Process Management in Health Care: A System for Preventing … · 2005-09-12 · BPM 2005, Nancy, France, September 2005 3 Motivations and Main Ideas (1) Patient safety, medical errors

Process Management in Health Care: ASystem for Preventing Risks and

Medical Errors

Massimo Ruffolo (1) (2), Rosario Curia (1), Lorenzo Gallucci (1) (3)(1) EXEURA, spin-off of University of Calabria

(2) ICAR-CNR(3) DEIS Dept, University of Calabria

PresentationPresentation byby

Domenico Domenico SaccàSaccà (2) (3)Also co-founder of EXEURA

2BPM 2005, Nancy, France, September 2005

Outline

Motivations and Main Ideas

System Description Clinical Process Life-Cycle

Clinical Process Design

Clinical Process Execution and Monitoring

Clinical Process Intelligence

An Application to the Oncological Domain

Process Management in Health Care: A Systemfor Preventing Risks and Medical Errors

M. Ruffolo, R. Curia, L. Gallucci, D. Saccà


Motivations and Main Ideas (1)

Patient safety, medical errors prevention, adverse eventsreporting are very challenging problems

Costs and risks management is a high priority issue forhealth care professionals and providers

Health care practices are characterized by complex clinicalprocesses in which high risk and high cost activities take place





A clinical process can be viewed as a particular workflow inwhich medical (e.g. treatment, drug administration, guidelineexecution, medical examination, etc.) and non-medical (e.gpatient enrollment, organization support, management, …)activities and events occur

A successful approach for reducing cost and risk andenhancing patient safety is realized by a process-orientedvision of health care services and practices





ORANGEE is developing a system for managing processes inhealth care to prevent risks and medical errors (and to makemoney)

EXEURA was appointed by ORANGEE to design andimplement a first prototype of the system




System Description The clinical process management system is based on a

clinical process life-cycle model with three phases: clinical process design clinical process execution & monitoring clinical process intelligence




Clinical Process Design Component (1) The Design Component contains software modules providing

functionalities for representing clinical processes, medicalguidelines and related ontologies

Design functionalities allow a formal and machine-readable clinicalprocesses specification

Process activities and their parameters, decision steps,conditions, patient states, patient data can be represented andsemantically annotated using concepts contained in the ontologies

Concept-based queries can be performed on stored clinicalprocesses




Clinical Process Design Component (2)

The system manages two kinds of ontologies:

corporate ontology containing knowledge about the structureof patients‘ data, medical records data, hospital and ward data

medical ontology, such as ICD9-CM, Loinc, MeSH, Snomed,concerning a wide variety of concepts related to the medicaldomain and to specific clinical knowledge areas: diseases,drugs, medical examinations, medical procedures, laboratoryterms, anatomy




Clinical Process Design Component (3) Clinical processes, guidelines and domain ontologies are

represented using a developing ad hoc formalism called DLP+

DLP+ is a knowledge representation logic-based language,developed at the University of Calabria, extending DLP by: object-oriented features such as relations, the notions of classes, objects

(class instances), object-identity, complex-objects, (multiple) inheritance, the concept of modular programming by means of reasoning modules

DLP+ has been implemented on the DLV system, a cross-platform development environment for knowledge modelingand advanced knowledge-based reasoning based ondisjunctive logic programming




Clinical Process Execution & Monitoring Component (1)

The Execution & Monitoring component contains softwaremodules providing functionalities for the assisted executionof a clinical process and for storing of process instances

Execution is curried out through a graphical user interface mainly composed

by web-based forms filled by doctors, nurses and/or systems has the following properties:

a clinical process is executed as a workflow in which actors can behumans or machines

Each activity or sub-process instance is invoked by selecting themost appropriate one to execute in a given moment (using semanticquery on the process base)




Clinical Process Execution & Monitoring Component (2)

Monitoring applies prediction models during the execution of process

instances, to identify exceptions, unusual or undesiredbehavior and to alert the users

is aimed at the prevention of adverse events and errors, thereduction of risks and the enhancement of patients safety

allows doctors and nurses to estimate the probability of errorsor adverse events occurrence or to recognize if an error or anadverse event has taken place

stores process instances (enriched traces)




Clinical Process Intelligence Component (1)

Allows the analysis of the clinical processes instances acquired aftertheir execution

The sub-component Process & Workflow Mining provides functionalitiesable to extract, from the workflow logs, relevant features characterizingclinical process instances acquired during the execution and to representthem in suitable dataset

Patterns related to adverse events, errors and cost dynamics, hidden in thestructure of clinical processes, that are cause of risks and of poorperformances, are eventually discovered

Process instances are classified w.r.t. their behavior and used as futurereferences to possibly suggest new clinical process schemes capable ofreducing risks for patients and the impact of errors




Clinical Process Intelligence Component (2)

The sub-component Clinical Process Evaluation providesfunctionalities to construct reports producing performance indexesand comparing process instances w.r.t. a reference clinical processon the base of possible risks

Process intelligence functionalities support medical andmanagerial decision making about cost- and risk-effectiveintervention and enable lesson learning about health care practicesin order to eventually perform clinical process restructuring orimprovement





The system has been applied in a real case concerningthe clinical process for caring the mammary carcinoma

The clinical process is referred to the practices carriedout in the oncological ward of an Italian hospital. Theprocess is not general but specific for the domain of theconsidered ward

The application suggests how the clinical processmanagement system can improve patient safety andcost control




An Application to the Oncological DomainThe clinical process which the patient is subjected to can be

organized and represented in the figure





The system allows computer-aided choice of the applicableguidelines

The user, having patient and pathology data available in electronicform, can query the knowledge base which contains one ormore guidelines base, getting as result a collection of everyguideline applicable to the patient

Final selection pertains to the oncologist and the patient, because itdepends on side effects level considered "bearable", but alsowanted results




An Application to the Oncological DomainA computerized Guideline




Conclusions

The practical application of the developed clinical process managementsystems is showing that is possible to improve risk prevention by adopting aprocess oriented approach in health care practices

The main challenging (industrial only?) research problems are: The development of an efficient query engine working with workflows and ontologies The definition of suitable process classification algorithms The extension of the DLP+ language for representing both static and dynamic knowledge

But the really main challenge is to sell the system to hospitals



Documents

Process Management in Health Care: A System for Preventing … · 2005-09-12 · BPM 2005, Nancy, France, September 2005 3 Motivations and Main Ideas (1) Patient safety, medical errors