Skip to main content
SpringerLink
Log in

Supporting the Refinement of Clinical Process Models to Computer-Interpretable Guideline Models

  • Research Paper
  • Published:
Business & Information Systems Engineering Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • Domínguez E, Pérez B, Zapata M (2010) Towards a traceable clinical guidelines application. A model-driven approach. Methods Inf Med 49(6):571–580

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • Martínez-Salvador B, Marcos M, Sánchez A (2014) An algorithm for guideline transformation: from BPMN to PROforma. Knowledge representation for health care. Springer, Heidelberg

    Google Scholar 

  • Martínez-Salvador B, Marcos M, Riaño D (2015) An algorithm for guideline transformation: from BPMN to SDA. Procedia Comput Sci 63:244–251

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Mendling J, Reijers H, van der Aalst W (2010) Seven process modeling guidelines (7 pgm). Inf Softw Technol 52:127–136

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Recker J (2010) Opportunities and constraints: the current struggle with bpmn. Bus Process Manag J 16(1):181–201

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Siegel R, Naishadham D, Jeme A (2013) Cancer statistics. Cancer J Clin 63(1):11–30

    Article  Google Scholar 

  • Sutton DR, Fox J (2003) The syntax and semantics of the proforma guideline modeling language. J Am Med Inform Assoc 10(5):433–443

    Article  Google Scholar 

  • 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

    Google Scholar 

  • Van der Aalst WM, Ter Hofstede AH, Kiepuszewski B, Barros AP (2003) Workflow patterns. Distrib Parallel Databases 14(1):5–51

    Article  Google Scholar 

  • 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

Download references

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

  1. Department of Computer Engineering and Science, Universitat Jaume I, Av. de Vicent Sos Baynat s/n, 12071, Castellón, Spain

    Begoña Martínez-Salvador & Mar Marcos

Authors
  1. Begoña Martínez-Salvador
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mar Marcos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Begoña Martínez-Salvador.

Additional information

Accepted after two revisions by Prof. Dr. Jarke.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12599-016-0443-3

Keywords

Search

Navigation