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research-article

BPMN in healthcare: : Challenges and best practices

Authors:

Francesca Zerbato,

Ingo WeberAuthors Info & Claims

Volume 107, Issue C

https://doi.org/10.1016/j.is.2022.102013

Published: 01 July 2022 Publication History

Abstract

The design and analysis of process models is a critical factor for organizational improvement across various industries. Thanks to its potential to enable common understanding and foster automation, process modeling is increasingly adopted in the healthcare sector. However, the complexity of the healthcare domain makes process modeling a challenging task, potentially explaining the modest uptake of process modeling standards like the Business Process Model and Notation (BPMN). In this paper, we identify common challenges of process modeling in healthcare, elicited from healthcare process modeling initiatives and supported by the literature. For each challenge, we present some BPMN best practices in the form of ready-to-use process fragments that guide the standard modeling of complex healthcare aspects. Also, we report the results of a first evaluation of the use and perceived usefulness of best practices conducted with junior experts in medicine and IT. We observed that the domain-specific process fragments help to capture healthcare aspects in detail and are perceived as a source of learning, turning out to be especially useful for modelers with a basic understanding of BPMN and the healthcare domain.

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Highlights

•

A structured elicitation of relevant modeling needs and challenges in healthcare processes.

•

The definition of a set of one or more BPMN best practices for each identified challenge in the form of ready-to-use process fragments applicable in existing BPMN modeling and execution tools.

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An indicative evaluation of the influence and perception of the BPMN best practices through a modeling experiment with participants having a mixed background in medicine or IT without and with the help of the best practices.

References

[1]

Buttigieg S.C., Dey P.K., Gauci D., Business process management in health care: current challenges and future prospects, Innov. Entrepreneurship Health 3 (1) (2016) 1–13,.

[2]

Reichert M., What BPM technology can do for healthcare process support, in: Conference on Artificial Intelligence in Medicine in Europe, Springer, 2011, pp. 2–13,.

[3]

Ferrante S., Bonacina S., Pozzi G., Pinciroli F., Marceglia S., A design methodology for medical processes, Appl. Clin. Inf. 7 (01) (2016) 191–210,.

[4]

Neumann J., Franke S., Rockstroh M., Kasparick M., Neumuth T., Extending BPMN 2.0 for intraoperative workflow modeling with IEEE 11073 SDC for description and orchestration of interoperable, networked medical devices, Int. J. Comput. Assist. Radiol. Surg. 14 (8) (2019) 1403–1413,.

[5]

Scheuerlein H., Rauchfuss F., Dittmar Y., Molle R., Lehmann T., Pienkos N., Settmacher U., New methods for clinical pathways—Business process modeling notation (BPMN) and tangible business process modeling (t.bpm), Langenbeck’s Arch. Surg. 397 (5) (2012) 755–761,.

[6]

Rojas E., Munoz-Gama J., Sepúlveda M., Capurro D., Process mining in healthcare: A literature review, J. Biomed. Inform. 61 (2016) 224–236,.

Digital Library

[7]

Poulymenopoulou M., Malamateniou F., Vassilacopoulos G., Emergency healthcare process automation using mobile computing and cloud services, J. Med. Syst. 36 (5) (2012) 3233–3241,.

Digital Library

[8]

Object Management Group M., Business process model and notation (BPMN), v2.0.2, 2013, URL http://www.omg.org/spec/BPMN/2.0.2/.

[9]

Weske M., Business Process Management - Concepts, Languages, Architectures, third ed., Springer, 2019,.

[10]

Kunze M., Berger P., Weske M., Lohmann N., Moser S., BPM academic initiative-fostering empirical research, in: BPM (Demos), in: CEUR Workshop Proceedings, vol. 940, CEUR-WS.org, 2012, pp. 1–5.

[11]

Object Management Group M., Decision model and notation (DMN), v1.1, 2016, Available at: http://www.omg.org/spec/DMN/1.1/.

[12]

OMG Healthcare Domain Taskforce M., Field guide to shareable clinical pathways, v. 2.0, 2019, online, Available at: https://www.omg.org/registration/registration-field-guide.htm.

[13]

Laurenza E., Quintano M., Schiavone F., Vrontis D., The effect of digital technologies adoption in healthcare industry: a case based analysis, Bus. Process Manag. J. 24 (5) (2018) 1124–1144,.

[14]

Dadam P., Reichert M., Kuhn K., Clinical workflows — The killer application for process-oriented information systems?, in: 4th International Conference on Business Information Systems, BIS 2000, Springer London, London, 2000, pp. 36–59,.

