S55: Introduction To Workflow Technology

Introduction to workflow technology
Representation of healthcare processes in a workflow

editor
dit andd their
th i execution
ti ini a workflow
kfl engine
i
Vojtech Huser MD PhD
AMIA NOW, Small Group session, Tutorial (1hr)

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Or direct URL: http://healthcareworkflow.wordpress.com/2010/05/21/tutorial-

introduction-to-workflow-technology-representation-of-healthcare-processes-in-a-
workflow editor and their execution in a workflow engine/
workflow-editor-and-their-execution-in-a-workflow-engine/
Download the bibliography document for all references mentioned in the presentation (at
the link above)
(In the workflow editor: use Shark view (Settings -> Configuration -> Shark))
2
Vojtech Huser, MD, PhD
Agenda
Part 1: Introduction,, history,
y, 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
3
Part 1: Introduction to workflow technology
Need for specifying workflow within IT systems
History of workflow technology
prior 1960s-1980s
development
p 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
t h l
technology tools
t l
Workflow Technology applied industries and healthcare
Future development and research challenges
4
Part 2: WT standards
standards, SDOs
SDOs, related theories
Workflow management coalitions (WfMC)
standards
Definition of WT terms
XML process definition
d f llanguage (XPDL)
( )
Other standardization efforts
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Business Process Modeling Notation (BPMN)
Research-originated
g WT standards
Petri Nets theory and its relationship to
workflows
5
Part 3: Practical tools demos
Demo of an editor and engine
E
Example
l 1:
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
6
prior 1960s-1980s
development
p after 1990
generic IT system
t h l
technology tools
t l
7
Workflow technology
BPM = business pprocess management
g
Adaptive workflow (Adaptive Case
g
Management) )
Computer supported collaborative work
(
(CSCW))
Why workflow?
Sepa at o o
Separation of data into
to databases
Separation of UI from IT system core
Separation
p of process
p knowledge
g
8
Process Example
Koetter (2007)
9
10
Workflow patterns examples
Parallel Split: When an intrusion alarm is received,
ti
trigger th dispatch-patrol
the di t h t l activity
ti it and th inform-police
d the i f li
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, th despatch-police
ll one or more off the d t h li ,
despatch-fire-engine and despatch-ambulance activities
is immediately initiated.
11
12
prior 1960s-1980s
development
p after 1990
generic IT system
t h l
technology tools
t l
13
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
14
15
16
17
18
prior 1960s-1980s
development
p after 1990
Components of workflow technology (process
definition, execution engine, analytical components)
generic IT system
t h l
technology tools
t l
19
Automating Workflow
Defined by Workflow Management
Coalition (WfMC)
www.wfmc.org
T
Terminology
i l and
d Glossary
Gl
http://www.wfmc.org/standards/docs/TC-
1011 te m glossa
1011_term_glossary_v3.pdf
3 pdf
20
Terms
Workflow
The automation of a business process, in
whole or ppart,, during
g 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
21
22
23
Humans & machines working together
24
Executable flowchart
25
26
Minimum components
edito
language
r
execution engine
27
Interfaces
28
prior 1960s-1980s
development
p after 1990
Benefits of implementing a workflow server within
a generic IT system
t h l
technology tools
t l
29
WT benefits
Non programmers understand processes
Non-programmers
Non-programmers can modify processes
Analytical tools
Faster IT system development (SOA+WT)
30
prior 1960s-1980s
development
p after 1990
generic IT system
Major workflow vendors and open-source
workflow
kfl technology
t h l tools
t l
31
Choice of Wf vendor
Major player
TIBCO
BEA
Global 360
IBM
Other
Fujitsu
F jit
IBM
Oracle
Microsoft
SAP
Lombardi
Open source
JBOSS
Taverna
Together
Bonita
YAWL
http://java-source.net/open-
source/workflow-engines
32
33
34
35
36
37
Workflow engine
38
Engine
39
Hi t
History off workflow
kfl ttechnology
h l
prior 1960s-1980s
development after 1990
Components
C t off workflow
kfl ttechnology
h l (process
( definition,
d fi iti
generic
i IT system
t
technology tools
W kfl
Workflow Technology
T h l applied
li d industries
i d i and d
healthcare
40
Use of WT
Pioneer domains
Banking
Manufacturing
Shipping
Government authorities
Pharmaceutical
Healthca e
Healthcare
Gartner 2008 report: <5% use
41
Examples of WT use in healthcare
Bed management
Infections 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.
FL, 2007
R. Hess, "The Chester County Hospital: Case Study," in 2007 Excellence in Practice: Moving the
Goalposts., 2007.
42
Stroke guideline (WfMS)
43
Soarian
44
45
Use at Marshfield Clinic
46
HealthFlow: RetroGuide,
RetroGuide FlowGuide
Workflow Workflow
mining editor
(ProM) (JaWE)
EHR System layer: Additional Components:
Notifications
Prospective mode Host EHR Passive
Knowledge Base Workflow Event (FlowGuide): Interaction Model
(workflow process
definitions) Execution Listener
EHR system Host EHR Active
Engine Interaction Model
(Shark) Actions
Retrospective mode
Additional External Services
(Terminology services, NLP services, Data Inquiry (RetroGuide):
Statistical Analysis) Data Visualization
Data Warehouse
Event Data Model
Workflow log analysis Reports
Ontology Model
47
Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
prior 1960s-1980s
development
p after 1990
generic IT system
t h l
technology tools
t l
48
Future of WT
Improvements
Adoption is growing
Software tools sophistication is improving
Competition, consolidation
Future similar to a database server inclusion in
IT systems
St d d consolidation
Standards lid ti
Research challenges
Process model visualization challenges
Process model cross-vendor portability
Adaptive workflow
49
Workflow patterns
http://
workflowpatterns.com/
50
Adaptive workflow
51
standards, SDOs
standards
( )
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Research-originated
g WT standards
workflows
52
standards, SDOs
standards
( )
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Research-originated
g WT standards
workflows
53
WfMC
Started in 1990
5 interfaces
XPDL 1.0,
1 0 2.0,
2 0 2.1
21
Yearly Workflow handbook
54
standards, SDOs
standards
( )
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Research-originated
g WT standards
workflows
55
56
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
rules.
Workflow Process = A set of one or more linked procedures or

