healthflow, amia summit

RetroGuide (new name: HealthFlow)a knowledge representation and execution system for clinical research informatics alerts based on workflow

technology

Vojtech Huser MD PhD

http://www.morgridgeinstitute.org/index.php

Vojtech Huser, MD, PhDVojtech Huser, MD, PhD

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Agenda Introduction

Background Workflow Technology (WT)

Methods Our architecture

Results Implemented processes

Discussion/Conclusion


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Background Knowledge representation

decision support, quality improvement, research Institutions

Marshfield Clinic (+Intermountain Healthcare)

Workflow technology engine, editor

Huser (2010) J Biomed Inform

HealthcareWorkflow.wordpress.com

http://www.morgridgeinstitute.org/index.php


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Workflow Technology Business process management system (BPMS)

Workflow = The automation of a business process, in whole or part, during which documents, information or tasks are passed from one participant to another for action, according to a set of procedural rules.

Workflow Process = A set of one or more linked procedures or activities which collectively realize a business objective or policy goal, normally within the context of an organizational structure defining functional roles and relationships (definition vs. instance)

Worklist Handler = A software component that manages the interaction between the user and the worklist maintained by a workflow engine (task display, completion, acceptance, referral)

WfMC: Terminology & Glossary, Document Number WFMC-TC-1011, Feb 99 http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74


http://www.wfmc.org/index.php?option=com_docman&task=doc_download&gid=93&Itemid=74


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HealthFlow System

Actions

Knowledge Base(workflow process

definitions)

Data Inquiry

Workflow Execution

Engine(Shark)

EHR System layer:

Workflow editor(JaWE)

Data Visualization

Additional Components:

Event Data Model

code.google.com/p/HealthFlow


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HealthFlow: RetroGuide, FlowGuide

EHR system

Event Listener

Notifications

Actions


definitions)

Data Inquiry

Workflow Execution

Engine(Shark)

EHR System layer:

Prospective mode (FlowGuide):

Retrospective mode(RetroGuide):

Reports

Data Warehouse


Data Visualization


Event Data Model

Additional External Services(Terminology services, NLP services,

Statistical Analysis)



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EHR system

Event Listener

Notifications

Actions


definitions)

Data Inquiry

Workflow Execution

Engine(Shark)

EHR System layer:



Reports

Data Warehouse

Workflow mining(ProM)


Data Visualization


Event Data Model

Ontology Model

Host EHR Passive Interaction Model

Host EHR Active Interaction Model



Workflow log analysis

Screenshot tour



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EHR system

Event Listener

Notifications

Actions


definitions)

Data Inquiry

Workflow Execution

Engine(Shark)

EHR System layer:



Reports

Data Warehouse



Data Visualization


Event Data Model

Ontology Model







10HealthcareWorkflow.wordpress.com


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Code Layer (node; right click properties)



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EHR system

Event Listener

Notifications

Actions


definitions)

Data Inquiry

Workflow Execution

Engine(Shark)

EHR System layer:



Reports

Data Warehouse



Data Visualization


Event Data Model

Ontology Model







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Together Workflow Engine (Community edition)



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Together Workflow Engine (Community edition)



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EHR system

Event Listener

Notifications

Actions


definitions)

Data Inquiry

Workflow Execution

Engine(Shark)

EHR System layer:



Reports

Data Warehouse



Data Visualization


Event Data Model

Ontology Model







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Example of execution

0.9% of patients with high

risk patients with

subsequent MI


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Results



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Implemented processes RetroGuide (v2) (2004-2008) (published)

Quality improvement Osteoporosis Cholesterol management Blood pressure control in diabetics

Decision support Computerized glucose management

protocol Adverse Drug Events

Research Hodgkin's lymphoma and pregnancy Hepatitis C

+ several other experimental

RetroGuide (v3) (2008 – now) IRB 1 20+ scenarios

US Prev. Services TF Health plan rules hsCRP Genetic counseling Thyroid disease, ACEi monitoring osteoporosis

FlowGuide – validation (IRB 2) Implemented (Nov 2009)

Surgical patient discharge (feasibility) (Sep 2009)

Cholesterol management Rheumatoid arthritis

Planned (IRB) Hearth failure Medical home recommendations

FlowGuide – production (IRB 3) IRB writing stage


Huser (2010) J Biomed Inform


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FlowGuide - Validation (RA, LDL)


Final Slides


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Discussion Advantages

cross industry technology graphical representation stand alone solution applicable to several domains (query problem, alert problem) retrospective/prospective switch

Disadvantages required technical infrastructure is complex complex logic will remain complex even if expressed as a flowchart Not all logic is supported by a given workflow suite - externalized (web-service,

other engines) Future work

More robust set of HealthFlow External Applications (FindEvent) Representation of phenotypes Better linkage to EHR system Support for all relevant standards (e.g., HL7 vMR, Terminology Services, HL7

DSS)



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Workflow technology workshop AMIA NOW!, May 2010


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Summary Successful integration of a workflow engine

with an EHR system Knowledge representation using cross-industry

technology Other institutions can implement a similar

framework, sharing of logic is possible



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Thank you [email protected]

http://healthcareworkflow.wordpress.com http://code.google.com/p/healthflow

Questions? http://marshfieldclinic.org/birc Acknowledgement: programmers: Luke Rasmussen, Ryan Oberg

mailto:[email protected]

http://healthcareworkflow.wordpress.com/

http://code.google.com/p/healthflow

http://marshfieldclinic.org/birc

healthflow, amia summit

Health & Medicine

workflow process

flowguide code

healthflow system code

workflow enginetask

execution system

crossindustry technology

flowguide validation

processes retroguide