Introduction to workflow technology Representation of healthcare processes in a workflow editor and their execution in a workflow engine Vojtech Huser, MD PhD Marshfield Clinic

1. Introduction to workflow technology
Representation of healthcare processes in a workflow
editor and their execution in a workflow engine
Vojtech Huser MD PhD
AMIA NOW, Small Group session, Tutorial (1hr)

2. Agenda
 Part 1: Introduction, history, overview
 Part 2: Standards, SDO, related theories
 Part 3: Practical tools demonstration
 Originally 2 hour workshop
 converted to 1 hour tutorial (with focus on introduction and
standards)
 Accompanying bibliography document
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Vojtech Huser, MD, PhD

3. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process definition,
execution engine, analytical components)
 Benefits of implementing a workflow server within a
generic IT system
 Major workflow vendors and open-source workflow
technology tools
 Workflow Technology applied industries and healthcare
 Future development and research challenges
3
Vojtech Huser, MD, PhD

4. Part 2: WT standards, SDOs, related theories
 Workflow management coalition’s (WfMC)
standards
 Definition of WT terms
 XML process definition language (XPDL)
 Other standardization efforts
 Business Process Execution Language (BPEL)
 Business Process Modeling Notation (BPMN)
 Research-originated WT standards
 Petri Nets theory and its relationship to
workflows
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5. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
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Vojtech Huser, MD, PhD

6. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process definition,
execution engine, analytical components)
 Benefits of implementing a workflow server within a
generic IT system
 Major workflow vendors and open-source workflow
technology tools
 Workflow Technology applied industries and healthcare
 Future development and research challenges
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Vojtech Huser, MD, PhD

7. Workflow technology
 BPM = business process management
 Adaptive workflow (Adaptive Case
Management)
 Computer supported collaborative work
(CSCW)
 Why workflow?
 Separation of data into databases
 Separation of UI from IT system core
 Separation of process knowledge
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8. Process Example
Koetter (2007)
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10. Workflow patterns examples
 Parallel Split: When an intrusion alarm is received,
trigger the dispatch-patrol activity and the inform-police
activity immediately.
 Exclusive Choice: After the review election activity is
complete, either the declare results or the recount votes
activity is undertaken.
 Multi Choice: Depending on the nature of the
emergency call, one or more of the despatch-police,
despatch-fire-engine and despatch-ambulance activities
is immediately initiated.
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12. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process definition,
execution engine, analytical components)
 Benefits of implementing a workflow server within a
generic IT system
 Major workflow vendors and open-source workflow
technology tools
 Workflow Technology applied industries and healthcare
 Future development and research challenges
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Vojtech Huser, MD, PhD

13. WT development
 1960s
 Petri Nets (Carl A. Petri PhD work)
 1960s-present
 Workflow components of various systems
 1999
 WfMC: terminology
 2000s
 2002: XPDL 1.0
 2005 XPDL 2.0
 2008 XPDL 2.1
 BPMN standard
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18. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process
definition, execution engine, analytical components)
 Benefits of implementing a workflow server within a
generic IT system
 Major workflow vendors and open-source workflow
technology tools
 Workflow Technology applied industries and healthcare
 Future development and research challenges
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19. Automating Workflow
 Defined by Workflow Management
Coalition (WfMC)
 www.wfmc.org
 Terminology and Glossary
 http://www.wfmc.org/standards/docs/TC-
1011_term_glossary_v3.pdf
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20. Terms
 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.
 WfMS = Workflow Management System
 BPM = Business Process Management
 BPMS = Business Process Management System
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23. Humans & machines working together
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24. Executable flowchart
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26. Minimum components
language edito
r
execution engine
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27. Interfaces
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28. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process definition,
execution engine, analytical components)
 Benefits of implementing a workflow server within
a generic IT system
 Major workflow vendors and open-source workflow
technology tools
 Workflow Technology applied industries and healthcare
 Future development and research challenges
28
Vojtech Huser, MD, PhD

