JMIR Publications

ABSTRACT

Background:

Clinical Pathways (CP) are usually expressed by means of workflow formalisms, providing healthcare personnel with an easy-to-understand high level conceptual model of medical steps in specific patient conditions, thereby improving overall healthcare process quality in clinical practice. From a standardized perspective, the Business Process Modeling Notation (BPMN), a widely-spread general-purpose process formalism, has been used for conceptual modelling in clinical domains mainly due to its easy-to-use graphical notation, facilitating the common understanding and communication of the healthcare involved parties. However, BPMN is not particularly oriented towards the peculiarities of complex clinical processes, such as infection diagnosis and treatment, in which time plays a critical role, reason why much of the BPMN clinical-oriented research has turned 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 workflow notation such as openEHR Task Planning (TP) could pose a major step towards clinical process improvement, enhancing process representation of typical care patterns in the treatment of infections.

Objective:

Our work aimed to analyze the suitability of a clinical-oriented formalism (openEHR TP) to successfully represent common process patterns in infection diagnosis and treatment, identifying domain-specific improvements to the standard that could help to better support the modelling of infection CPs, thereby promoting the wide-spread adoption of clinical conceptual models to improve antibiotic therapies.

Methods:

Our methodology consisted of 4 major steps: 1) literature review and state of the art of clinical process modelling; 2) analysis of expressive power of the BPMN standard and its extensions and the clinical oriented openEHR TP, comparing what we consider to be their key features; 3) modelling of the Catheter-Related Blood Stream Infection (CR-BSI) use case using both standards; and 4) proposal of improvements in view of the results of the use-case scenario

Results:

Although we were able to easily represent in TP the same logic used in the existing BPMN-based process models of our case-study, using standard TP primitives, we identified some improvement areas and suggested possible extensions to the current version of the TP standard, that could allow for an easier and simpler conceptual model representation of common infection process patterns, and likely of other complex clinical processes

Conclusions:

Our research showed that despite the TP specification being able to successfully represent most clinical-oriented concepts, including the most complex BPMN-based CR-BSI infection process patterns depicted in our use-case, there are opportunities for improvements to the TP standard that can increase its adequacy for modelling infection CPs and possibly other complex clinical conditions.