Business Process
Management in Healthcare
Closing the loop by mining careflows
Prof.dr.ir. Wil van der Aalst
Eindhoven University of Technology
Department of Information and Technology
P.O. Box 513, 5600 MB Eindhoven
The Netherlands
w.m.p.v.d.aalst@tm.tue.nl
Outline
•
•
•
•
•
•
Business Process Management (BPM) in healthcare
Closing the BPM cycle
What is workflow management?
25 years of workflow management (systems)
Challenges for the next 25 years
Process mining
– Overview
– Toolset
– Examples
• Conclusion
BPM in healthcare
From workflow to careflow
• Workflow Management (WFM) and Business
Process Management (BPM) are widely applied in
administrative processes but not in healthcare.
• Increasingly, clinical decisions need to be based on
scientific evidence, social-ethical values and
economic factors.
• Evidence-based care requires transparency,
justification, and accountability.
• Careflow processes need to be supported,
controlled, and monitored.
Medical protocols
• Also named medical guidelines (to emphasize
support) or pathways (to emphasize prediction).
protocols
action
assess and refine
protocol
protocol selection
and customization
protocol
measure
patient data
Comparing classical workflow with careflow
Process
definition
protocols
assess and refine
protocol
cases
action
protocol selection
and customization
protocol
measure
patient data
Medical protocols
• Existing languages for describing medical
protocols, guidelines and/or pathways: Asbru,
EON, GLIF, GUIDE, PRODIGY and PROforma.
• Use of the protocols:
– Passive: used to check afterwards
– Active: used to “control” the careflow
• BPM software/research supports both uses:
– Passive: process mining tools
– Active: workflow management systems
Closing the BPM cycle …
What is workflow management ?
www.workflowcourse.com
25 years of workflow management
office automation = workflow management = business process management = WSCL
Historical overview of systems
Office Automa tion P rototype s
Office ta lk-P
Office ta lk-D
Office ta lk-Ze ro
S cie ntific Workflow S ys te ms
Cros s Flow
P roMIna nD (Es prit)
ADOME
Ba ckta lk
Ma riflow
Me lma c
Domino
MENTOR
WIDE
AP RICOT
S COOP
WorCRAFT
DAIS Y
WorCOS
INCA
MOBILE
Obje ctLe ns
Fre e Flow
OVAL
METEOR
TRAMs
WIS E
P a nta Rhe i
WAMO
WAS A
P ois e
1980
P olyme r
1985
D-P olyme r
WAS A2
P olyflow
1990
1995
2000
(Zur Muehlen, 2003)
Comme rcia l Workflow S ys te ms
Vie wS ta r
Luce nt Mos a ix
e iS
WANG Workflow
Blue Cros s
Blue S hie ld
Ea s tma n
S IGMA
WANG
J CALS
Workflow
management is
already 25 years old
(cf. OfficeTalk, Skip
Ellis/Xerox)!
The WFM hype is
over …, but there
are more and more
applications, and
WFM is adopted by
many other
technologies (ERP,
Web Services, etc.).
CA
Ve rve
V
MS 2 Acce le r
Vis ua lInfo
Continuum
Ne ts ca pe P M
i
jFlow
B
DST AWD
DST AWD
Ima ge P lus FMS /FAF
Pa vone
One s tone
Domino Wo
NCR P roce s s IT
Exotica I - III
FlowMa rk
P e ga s us
MQSe rie s Work
Ope nPM
WorkMa na ge r
FlowJ e t
AdminFlow
Cha nge
SNI WorkPa rty
Re cognition Int.
P le xus FloWa re
COS A
Ba ncTe c Flo
Ba a N
Le y
Ora cle Workflow
Digita l Obje ctflow
DEC LinkWorks
Digita l P roc.Flo.
