Business Process Model and Notation and openEHR Task Planning for Clinical Pathway Standards in Infections: Critical Analysis

Abstract

Background: Clinical pathways (CPs) are usually expressed by means of workflow formalisms, providing health care personnel with an easy-to-understand, high-level conceptual model of medical steps in specific patient conditions, thereby improving overall health care process quality in clinical practice. From a standardized perspective, the business process model and notation (BPMN), a widely spread general-purpose process formalism, has been used for conceptual modeling in clinical domains, mainly because of its easy-to-use graphical notation, facilitating the common understanding and communication of the parties involved in health care. However, BPMN is not particularly oriented toward the peculiarities of complex clinical processes such as infection diagnosis and treatment, in which time plays a critical role, which is why much of the BPMN clinical-oriented research has revolved around how to extend the standard to address these special needs. The shift from an agnostic, general-purpose BPMN notation to a natively clinical-oriented notation such as openEHR Task Planning (TP) could constitute a major step toward clinical process improvement, enhancing the representation of CPs for infection treatment and other complex scenarios.Objective: Our work aimed to analyze the suitability of a clinical-oriented formalism (TP) to successfully represent typical process patterns in infection treatment, identifying domain-specific improvements to the standard that could help enhance its modeling capabilities, thereby promoting the widespread adoption of CPs to improve medical practice and overall health care quality.Methods: Our methodology consisted of 4 major steps: identification of key features of infection CPs through literature review, clinical guideline analysis, and BPMN extensions; analysis of the presence of key features in TP; modeling of relevant process patterns of catheter-related bloodstream infection as a case study; and analysis and proposal of extensions in view of the results. Results:We were able to easily represent the same logic applied in the extended BPMN-based process models in our case study using out-of-the-box standard TP primitives. However, we identified possible improvements to the current version of TP to allow for simpler conceptual models of infection CPs and possibly of other complex clinical scenarios. Conclusions:Our study showed that the clinical-oriented TP specification is able to successfully represent the most complex catheter-related bloodstream infection process patterns depicted in our case study and identified possible extensions that can help increase its adequacy for modeling infection CPs and possibly other complex clinical conditions.

Improving Implementation of an Electronic Prescription System for COVID-19 Vaccination in the Czech Republic: Process Modeling Approach

“…The specifics of health care are based on very complex problems that have to be modeled. For example, complex causal process diagrams [5] have been used for specifying the causal linkages in complex systems, organizing interdisciplinary research, and serving as a basis for modeling. Similarly, five business process modeling techniques (data flow diagram, flow chart, integrated computer-aided manufacturing definition for function modeling, lean value stream map, and the patient journey modeling tool) have been used to represent selected patient journey models to obtain the necessary background for quantitative and qualitative analyses [6].…”

“…However, as above, the process modeling was only used to describe existing legislation, whereas we have used this approach to define the fundaments of a legislative norm and to reach consensus. BPMN has also been applied in the context of task planning to identify, describe, and find typical process patterns and scenarios [5]. Using BPMN as part of openEHR-which is an open standard specification in health informatics that describes the management and storage, retrieval, and exchange of health data in electronic health records-can improve understanding of that approach using the process visualization.…”

Formalization of BPMN Gateways using the DD-LOTOS Formal Language

“…Today, BPMN is used in many different fields, including healthcare, finance, and industry. In the healthcare sector, works [3][4][5] have shown how BPMN can enhance the quality of clinical care. Likewise, in finance, research [6,7] showcases how organizations employ BPMN to deliver high-quality services at a reduced cost.…”