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Edited by
Marcial García-Rojo
Pathology Department, Hospital General Universitario de Ciudad Real, Spain
Bernd Blobel
eHealth Competence Center, University Hospital Regensburg, Germany
and
Arvydas Laurinavicius
Vilnius University Faculty of Medicine and National Center of Pathology,
Vilnius, Lithuania
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Contents
Preface v
Marcial García-Rojo, Bernd Blobel and Arvydas Laurinavicius
COST Action IC0604: Management Committee Members and Participants vii
Part I. Introduction
Introduction
Any system development process covering the system’s lifecycle from analysis through
design, specification, implementation, testing, certification and maintenance must be
started from the business needs to be met by running an appropriate business process.
For describing that business process in a way understandable by both humans and
machines, business process modeling is widely used in any kind of enterprises. This
also holds for the medical domain. The objectives driving this procedure range from
the economic aspects of process optimization through the increase of transparency and
exchangeability of data and knowledge up to the assurance and certification of quality.
The development and standardization of meta-languages to formally describe and
model business processes as well as solutions for the execution of model files enables
the reuse of those models for different purposes with theoretical and practical
implications.
Various modeling languages have been developed to cover different aspects of
business processes and organizations. In that context, the Business Process Modeling
and Notation (BPMN) standardized by the Object Management Group (OMG) plays a
pivotal role. Some of the models and notations (e.g. organigram, value added chains)
are used to describe structures and processes on a very high abstract level and cannot
1
Corresponding Author. Francisco Ruiz González. Dep. of Technology and Information Systems.
School of Computing Engineering. University of Castilla-La Mancha. Paseo de la Universidad, 4. E-13071
Ciudad Real (Spain). Email: francisco.ruizG@uclm.es Phone: +34-926-295300 ext 3741 Fax: +34-926-
295354. URL: web: http://alarcos.inf-cr.uclm.es/per/fruiz/
be executed. BPMN and the Business Process Execution Language (BPEL) in contrast
enable modeling problems on an abstract level and facilitate execution and re-usage.
BPMN models also support communication between domain experts and computer
scientist. Figure 1 presents the BPMN and BPEL stack in an Web services environment.
Chapter 5 of this volume aims at introducing business modeling with BPMN and
presents the state of the art in practical application of modeling in Pathology. Chapter
5.1 covers state of the art in modeling and analysis, Chapter 5.2 exemplifies advanced
models, and Chapter 5.3 discusses future trends in business modeling.
This introductory chapter is organized as follows: First, importance and role of
business processes for organizations are discussed in general, also tackling the
characteristics and usefulness of process models. The second section describes the
BPMN language for the representation of business processes. Finally, some
experiences about applying the business process perspective and/or BPMN in Health
sector are presented.
Evaluation Improvement
Using opportunities
Process mining, => new iteration
Business Activity Monitoring,
…
Design
Execution BP life cycle BP identification and
Operation, Monitoring, modeling
Maintenance …
Analysis (validation,
simulation, verification)
Configuration
IT selection &
implementation
Organizational View
Some specific advantages of the availability of BP models are [2]: a) To ease the
understanding of the key mechanisms of an existing business (please remember here
‘business’ is similar to ‘organizational’); b) To serve as the basis for the creation of
appropriate information systems that support the business; c) To improve the current
business structure and operation; d) To show the structure of an innovated business; e)
To identify outsourcing opportunities; and f) To facilitate the alignment of IT
framework and systems with business goals and needs.
2. BPMN Language
As mentioned in the introductory section already, BPMN is the industrial standard for
modeling BPs. The goal of this standard is to provide business people – non experts in
information technology – with a legible and understandable notation. BPMN aims at
serving as a communication bridge between business users, who are devoted to the
process design, and technical people, who are responsible of the process
implementation, both using their own terminology and ontology (see also Chapter 4.3).
The main elements for each BPMN element category are summarized in the following
tables (from 1 to 5) [3]:
Choreography Task
A Gateway is used to control the divergence and convergence of Sequence Flows in a
Process and in a Choreography. In their convergence version they have one ingoing sequence
flow and several outgoing flows whereas in their divergence version they have several
ingoing flows and one outgoing flow.