activities which collectivelyy realize a business objective
j or policy
p y goal,
g ,
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,DocumentNumberWFMCTC1011,Feb99
http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74
57
Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com
standards, SDOs
standards
d fi i i llanguage (XPDL)
( )
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Research-originated
g WT standards
workflows
58
XPDL
XML file based on a XSD schema
http://wfmc.org/xpdl.html
First introduced in 1999
Conformance testing available
h
http://www.xpdl.org/Validate/ValidateXpdl
// dl / ld / ld dl
Exchange format
Adoption (70+ products)
http://wfmc.org/xpdl-implementations.html
p // g/ p p
59
Standards Timeline
60
Example xpdl
Example.xpdl
61
Process Schema
62
Activities
63
standards, SDOs
standards
( )
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Research-originated
g WT standards
workflows
64
WT standards
Historical
WSDL
Current major
j
XPDL, BPMN, BPEL
Proprietary (vendor specific):
JBPM (JBoss)
(JB )
Win Workflow Foundation (Microsoft)
T2Flow->SCUFL2 (Taverna)
internal format (Weka)
Research ones
YAWL
65
standards, SDOs
standards
( )
Business
B siness P
Process
ocess E
Execution
ec tion Lang
Language
age (BPEL)
Research-originated
g WT standards
workflows
66
Petri Nets
Mathematical theory
Basics
Petri net consist two types of nodes: places
andd transitions.
t iti
A place may have zero or more tokens.
G aphic representations
Graphic ep esentations :Places
Places (ci
(circles),
cles)
transitions (bars), arcs (arrows), and
tokens ((dots))
p1 t1 p2
67
Definition of Petri Net
C = ( P,, T,, I,, O))
Places
P = { p1, p2, p3, , pn}
Transitions
T = { t1, t2, t3, , tn}
Input
I : T Pr (r = number of places)
Output
O : T Pq (q = number of places)
68
69
70
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
71
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
72
Together workflow suite
Editor
JaWE Together Workflow Editor (TWE)
v1 4 v2,
v1.4, v2 v3
Engine
Shark Together Workflow Engine (TWS)
Web-based module
I t
Integration
ti with
ith O
Outlook
tl k
73
Demo
74
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
75
76
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
77
78
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
79
80
Log schema
81
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
82
83
84
85
http://www.marshfieldclinic.org/birc/pages/default.aspx?page=mcrf_birc_pubs_presentations 86
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
Brief overview of other workflow technology
software
W kfl
Workflow engines
i andd Decision
D i i supportt engines
i
87
Other WT software components
Editor, engine
Administration (load a process)

Monitoring (exception)
Analysis (bottleneck finding)
Workflow simulation
Workflow mining
88
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
Case studies of use in healthcare/informatics
research
W kfl
Workflow engines
i and
d Decision
D i i supportt engines
i
89
Use case studies
Marshfield Clinic
MainLine Health
U of Pavia
Einthoven University (NL)
Chester County hospital
See bibliography for references
90
E
Example
l 1:
1
enrolment process
Example 2:
Example 3:
91
WT and DSS
Clear overlap
Many decision support engines have workflow features
Many workflow engines have decision support features
Workflow support vs. decision support
Wh to do
What d and
d when
h
Published case studies of use of WT for decision support
Related
e ated work
o
Peleg at al.
Guidelines and workflow models
Design
g Patterns of Clinical Guidelines (2010)
( ) ((Bonita wf editor))
Mulyar at al.
Comparison of Guidelines formalisms and workflow patterns
92
Mulyar at al (2007)
93
GLIF
guideline
id li
94
Sage flowchart example
P. Ram (2004)
Executing Clinical Practice Guidelines
Using the SAGE Execution Engine,
Medinfo, pp. 251-5, 2004
SAGEs decision maps

subflows.
Rule-in and Rule-out
contructs
Linking workflow engine
with a rule engine
95
Summary
Part 1: Basic terms,, history,
y, use
Part 2: Standards
Part 3: Tools demonstration
Cross-industry modeling
and execution platform
with growing vendor and
tool base and healthcare
use examples
l
huser.vojtech@marshfieldclinic.org
j g
96
Questions ?
huser vojtech@marshfieldclinic org
huser.vojtech@marshfieldclinic.org
huser.vojtech@gmail.com
97

S55: Introduction To Workflow Technology

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S55: Introduction To Workflow Technology

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Introduction to workflow technology

Representation of healthcare processes in a workflow

Vojtech Huser MD PhD

AMIA NOW, Small Group session, Tutorial (1hr)

Or direct URL: http://healthcareworkflow.wordpress.com/2010/05/21/tutorial-

Originally 2 hour workshop

Exclusive Choice: After the review election activity is

Multi Choice: Depending on the nature of the

BPM = Business Process Management

Workflow = The automation of a business process, in whole or

Workflow Process = A set of one or more linked procedures or

Worklist Handler = A software component that manages the

Administration (load a process)

See bibliography for references

SAGEs decision maps

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