Be yond Be yondMa il
Alta Vis ta Proc.Fl
Ba nya n Be yondMa il
Fujits u iF
Fujits u Re ga tta
Te a mwa re Flow
S ta ffwa re
File Ne t WorkFlo
Vis ua l WorkFlo
P a na gon W
File Ne t Ens e mble
Action Coordina tor
ActionWorkflow
Da Vinci
ActionWorks Me tro
Xe rox InConce rt
TIB/InC
IABG P roMIna nD
Olive tti X_Workflow
1980
1985
1990
LEU
1995
2000
Workflow patterns
asic Control Flow Patterns
Pattern 1 (Sequence)
Pattern 2 (Parallel Split)
Pattern 3 (Synchronization)
Pattern 4 (Exclusive Choice)
Pattern 5 (Simple Merge)
Advanced Branching and
Synchronization Patterns
• Pattern 6 (Multi-choice)
• Pattern 7 (Synchronizing Merge)
• Pattern 8 (Multi-merge)
• Pattern 9 (Discriminator)
Patterns involving Multiple Instances
• Pattern 12 (Multiple Instances Without
Synchronization)
• Pattern 13 (Multiple Instances With a Priori
Design Time Knowledge)
• Pattern 14 (Multiple Instances With a Priori
Runtime Knowledge)
• Pattern 15 (Multiple Instances Without a Priori
Runtime Knowledge)
Structural Patterns
• Pattern 10 (Arbitrary Cycles)
• Pattern 11 (Implicit Termination
State-based Patterns
• Pattern 16 (Deferred
Choice)
• Pattern 17 (Interleaved
Parallel Routing)
•
Pattern 18 (Milestone)
Cancellation Patterns
• Pattern 19 (Cancel Activity)
• Pattern 20 (Cancel Case)
www.workflowpatterns.com
1 (seq)
2 (par-spl)
3 (synch)
4 (ex-ch)
5 (simple-m)
6 (m-choice)
7 (sync-m)
8 (multi-m)
9 (disc)
10 (arb-c)
11 (impl-t)
12 (mi-no-s)
13 (mi-dt)
14 (mi-rt)
15 (mi-no)
16 (def-c)
17 (int-par)
18 (milest)
19 (can-a)
20 (can-c)
Staffw. COSA InConc. Eastm. Verve MQSeries SAP/R3 BPML BPEL4WS
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+/+
+
+
+
+
+
+
+
+/+
+
+
+
+
+
+
+
+/+
+
+
+/+
+
+
+
+
+/+
+
+
+/+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+/+
+
+
+
+
+
+
+
+
+
+
+/+
+
+
+
+/+
+
+
+
+
+
+
+
+
+
Challenges for the next 25 years
Challenges
• Realize what has been promised in the last 25
years …..
– Design support
– Verification, validation and performance analysis
– Cross-organizational workflow support
– More flexibility (case handling)
– Better management information (process mining)
–…
• These challenges also apply to careflow!
Process mining
Process mining: Reversing the process
Prepare
shipment
process
mining
Register
order
Ship
goods
(Re)send
bill
Archive
order
Receive
payment
Contact
customer
• Process mining can be used for:
– Process discovery (What is the process?)
– Delta analysis (Are we doing what was specified?)
– Performance analysis (How can we improve?)