29. WT benefits
 Non-programmers understand processes
 Non-programmers can modify processes
 Analytical tools
 Faster IT system development (SOA+WT)
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30. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process definition,
execution engine, analytical components)
 Benefits of implementing a workflow server within a
generic IT system
 Major workflow vendors and open-source
workflow technology tools
 Workflow Technology applied industries and healthcare
 Future development and research challenges
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31. Choice of Wf vendor
 Major player
 TIBCO
 BEA
 Global 360
 IBM
 Other
 Fujitsu
 IBM
 Oracle
 Microsoft
 SAP
 Lombardi
 Open source
 JBOSS
 Taverna
 Together
 Bonita
 YAWL
 http://java-source.net/open-
source/workflow-engines
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37. Workflow engine
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38. Engine
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39. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process definition,
execution engine, analytical components)
 Benefits of implementing a workflow server within a
generic IT system
 Major workflow vendors and open-source workflow
technology tools
 Workflow Technology applied industries and
healthcare
 Future development and research challenges
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40. Use of WT
 Pioneer domains
 Banking
 Manufacturing
 Shipping
 Government authorities
 Pharmaceutical
 Healthcare
 Gartner 2008 report: <5% use
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41. Examples of WT use in healthcare
Bed management
Infections control (MRSA)
J. Emanuele and L. Koetter, "Workflow Opportunities and Challenges in Healthcare," in 2007 BPM
& Workflow Handbook, 2007.
L. Koetter, "MRSA infection control with workflow technology," Spring AMIA Conference, Orlando,
FL, 2007.
R. Hess, "The Chester County Hospital: Case Study," in 2007 Excellence in Practice: Moving the
Goalposts., 2007.
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42. Stroke guideline (WfMS)
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43. Soarian
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45. Current Soarian Example
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46. Use at Marshfield Clinic
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47. HealthFlow: RetroGuide, FlowGuide
Workflow Workflow
mining editor
(ProM) (JaWE)
EHR System layer: Additional Components:
Notifications
Prospective mode Host EHR Passive
Knowledge Base Workflow Event (FlowGuide): Interaction Model
(workflow process
definitions) Execution Listener
EHR system Host EHR Active
Engine Interaction Model
(Shark) Actions
Retrospective mode
Additional External Services
(Terminology services, NLP services, Data Inquiry (RetroGuide):
Statistical Analysis) Data Visualization
Data Warehouse
Event Data Model
Workflow log analysis Reports
Ontology Model
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Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com

48. Part 1: Introduction to workflow technology
 Need for specifying workflow within IT systems
 History of workflow technology
 prior 1960s-1980s
 development after 1990
 Components of workflow technology (process definition,
execution engine, analytical components)
 Benefits of implementing a workflow server within a
generic IT system
 Major workflow vendors and open-source workflow
technology tools
 Workflow Technology applied industries and healthcare
 Future development and research challenges
48
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49. Future of WT
 Improvements
 Adoption is growing
 Software tools sophistication is improving
 Competition, consolidation
 Future similar to a database server inclusion in
IT systems
 Standards consolidation
 Research challenges
 Process model visualization challenges
 Process model cross-vendor portability
 Adaptive workflow
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50. Workflow patterns
http://
workflowpatterns.com/
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51. Adaptive workflow
structured production workflow
process
ad-hoc workflow
unstructured computer-supported
process collaborative work
information process
centric centric
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52. Part 2: WT standards, SDOs, related theories
 Workflow management coalition’s (WfMC)
standards
 Definition of WT terms
 XML process definition language (XPDL)
 Other standardization efforts
 Business Process Execution Language (BPEL)
 Business Process Modeling Notation (BPMN)
 Research-originated WT standards
 Petri Nets theory and its relationship to
workflows
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53. Part 2: WT standards, SDOs, related theories
 Workflow management coalition’s (WfMC)
standards
 Definition of WT terms
 XML process definition language (XPDL)
 Other standardization efforts
 Business Process Execution Language (BPEL)
 Business Process Modeling Notation (BPMN)
 Research-originated WT standards
 Petri Nets theory and its relationship to
workflows
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54. WfMC
 Started in 1990
 5 interfaces
 XPDL 1.0, 2.0, 2.1
 Yearly Workflow handbook
…
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55. Part 2: WT standards, SDOs, related theories
 Workflow management coalition’s (WfMC)
standards
 Definition of WT terms
 XML process definition language (XPDL)
 Other standardization efforts
 Business Process Execution Language (BPEL)
 Business Process Modeling Notation (BPMN)
 Research-originated WT standards
 Petri Nets theory and its relationship to
workflows
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56. 56
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57. 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
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Vojtech Huser, MD, PhD HealthcareWorkflow.wordpress.com