[15]

Rosemann M., Potential pitfalls of process modeling: part a, Bus. Process Manag. J. 12 (2) (2006) 249–254,.

[16]

Müller R., Rogge-Solti A., BPMN for healthcare processes, in: Proceedings of the 3rd Central-European Workshop on Services and their Composition, in: CEUR Workshop Proceedings, vol. 705, ZEUS 2011, CEUR-WS.org, 2011, pp. 65–72.

[17]

J. Neumann, M. Rockstroh, S. Franke, T. Neumuth, BPMNSIX–A BPMN 2.0 Surgical Intervention Extension, in: 7th Workshop on Modeling and Monitoring of Computer Assisted Interventions (M2CAI), At MICCAI 2016, Athens, Greece, 2016.

[18]

Braun R., Schlieter H., Burwitz M., Esswein W., BPMN4CP: Design and implementation of a BPMN extension for clinical pathways, in: IEEE International Conference on Bioinformatics and Biomedicine, BIBM, IEEE, 2014, pp. 9–16,.

[19]

Onggo B.S.S., Proudlove N.C., D’Ambrogio S.A., Calabrese A., Bisogno S., Ghiron N.L., A BPMN extension to support discrete-event simulation for healthcare applications: an explicit representation of queues, attributes and data-driven decision points, J. Oper. Res. Soc. 69 (5) (2018) 788–802,.

[20]

Zarour K., Benmerzoug D., Guermouche N., Drira K., A systematic literature review on BPMN extensions, Bus. Process Manag. J. 26 (6) (2019) 1473–1503,.

[21]

Combi C., Pozzi G., Veltri P., Process Modeling and Management for Healthcare, CRC Press, 2017.

[22]

Lenz R., Reichert M., IT Support for healthcare processes - premises, challenges, perspectives, Data Knowl. Eng. 61 (1) (2007) 39–58,.

Digital Library

[23]

Jiménez-Ramírez A., Barba I., Reichert M., Weber B., Del Valle C., Clinical processes - the killer application for constraint-based process interactions, in: International Conference on Advanced Information Systems Engineering, in: LNCS, Springer International Publishing, Cham, 2018, pp. 374–390,.

Digital Library

[24]

Ruiz F., Garcia F., Calahorra L., Llorente C., Gonçalves L., Daniel C., Blobel B., Business process modeling in healthcare, Stud. Health Technol. Inf. 179 (2012) 75–87,.

[25]

Svagård I., Farshchian B.A., Using business process modelling to model integrated care processes: Experiences from a european project, in: International Work-Conference on Artificial Neural Networks, in: LNCS, vol. 5518, Springer, 2009, pp. 922–925,.

Digital Library

[26]

Combi C., Oliboni B., Zerbato F., A modular approach to the specification and management of time duration constraints in BPMN, Inf. Syst. 84 (2019) 111–144,.

Digital Library

[27]

Lanz A., Weber B., Reichert M., Time patterns for process-aware information systems, Requir. Eng. 19 (2) (2014) 113–141,.

Digital Library

[28]

Genon N., Heymans P., Amyot D., Analysing the cognitive effectiveness of the BPMN 2.0 visual notation, in: Software Language Engineering, in: LNCS, vol. 6563, Springer Berlin Heidelberg, Berlin, Heidelberg, 2011, pp. 377–396,.

[29]

Combi C., Oliboni B., Zardini A., Zerbato F., Seamless design of decision-intensive care pathways, in: IEEE International Conference on Healthcare Informatics, ICHI 2016, IEEE, 2016, pp. 35–45,.

[30]

Combi C., Oliboni B., Zardini A., Zerbato F., A methodological framework for the integrated design of decision-intensive care pathways—an application to the management of COPD patients, J. Healthc. Inform. Res. 1 (2) (2017) 157–217,.

[31]

Russo A., Mecella M., On the evolution of process-oriented approaches for healthcare workflows, Int. J. Bus. Process Integr. Manag. 6 (3) (2013) 224–246,.

[32]

Haddar N.Z., Makni L., Abdallah H.B., Literature review of reuse in business process modeling, Softw. Syst. Model. 13 (3) (2014) 975–989,.

Digital Library

[33]

Koschmider A., Reijers H.A., Improving the process of process modelling by the use of domain process patterns, Enterp. Inf. Syst. 9 (1) (2015) 29–57,.

Digital Library

[34]

Chung E.S., Hong J.I., Lin J., Prabaker M.K., Landay J.A., Liu A.L., Development and evaluation of emerging design patterns for ubiquitous computing, in: Proceedings of the 5th Conference on Designing Interactive Systems: Processes, Practices, Methods, and Techniques, 2004, pp. 233–242,.

