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Eric Browne. Workflow Modelling of Coordinated Inter-Health-Provider Care Plans.
PhD thesis submitted to the Division of Information Technology,
Engineering and the Environment. January 2005. Abstract. (full thesis - PDF).
Abstract
Workflow in healthcare, particularly for the shared and coordinated
management of chronic illnesses, is very difficult to model. It is also
difficult to support via current Clinical Information Systems and
current information technologies. This dissertation contributes
significant enhancements to the current methodologies for designing and
implementing Workflow Management Systems (Wf MSs ) suitable for
healthcare. The contribution comprises three interrelated aspects of
workflow system architecture as follows:-
- Firstly, it shifts the emphasis of workflow modelling and
enactment to a focus on goals, and the monitoring and facilitation of
their achievement.
- Secondly, it introduces the concept of self-modifying workflow in
the context of health care planning, whereby explicit tasks in the
goal-based care plan are devoted to assessing and modifying downstream
workflow.
- Thirdly, this dissertation proposes methodologies for identifying
and dealing with tasks which overlap, subsume or interfere with other
tasks elsewhere in a given workflow.
The language and methods introduced in goal-based requirements
engineering research have been carried into the domain of Wf MSs and
adapted by the author as a mechanism for deriving workflow models that
can be communicated and enacted by health care providers contributing
to the shared care of a patient. A methodology is described, whereby a
hierarchical goal-based view for the management of a chronic condition
or conditions can be automatically translated into a workflow schema.
This workflow schema contains subworkflows corresponding to each goal,
together with specfic tasks dedicated to monitoring, and, if necessary,
altering the downstream workflow to optimally achieve each goal target.
For self-modifying workflow, certain tasks in the workflow schema
are devoted to modifying the downstream workflow on an instance by
instance basis. Such
self-modifying schemas provide the necessary exibility to suit the
evolving diagnostic and therapeutic processes encountered in Chronic
Disease Management
(CDM), particularly in complex areas requiring significant
individualisation. The management of Diabetes Mellitus in a community
care setting provides an example
to illustrate this complexity. In order to facilitate self-modification
of workflow schemas, this dissertation enunciates a set of valid
operations that can be applied to downstream components of a workflow
schema. These operations are primarily concerned with turning abstract
subworkflows into concrete ones through completion and alteration of
template primitives. There are many situations in inter-organisational
health care, where, for a given care process, activities might be
undertaken in one clinic that overlap with, or repeat activities
undertaken elsewhere. This dissertation proposes solutions to
situations where duplicated tests and procedures are costly and can
have negative health impacts on patients undergoing unnecessary tests
and interventions.
The approach builds on the two-tier goal/process representation of
healthcare processes and describes an execution model comprising a
candidate discovery phase, followed by a component crediting phase. The
notions of full vs. partial crediting, and goal-level vs.
activity-level crediting are introduced. The role that temporal
constraints play in determining candidate components for crediting is
also examined.
Aspects of a prototype Workflow Management System (called StreamLine
) that the author has built, are described in order to illustrate how
the approach of goal-based workflow schema derivation, self-modifying
worklow schemas, and activity overlap identication and crediting can
provide sufficient flexibility and
focus to substantially improve the management of complex, chronic conditions.
The author's prototype is tested using the current local work
practices for treating Non-Insulin Dependent Diabetes Mellitus
involving shared care plans based on
Australian guidelines. The dissertation concludes with an assessment of
the implications of goalbased, self-modifying, redundancy-reducing
workflow models for developers and implementors of Wf MSs as well
as for implementors of future Health Information Networks employing
such complex workflow solutions.
Last changed:
$Date: 2006-03-23 22:48:25 +0000 (Thu, 23 Mar 2006) $ $Revision: 57 $
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