Abstract
Clinical guidelines contain recommendations on the appropriate management of patients with specific clinical conditions. A prerequisite for using clinical guidelines in information systems is to encode them in a Computer-Interpretable Guideline (CIG) language. However, this is a difficult and demanding task, usually done by IT staff. The goal of the paper is to facilitate the encoding of clinical guidelines in CIG languages, while increasing the involvement of clinicians. To achieve this, it is proposed to support the refinement of guideline processes from a preliminary specification in a business process language to a detailed implementation in one of the available CIG languages. The approach relies on the use of the Business Process Model and Notation (BPMN) for the specification level, a CIG language for the implementation level, and on algorithms to semi-automatically transform guideline models in BPMN into the CIG language of choice. As a first step towards the implementation of the approach, in this work algorithms are implemented to transform a BPMN specification of clinical processes into the PROforma CIG language, and are successfully applied to several clinical guidelines.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Notes
http://www.jdom.org/docs/apidocs/org/jdom2/input/SAXBuilder.html. Accessed 13 June 2013.
References
Bae J, Bae H, Kang SH, Kim Y (2004) Automatic control of workflow processes using ECA rules. IEEE Trans Knowl Data Eng 16(8):1010–1023
Boxwala AA, Tu S, Peleg M, Zeng Q, Ogunyemi O, Greenes RA, Shortliffe EH, Patel VL (2001) Toward a representation format for sharable clinical guidelines. J Biomed Inform 34(3):157–169
Bury J, Hurt C, Aea Roy (2005) Lisa: a web-based decision-support system for trial management of childhood acute lymphoblastic leukaemia. Br J Haematol 129:746–754
COSSAC (2013a) Credo project. Interdisciplinary Research Collaboration in Cognitive Science and Systems Engineering (COSSAC). https://cossac.org/projects/credo. Accessed 28 July 2016
COSSAC (2013b) Tallis training. Interdisciplinary Research Collaboration in Cognitive Science and Systems Engineering. http://archive.cossac.org/tallis/index.html. Accessed 28 July 2016
Coulson A, Glasspool D, Fox J, Emery J (2001) Rags: a novel approach to computerised genetic risk assessment and decision support from pedigrees. Methods Inform 40:315–322
de Clercq PA, Blom JA, Korsten HH, Hasman A et al (2004) Approaches for creating computer-interpretable guidelines that facilitate decision support. Artif Intell Med 31(1):1–28
Domínguez E, Pérez B, Zapata M (2010) Towards a traceable clinical guidelines application. A model-driven approach. Methods Inf Med 49(6):571–580
Dugan L, Palmer N (2012) BPMN 2.0 handbook second edition: updated and expanded. Making a BPMN 2.0 model executable, Future Strategies Inc., Book Division, pp 71–91
Emery J, Walton R, Murphy M et al (2000) Computer support for interpreting family histories of breast and ovarian cancer in primary care: comparative study with simulated cases. Br Med J 321:28–32
Field MJ, Lohr KN (1990) Clinical practice guidelines: directions for a new program. The National Academies Press, Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine
González-Ferrer A, Fernández-Olivares J, Castillo L (2013) From business process models to hierarchical task network planning domains. Knowl Eng Rev 28(2):175–193
Götz M, Roser S, Lautenbacher F, Bauer B (2009) Token analysis of graph-oriented process models. In: 13th IEEE enterprise distributed object computing conference workshops (EDOCW), pp 15–24
Grando MA, Glasspool D, Fox J (2012) A formal approach to the analysis of clinical computer-interpretable guideline modeling languages. Artif Intell Med 54(1):1–13
Hashemian N, Abidi SSR (2012) Modeling clinical workflows using business process modeling notation. In: 25th international symposium on computer-based medical systems (CBMS), pp 1–4
Kiepuszewski B, Maria ter Hofstede AH, Bussler CJ (2000) On structured workflow modelling. LNCS 1789. Springer, Heidelberg
Kirchner K, Malessa C, Scheuerlein H, Settmacher U (2014) Experience from collaborative modeling of clinical pathways. In: Hess M, Schlieter H (eds) Modellierung im Gesundheitswesen: Tagungsband des Workshops im Rahmen der Modellierung, p 13
Marcos M, Balser M, ten Teije A, van Harmelen F, Duelli C (2003) Experiences in the formalisation and verification of medical protocols. Artificial intelligence in medicine. Springer, Heidelberg