Digital Library

[35]

Mathisen E., Krogstie J., Modeling of processes and decisions in healthcare-state of the art and research directions, in: IFIP Working Conference on the Practice of Enterprise Modeling, in: LNBIP, vol. 134, Springer, 2012, pp. 101–116,.

[36]

Kaiser K., Marcos M., Leveraging workflow control patterns in the domain of clinical practice guidelines, BMC Med. Inf. Decis. Mak. 16 (1) (2015) 20,.

[37]

Peleg M., Computer-interpretable clinical guidelines: A methodological review, J. Biomed. Inform. 46 (4) (2013) 744–763,.

Digital Library

[38]

Shahar Y., Miksch S., Johnson P., The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines, Artif. Intell. Med. 14 (1–2) (1998) 29–51,.

[39]

Musen M.A., Tu S.W., Das A.K., Shahar Y., EON: A component-based approach to automation of protocol-directed therapy, J. Am. Med. Inf. Assoc. 3 (6) (1996) 367–388,.

[40]

Terenziani P., Montani S., Bottrighi A., Torchio M., Molino G., Correndo G., The GLARE approach to clinical guidelines: main features, Stud. Health Technol. Inf. 101 (6) (2004) 162–166,.

[41]

Boxwala A.A., Peleg M., Tu S., Ogunyemi O., Zeng Q.T., Wang D., Patel V.L., Greenes R.A., Shortliffe E.H., GLIF3: a representation format for sharable computer-interpretable clinical practice guidelines, J. Biomed. Inform. 37 (3) (2004) 147–161,.

Digital Library

[42]

Sutton D.R., Fox J., The syntax and semantics of the PROforma guideline modeling language, J. Am. Med. Inf. Assoc. 10 (5) (2003) 433–443,.

[43]

Mulyar N., Van der Aalst W.M., Peleg M., A pattern-based analysis of clinical computer-interpretable guideline modeling languages, J. Am. Med. Inf. Assoc. 14 (6) (2007) 781–787,.

[44]

Gatta R., Vallati M., Fernandez-Llatas C., Martinez-Millana A., Orini S., Sacchi L., Lenkowicz J., Marcos M., Munoz-Gama J., Cuendet M., et al., Clinical guidelines: A crossroad of Many Research Areas. Challenges and opportunities in process mining for healthcare, in: International Conference on Business Process Management, in: LNBIP, vol. 362, Springer, 2019, pp. 545–556,.

[45]

Vanwersch R., Pufahl L., Vanderfeesten I., Reijers H., The RePro technique: a new, systematic technique for rethinking care processes, in: BETA Publicatie: Working Papers, Vol. 465, Citeseer, 2014.

[46]

Chiao C.M., Künzle V., Reichert M., Object-aware process support in healthcare information systems: Requirements, conceptual framework and examples, Int. J. Adv. Life Sci. 5 (1 & 2) (2013) 11–26.

[47]

E. Rolón, E. Aguilar, F. Garcia, F. Ruiz, M. Piattini, L. Calahorra, et al., Process modeling of the health sector using BPMN: a case study, in: Proceedings of the First International Conference on Health Informatics, HEALTHINF, 2008, pp. 173–178.

[48]

Rojo M.G., Rolón E., Calahorra L., García F.O., Sánchez R.P., Ruiz F., Ballester N., Armenteros M., Rodríguez T., Espartero R.M., Implementation of the business process modelling notation (BPMN) in the modelling of anatomic pathology processes, Diagn. Pathol. 3 (1) (2008) S22,.

[49]

Grosskopf A., Edelman J., Weske M., Tangible business process modeling–methodology and experiment design, in: International Conference on Business Process Management, Springer, 2009, pp. 489–500,.

[50]

Barbagallo S., Corradi L., de Goyet J.d.V., Iannucci M., Porro I., Rosso N., Tanfani E., Testi A., Optimization and planning of operating theatre activities: an original definition of pathways and process modeling, BMC Med. Inf. Decis. Mak. 15 (1) (2015) 38,.

[51]

Zerbato F., Oliboni B., Combi C., Campos M., Juarez J.M., BPMN-based representation and comparison of clinical pathways for catheter-related bloodstream infections, in: 2015 International Conference on Healthcare Informatics, IEEE, 2015, pp. 346–355,.

Digital Library

[52]

Mincarone P., Leo C.G., Trujillo-Martín M.d.M., Manson J., Guarino R., Ponzini G., Sabina S., Standardized languages and notations for graphical modelling of patient care processes: a systematic review, Int. J. Qual. Health Care 30 (3) (2018) 169–177,.

