequential ordering of actions
• Concurrency
• Iterations
• Support nested guidelines

13
Business Process Modelling in UML

• Supports concepts of control and data flow in
  form of activity diagrams
• Supports data modelling of information resources
  in form of class diagrams
• Modelling of activities, decisions, patient
  states, execution states
• UML control flow includes sequential order,
  concurrency, iterations.
• Nested activity diagrams are supported.

14
UML Process Modelling Elements
15
Part of our eCPG on Diabetes Mellitus (1/2)
16
Part of our eCPG on Diabetes Mellitus(2/2)
17
Summary

• eCPGs can be modelled with mainstream
  standardised technology
• - UML, XMI, XML
• - leveraging new technological developments
• Aspects of control and data flow important for
  enactment need to be integrated in eCPGs
• eCPGs must be human readable
• Using standardised technologies eCPGs become
  sharable (reusable) for many institutions

18
Where to Get More Information
Thank you !
Any Questions ?