With BPMN, it is possible to cover three basic models of processes: Private Processes
(both executable and non executable), Public Processes, and Choreographies. To settle
those models, different types of diagrams are used. The three main sub-models covered
are:
Like in all type of organization, also in the health sector it is of vital importance to stay
updatded in relation to its BPs. This is not only a requirement for the continuous
improvement of services, but it also constitutes a fundamental part of quality programs
the organizations are connected with. In a competitive healthcare market, hospitals
have to re-organize their structure and operations [4] to become more responsive
organizations with a patient service as efficient as possible. For that reason not only
labor and capital but also information will be a critical resource: availability,
correctness, and facilities to process information are crucial for an efficient patient
service. Nevertheless, properly designed processes are a key aspect for a good use of
information systems. The lack of control in processes used to deliver medical care is
clearly a major problem in the context of preventable medical errors with lethal
damages and high economic costs in many hospitals. On the other hand, care safety
assessment, activity-based analysis, workflow technology and knowledge of care
pathways provide the methodological basis for continuous quality improvement in the
health sector [5]. Additionally, the ISO 9000 standards promote enterprise process
analysis and the use of business process redesigning to describe major processes and a
functional view across enterprises. With all those considerations, it seems clear that BP
models – expressed in an explicit way and understandable for all participants – can be a
very good tool for improving the healthcare service quality.
There are some interesting experiences addressing this issue like the work of
Garcia et al [6], who described how BPMN was used to model the anatomic pathology
processes in a public hospital in Spain. The team was constituted by staff of the
hospital including experts on selected processes and persons responsible for
administrative and quality issues, and external IT experts. Similar experiences have
been published by Parra et al. [7], who applied BP modeling and simulation in
processes like telemedicine and post-transplant hepatitis, however not using BPMN. In
[8], a methodology used to model and describe existing chronic care processes and
pathways in a Norwegian hospital is presented. As a result, it has been concluded that
BPMN is useful for modeling care processes and that it can benefit from adaptations to
healthcare environments to be optimally exploited. A more recent work on using BP
models in hospitals has been presented by Strasser et al. [9]. These authors describes a
new process management system for defining and reconstructing clinical care
processes by using the BPMN language for modeling and also executing processes.
The main goal of the system is to assist hospital operators and clinical process
managers to detect discrepancies between defined and actual clinical processes as well
as to identify main causes for high medical costs.
The Chester County Hospital experience in BPM has been reported with regard to
a workflow system that integrates clinical, operational and financial processes which
provide a significant improvement in patient’s safety, efficiency, and particularly in
bed management and infection control [10]. For instance, the system alerts staff when a
bed is not cleaned in a predetermined amount of time. Hospital BPs modeling has also
been employed in radiology interpretation [11]. In this work, a detailed description of
each task, role and route of the interpretation sub-process was carried out, in addition to
those related to the information flow. Predefined reports associated with each
procedure were created, thus leading to a substantial improvement in efficiency. A last
and very recent example of the application of BP models is a case study of healthcare
human collaboration processes performed at a Dutch academic hospital to evaluate a
novel interaction-centric process modeling method [12]. The process under study is the
care pathway performed by the head and neck oncology team, and the case study
illustrates how the method utilizes BPMN for effective tree-based description of
interactions, their composition and routing relations, and their roles. In summary, BPM
technology in general, and tools for support the BP modeling and simulation in
particular, have achieved a high level of maturity. and their use is growing in all sectors
and specially in healthcare. Previously mentioned references are only a few samples of
a great amount of information available in bibliographies and on the Web.
4. Difficulties and Challenges when Applying BPM in the Health Sector.
The order of the activities can be modified to achieve certain objectives. Moreover, in
some cases, there may be optional activities that include additional functions and roles
in the process. On the other hand, the complexity of patients’ treatment at a hospital
might involve many exceptions that occur in healthcare processes [14].
. Results published by various authors in this area are promising in order to get all the
information relevant to the care of patients in the right place and at the right time,
providing continuity of care and ensuring security and privacy [15], (see also Chapter
8.3 in this volume). However, most of these experiences are in initial phases, and the
development of efficient information systems in the health care sector is occurring
slowly.
5. Conclusion
Acknowledgement
References