[53]

van Der Aalst W.M., Ter Hofstede A.H., Kiepuszewski B., Barros A.P., Workflow patterns, Distrib. Parallel Databases 14 (1) (2003) 5–51,.

Digital Library

[54]

Weber B., Reichert M., Rinderle-Ma S., Change patterns and change support features–enhancing flexibility in process-aware information systems, Data Knowl. Eng. 66 (3) (2008) 438–466,.

Digital Library

[55]

Thom L.H., Reichert M., Iochpe C., Activity patterns in process-aware information systems: Basic concepts and empirical evidence, Int. J. Bus. Process Integr. Manag. 4 (2) (2009) 93–110,.

[56]

Scholta H., Niemann M., Delfmann P., Räckers M., Becker J., Semi-automatic inductive construction of reference process models that represent best practices in public administrations: A method, Inf. Syst. 84 (2019) 63–87,.

Digital Library

[57]

Hevner A.R., March S.T., Park J., Ram S., Design science in information systems research, MIS Q. (2004) 75–105,.

[58]

Peffers K., Tuunanen T., Rothenberger M.A., Chatterjee S., A design science research methodology for information systems research, J. Manage. Inf. Syst. 24 (3) (2007) 45–77,.

Digital Library

[59]

Wieringa R.J., Design Science Methodology for Information Systems and Software Engineering, Springer, 2014,.

Digital Library

[60]

Canovas-Segura B., Zerbato F., Oliboni B., Combi C., Campos M., Morales A., Juarez J.M., Marin R., Palacios F., A process-oriented approach for supporting clinical decisions for infection management, in: 2017 IEEE International Conference on Healthcare Informatics, ICHI, 2017, pp. 91–100,.

[61]

Object Management Group B., Unified modeling language, v2.5, 2015, Available at: http://www.omg.org/spec/UML/2.5/.

[62]

Braun R., Schlieter H., Burwitz M., Esswein W., BPMN4CP Revised–extending BPMN for multi-perspective modeling of clinical pathways, in: 2016 49th Hawaii International Conference on System Sciences, HICSS, IEEE, 2016, pp. 3249–3258,.

Digital Library

[63]

Ferrante S., Bonacina S., Pinciroli F., Modeling stroke rehabilitation processes using the unified modeling language (UML), Comput. Biol. Med. 43 (10) (2013) 1390–1401,.

Digital Library

[64]

Cossu F., Marrella A., Mecella M., Russo A., Bertazzoni G., Suppa M., Grasso F., Improving operational support in hospital wards through vocal interfaces and process-awareness, in: IEEE International Symposium on Computer-Based Medical Systems, CBMS, IEEE, 2012, pp. 1–6,.

[65]

Cutting E.M., Overby C.L., Banchero M., Pollin T., Kelemen M., Shuldiner A.R., Beitelshees A.L., Using workflow modeling to identify areas to improve genetic test processes in the university of maryland translational pharmacogenomics project, in: AMIA Annual Symposium Proceedings Archive, Vol. 2015, American Medical Informatics Association, 2015, p. 466.

[66]

Ramos-Merino M., Álvarez-Sabucedo L.M., Santos-Gago J.M., Sanz-Valero J., A BPMN based notation for the representation of workflows in hospital protocols, J. Med. Syst. 42 (10) (2018) 181,.

Digital Library

[67]

Yao W., Rolia J., Basu S., Singhal S., Kumar A., A context-aware framework for patient navigation and engagement (CANE), in: 8th International Conference on Collaborative Computing: Networking, Applications and Worksharing, CollaborateCom, 2012, pp. 316–325,.

[68]

Noumeir R., Radiology interpretation process modeling, J. Biomed. Inform. 39 (2) (2006) 103–114,.

Digital Library

[69]

A. Alahmadi, B. Soh, A. Ullah, Automated Health Business Process Modelling and Analysis for E-Health System Requirements Elicitation, in: Pacific Asia Conference on Information Systems, Vol. 1, 2014, pp. 1–13.

[70]

Askari M., Improving Quality of Fall Prevention and Management in Elderly Patients Using Information Technology: The Impact of Computerized Decision Support, (Ph.D. thesis) University of Amsterdam, 2014.

[71]

Martin M., Champion R., Kinsman L., Masman K., Mapping patient flow in a regional Australian emergency department: a model driven approach, Int. Emerg. Nurs. 19 (2) (2011) 75–85,.

[72]

Campbell H., Hotchkiss R., Bradshaw N., Porteous M., Integrated care pathways, Br. Med. J. 316 (7125) (1998) 133–137,.

[73]

Reichert M., Weber B., Enabling Flexibility in Process-Aware Information Systems: Challenges, Methods, Technologies, Springer-Verlag Berlin Heidelberg, 2012,.

