An integrated framework for verifying multiple care pathways

Abstract

Common chronic conditions are routinely treated following standardised procedures known as clinical pathways. For patients suffering from two or more chronic conditions, referred to as multimorbidities, several pathways have to be applied simultaneously. However, since pathways rarely consider the presence of comorbidities, applying several pathways may lead to potentially harmful (medication) conflicts. This paper proposes an automated framework to detect, highlight and resolve conflicts in the treatments used for patients with multimorbidites. We use BPMN as a modelling language for capturing care guidelines. A BPMN model is transformed into an intermediate formal model capturing the possible unfoldings of the pathway. Putting together the constraint solver Z3 and the theorem prover Isabelle, we combine treatment plans and check the correctness of the approach. We illustrate the approach with an example from the medical domain and discuss future work.

Clinical pathway modelling: a literature review

“…Eleven papers specifically stated other methods of collecting the information on the pathway, which are as follows - [19,22,41,82,116,169] stated that the information was provided to them in some way, [79] through previous work (also consulted with experts and stakeholders), [128] online user input, and [21,24,60] used national guidelines.…”

“…Furthermore, six papers [3,14,24,151,164,202] discuss the use of 'Business Process Modeling Notation' (BPMN). BPMN is the use of graphical notation for the purpose of illustrating business processes.…”

“…JCR Category MI [3, 11, 13, 14, 16, 17, 19, 32, 37, 42, 45-47, 52, 54, 56, 57, 66, 72, 73, 1-93, 95-97, 99-101, 108, 122, 124, 131, 140, 144, 149, 150, 157, 160, 164, 170, 178, 187, 196, 197, 206, 211] OR/MS [7,8,12,18,22,23,27,30,31,43,50,51,64,75,79,90,113,114,134,151,158,165,169,190,203,212] HPS [9, 10, 21, 33, 39, 40, 80, 102-104, 110, 116, 141, 143, 153, 163, 166, 209] IE [34,120] AN [53,133] No ISSN [15,24,36,60,70,71,82,127,138,139,142,161,183,[198][199][200] Table A4. Way in which information about the pathway was obtained.…”

“…Obtained Data Driven [5, 7-9, 11, 13, 32, 33, 37, 47-49, 54, 58, 62, 66, 70-72, 74-76, 80, 81, 83, 85-99, 104, 107, 108, 112, 120, 121, 124, 126, 127, 131, 133, 134, 138-140, 143, 144, 147-150, 153, 157, 160, 162, 167, 170, 172, 177-179, 183-185, 191, 192, 195, 197-206, 209-211] Collaboration [3,10,14,17,27,42,51,73,100,114,142,152,163] Both [12,20,35,40,56,101,103,129,136,146,154,166,171,186] Other [19,21,22,24,41,60,79,82,116,128,169] Table A6. Care level considered.…”

Automated Verification of Care Pathways Using Constraint Programming

“…In the mentioned work, CPN models are enhanced with logical constraints to represent potential conflicts. Another similar approach is the integrated framework developed in [27] which detects and resolves conflicts in the pathways used for patients with multimorbidities. They also use BPMN to model the guidelines that is transformed into an intermediate formal model for a better analysis, then using a constraint solver Z3 [28] to check the satisfiability of a set of assertions expressed in first-order logic, together with the theorem prover Isabelle [29], a proof assistant which provides a framework to accommodate logical systems to compute the validity of logical deductions, to combine treatment plans and check the correctness of the approach.…”