www.processmining.o
Process mining (overview)
2) process model
3) organizational model
4) social network
Start
Register order
Prepare
shipment
(Re)send bill
Ship goods
Contact
customer
Receive payment
Archive order
End
1) basic
performance
metrics
5) performance
characteristics
6) auditing/security
If …then …
Process Mining: Tooling
workflow management systems
case handling / CRM systems
ERP systems
Staffware
FLOWer
SAP R/3
InConcert
Vectus
BaaN
MQ Series
Siebel
Peoplesoft
common XML format for storing/
exchanging workflow logs
mining tools
EMiT
Thumb
MiSoN
Focus of BPM vendors so far …
2) process model
3) organizational model
4) social network
Start
Register order
Prepare
shipment
(Re)send bill
Ship goods
Contact
customer
Receive payment
Archive order
End
1) basic
performance
metrics
5) performance
characteristics
6) auditing/security
If …then …
Example (ARIS PPM)
IDS Scheer's ARIS Process Performance Manager
Example: mining process models (control-flow)
2) process model
3) organizational model
4) social network
Start
Register order
Prepare
shipment
(Re)send bill
Ship goods
Contact
customer
Receive payment
Archive order
End
1) basic
performance
metrics
5) performance
characteristics
6) auditing/security
If …then …
Example: processing customer orders
Example in
Staffware:
7 tasks and
all basic
routing
constructs
ragment of Staffware log
Case 21
Diractive Description
Event
User
yyyy/mm/dd hh:mm
---------------------------------------------------------------------------Start
swdemo@staffw_edl 2003/02/05 15:00
Register order
Processed To
swdemo@staffw_edl 2003/02/05 15:00
Register order
Released By
swdemo@staffw_edl 2003/02/05 15:00
Prepare shipment
Processed To
swdemo@staffw_edl 2003/02/05 15:00
(Re)send bill
Processed To
swdemo@staffw_edl 2003/02/05 15:00
(Re)send bill
Released By
swdemo@staffw_edl 2003/02/05 15:01
Receive payment
Processed To
swdemo@staffw_edl 2003/02/05 15:01
Prepare shipment
Released By
swdemo@staffw_edl 2003/02/05 15:01
Ship goods
Processed To
swdemo@staffw_edl 2003/02/05 15:01
Ship goods
Released By
swdemo@staffw_edl 2003/02/05 15:02
Receive payment
Released By
swdemo@staffw_edl 2003/02/05 15:02
Archive order
Processed To
swdemo@staffw_edl 2003/02/05 15:02
Archive order
Released By
swdemo@staffw_edl 2003/02/05 15:02
Terminated
2003/02/05 15:02
Case 22
Diractive Description
Event
User
yyyy/mm/dd hh:mm
---------------------------------------------------------------------------Start
swdemo@staffw_edl 2003/02/05 15:02
Register order
Processed To
swdemo@staffw_edl 2003/02/05 15:02
Register order
Released By
swdemo@staffw_edl 2003/02/05 15:02
Prepare shipment
Processed To
swdemo@staffw_edl 2003/02/05 15:02
Fragment of XML file
<?xml version="1.0"?>
<!DOCTYPE WorkFlow_log SYSTEM
"http://www.tm.tue.nl/it/research/workflow/mining/WorkFlow_log.dtd">
<WorkFlow_log>
<source program="staffware"/>
<process id="main_process">
<case id="case_0">
<log_line>
<task_name>Case start</task_name>
<event kind="normal"/>
<date>05-02-2003</date>
<time>15:04</time>
</log_line>
<log_line>
<task_name>Register order</task_name>
<event kind="schedule"/>
<date>05-02-2003</date>
<time>15:04</time>
EMiT
Focus on time.
Example: mining social networks
2) process model
3) organizational model
4) social network
Start
Register order
Prepare
shipment
(Re)send bill
Ship goods
Contact
customer
Receive payment
Archive order
End
1) basic
performance
metrics
5) performance
characteristics
6) auditing/security
If …then …
SN based on hand-over of work metric
density of network is
0.225
SN based on working together (and ego network)
SN based on joint activities
SN based on hand-over of work between groups
Relating tasks and performers
(using correspondence analysis)
Conclusion
diagnosis
Conclusion
proces
design
process
enactment
implementation/
configuration
Careflow is an interesting but also challenging application
domain for BPM/WFM technology.
It is important to close the BPM loop. Process mining is one
way to do this.
Process mining provides many interesting challenges for
scientists, customers, users, managers, consultants, and tool
developers.
Process mining is particularly interesting in the healthcare
domain (cf. evidence-based medicine, increased
accountability, and need to cut costs).
More information
http://www.workflowcourse.com
http://www.workflowpatterns.com
http://www.processmining.org
W.M.P. van der Aalst and K.M. van Hee.
Workflow Management: Models, Methods, and
Systems.
MIT press, Cambridge, MA, 2002/2004.