Digital Library

[74]

Rosa M.L., Van Der Aalst W.M., Dumas M., Milani F.P., Business process variability modeling: A survey, ACM Comput. Surv. 50 (1) (2017) 2,.

Digital Library

[75]

Cheikhrouhou S., Kallel S., Guermouche N., Jmaiel M., Toward a time-centric modeling of business processes in BPMN 2.0, in: International Conference on Information Integration and Web-Based Applications & Services, in: IIWAS ’13, ACM, 2013, pp. 154–163,.

Digital Library

[76]

Adolfsson P., Parkin C.G., Thomas A., Krinelke L.G., Selecting the appropriate continuous glucose monitoring system–a practical approach, Eur. Endocrinol. 14 (1) (2018) 24,.

[77]

Mackway-Jones K., Marsden J., Windle J. (Eds.), Emergency Triage, BMJ Publishing Group, 1997.

[78]

Russell N., van der Aalst W.M., Ter Hofstede A.H., Edmond D., Workflow resource patterns: Identification, representation and tool support, in: International Conference on Advanced Information Systems Engineering, Springer, 2005, pp. 216–232,.

Digital Library

[79]

Hall R., Belson D., Murali P., Dessouky M., Modeling patient flows through the healthcare system, in: Patient Flow: Reducing Delay in Healthcare Delivery, Springer, 2006, pp. 1–44,.

[80]

Di Saverio S., Birindelli A., Kelly M.D., Catena F., Weber D.G., Sartelli M., Sugrue M., De Moya M., Gomes C.A., Bhangu A., et al., WSES jerusalem guidelines for diagnosis and treatment of acute appendicitis, World J. Emerg. Surg. 11 (1) (2016) 34,.

[81]

Wohlin C., Runeson P., Host M., Ohlsson M., Regnell B., Wesslén A., Experimentation in Software Engineering, Springer-Verlag Berlin Heidelberg, 2012,.

Cited By

Egger Ater Hofstede AKratsch WLeemans SRöglinger MWynn M(2024)Bot log miningInformation Systems10.1016/j.is.2024.102431126:COnline publication date: 1-Dec-2024
https://dl.acm.org/doi/10.1016/j.is.2024.102431
Zerbato FPufahl LTeije A(2023)PrefaceArtificial Intelligence in Medicine10.1016/j.artmed.2023.102631143:COnline publication date: 1-Sep-2023
https://dl.acm.org/doi/10.1016/j.artmed.2023.102631
Michalowski MRao MWilk SMichalowski WCarrier M(2023)Using graph rewriting to operationalize medical knowledge for the revision of concurrently applied clinical practice guidelinesArtificial Intelligence in Medicine10.1016/j.artmed.2023.102550140:COnline publication date: 1-Jun-2023
https://dl.acm.org/doi/10.1016/j.artmed.2023.102550
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BPMN in healthcare: Challenges and best practices

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cover image Information Systems

Information Systems Volume 107, Issue C

Jul 2022

240 pages

ISSN:0306-4379

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Elsevier Science Ltd.

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Published: 01 July 2022

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Cited By

Egger Ater Hofstede AKratsch WLeemans SRöglinger MWynn M(2024)Bot log miningInformation Systems10.1016/j.is.2024.102431126:COnline publication date: 1-Dec-2024
https://dl.acm.org/doi/10.1016/j.is.2024.102431
Zerbato FPufahl LTeije A(2023)PrefaceArtificial Intelligence in Medicine10.1016/j.artmed.2023.102631143:COnline publication date: 1-Sep-2023
https://dl.acm.org/doi/10.1016/j.artmed.2023.102631
Michalowski MRao MWilk SMichalowski WCarrier M(2023)Using graph rewriting to operationalize medical knowledge for the revision of concurrently applied clinical practice guidelinesArtificial Intelligence in Medicine10.1016/j.artmed.2023.102550140:COnline publication date: 1-Jun-2023
https://dl.acm.org/doi/10.1016/j.artmed.2023.102550
Dragoni MEccher CFerro ABailoni TMaimone RZorzi ABacchiega AStulzer GGhidini C(2023)Supporting patients and clinicians during the breast cancer care path with AIArtificial Intelligence in Medicine10.1016/j.artmed.2023.102514138:COnline publication date: 1-Apr-2023
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Godfrey TKühn TSousa V(2022)Participatory agent-based modelling in healthcareProceedings of the 25th International Conference on Model Driven Engineering Languages and Systems: Companion Proceedings10.1145/3550356.3552370(209-212)Online publication date: 23-Oct-2022
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