Martínez-Salvador B, Marcos M, Sánchez A (2014) An algorithm for guideline transformation: from BPMN to PROforma. Knowledge representation for health care. Springer, Heidelberg
Martínez-Salvador B, Marcos M, Riaño D (2015) An algorithm for guideline transformation: from BPMN to SDA. Procedia Comput Sci 63:244–251
Mendling J, Lassen KB, Zdun U (2008) On the transformation of control flow between block-oriented and graph-oriented process modelling languages. Int J Bus Process Integr Manag 3(2):96–108
Mendling J, Reijers H, van der Aalst W (2010) Seven process modeling guidelines (7 pgm). Inf Softw Technol 52:127–136
Mohler J, Amstrong A, Bahnson R, Boston B, Busby J, D’Amico A, Eastham J, Enke C, Farrington T, Higano C, Horwitz E, Kantoff P, Kawachi M, Kuette M, Lee R, MacVicar G, Malcolm A, Miller D, Plimack E, Pow-Sang J, Mr Roach, Rohren E, Rosenfeld S, Srinivas S, Strope S, Tward J, Twardowski P, Walsh P, Ho M, Sheadm D (2012) Prostate cancer, version 3.2012: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 10(9):1081–1087
OMG (2011) Busines process model and notation (BPMN) version 2.0. http://www.omg.org/spec/BPMN/2.0. Accessed 28 July 2016
Ouyang C, Dumas M, Aalst WM, Hofstede AHT, Mendling J (2009) From business process models to process-oriented software systems. ACM Transactions on Software Engineering and Methodology (TOSEM) 19(1):2
Parra C, Jódar-Sánchez F, Jiménez-Hernández MD, Vigil E, Palomino-García A, Moniche-Álvarez F, De la Torre-Laviana FJ, Bonachela P, Fernández FJ, Cayuela-Domínguez A et al (2012) Development, implementation, and evaluation of a telemedicine service for the treatment of acute stroke patients: telestroke. Interact J Med Res 1(2)
Patel VL, Allen VG, Arocha JF, Shortliffe EH (1998) Representing clinical guidelines in GLIF individual and collaborative expertise. J Am Med Inform Assoc 5(5):467–483
Peleg M, Tu S, Bury J, Ciccarese P, Fox J, Greenes RA, Hall R, Johnson PD, Jones N, Kumar A et al (2003) Comparing computer-interpretable guideline models: a case-study approach. J Am Med Inform Assoc 10(1):52–68
Recker J (2010) Opportunities and constraints: the current struggle with bpmn. Bus Process Manag J 16(1):181–201
Rojo MG, Rolón E, Calahorra L, García F, Sánchez RP, Ruiz F, Ballester N, Armenteros M, Rodríguez T, Espartero RM et al (2008) Implementation of the business process modelling notation (BPMN) in the modelling of anatomic pathology processes. Diagn Pathol 3(Suppl 1):S22
Rolón E, García F, Ruiz F, Piattini M, Calahorra L, García M, Martin R (2008) Process modeling of the health sector using bpmn: a case study. In: Proceedings of the first international conference on health informatics (HEALTHINF), diagnostic pathology, vol 2, pp 173–178
Scheuerlein H, Rauchfuss F, Dittmar Y, Molle R, Lehmann T, Pienkos N, Settmacher U (2012) New methods for clinical pathways – business process modeling notation (BPMN) and tangible business process modeling (t. BPM). Langenbeck’s. Arch Surg 397(5):755–761
Siegel R, Naishadham D, Jeme A (2013) Cancer statistics. Cancer J Clin 63(1):11–30
Sutton DR, Fox J (2003) The syntax and semantics of the proforma guideline modeling language. J Am Med Inform Assoc 10(5):433–443
Svagård I, Farshchian BA (2009) Using business process modelling to model integrated care processes: experiences from a European project. Distributed computing, artificial intelligence, bioinformatics, soft computing, and ambient assisted living. Springer, Heidelberg
Van der Aalst WM, Ter Hofstede AH, Kiepuszewski B, Barros AP (2003) Workflow patterns. Distrib Parallel Databases 14(1):5–51
zur Muehlen M, Recker J (2008) How much language is enough? Theoretical and practical use of the business process modeling notation. In: 20th international conference on advanced information systems engineering, LNCS. Springer, Heidelberg
Acknowledgments
This research has been supported by Universitat Jaume I through Project P1\(\cdot\)1B2013-15, and by the Spanish Ministry of Economy and Competitiveness and the EU FEDER programme through Project TIN2014-53749-C2-1-R.
Author information
Authors and Affiliations
Corresponding author
Additional information
Accepted after two revisions by Prof. Dr. Jarke.
Rights and permissions
About this article
Cite this article
Martínez-Salvador, B., Marcos, M. Supporting the Refinement of Clinical Process Models to Computer-Interpretable Guideline Models. Bus Inf Syst Eng 58, 355–366 (2016). https://doi.org/10.1007/s12599-016-0443-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12599-016-0443-3