58. Part 2: WT standards, SDOs, related theories
 Workflow management coalition’s (WfMC)
standards
 Definition of WT terms
 XML process definition language (XPDL)
 Other standardization efforts
 Business Process Execution Language (BPEL)
 Business Process Modeling Notation (BPMN)
 Research-originated WT standards
 Petri Nets theory and its relationship to
workflows
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59. XPDL
 XML file based on a XSD schema
 http://wfmc.org/xpdl.html
 First introduced in 1999
 Conformance testing available
 http://www.xpdl.org/Validate/ValidateXpdl
 Exchange format
 Adoption (70+ products)
 http://wfmc.org/xpdl-implementations.html
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60. Standards Timeline
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61. Example.xpdl
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62. Process Schema
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63. Activities
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64. Part 2: WT standards, SDOs, related theories
 Workflow management coalition’s (WfMC)
standards
 Definition of WT terms
 XML process definition language (XPDL)
 Other standardization efforts
 Business Process Execution Language (BPEL)
 Business Process Modeling Notation (BPMN)
 Research-originated WT standards
 Petri Nets theory and its relationship to
workflows
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65. WT standards
 Historical
 WSDL
 Current major
 XPDL, BPMN, BPEL
 Proprietary (vendor specific):
 JBPM (JBoss)
 Win Workflow Foundation (Microsoft)
 T2Flow->SCUFL2 (Taverna)
 internal format (Weka)
 Research ones
 YAWL
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66. Part 2: WT standards, SDOs, related theories
 Workflow management coalition’s (WfMC)
standards
 Definition of WT terms
 XML process definition language (XPDL)
 Other standardization efforts
 Business Process Execution Language (BPEL)
 Business Process Modeling Notation (BPMN)
 Research-originated WT standards
 Petri Nets theory and its relationship to
workflows
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67. Petri Nets
 Mathematical theory
 Basics
 Petri net consist two types of nodes: places
and transitions.
 A place may have zero or more tokens.
 Graphic representations :Places (circles),
transitions (bars), arcs (arrows), and
tokens (dots)
p1 t1 p2
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68. Definition of Petri Net
 C = ( P, T, I, O)
 Places
P = { p1, p2, p3, …, pn}
 Transitions
T = { t1, t2, t3, …, tn}
 Input
I : T  Pr (r = number of places)
 Output
O : T  Pq (q = number of places)
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71. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
71
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72. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
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73. Together workflow suite
 Editor
 JaWE  Together Workflow Editor (TWE)
 v1.4, v2, v3
 Engine
 Shark  Together Workflow Engine (TWS)
 Web-based module
 Integration with Outlook
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74. Demo
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75. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
75
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76. 76
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77. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
77
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79. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
79
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81. Log schema
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82. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
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87. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology
software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
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88. Other WT software components
 Editor, engine
 Administration (load a process)
 Monitoring (exception)
 Analysis (bottleneck finding)
 Workflow simulation
 Workflow mining
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89. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics
research
 Workflow engines and Decision support engines
89
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90. Use case studies
 Marshfield Clinic
 MainLine Health
 U of Pavia
 Einthoven University (NL)
 Chester County hospital
 See bibliography for references
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91. Part 3: Practical tools demos
 Demo of an editor and engine
 Example 1:
 Representing a surgical procedure, discharge and RCT trial
enrolment process
 Example 2:
 Two rheumatology decision support processes (TB screening,
Pneumococcal vaccine)
 Process mining tool (ProM)
 Example 3:
 Mining a progression of a chronic kidney disease from EHR data
 Brief overview of other workflow technology software
 Case studies of use in healthcare/informatics research
 Workflow engines and Decision support engines
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92. WT and DSS
 Clear overlap
 Many decision support engines have workflow features
 Many workflow engines have decision support features
 Workflow support vs. decision support
 What to do and when
 Published case studies of use of WT for decision support
 Related work
 Peleg at al.
 Guidelines and workflow models
 Design Patterns of Clinical Guidelines (2010) (Bonita wf editor)
 Mulyar at al.
 Comparison of Guidelines formalisms and workflow patterns
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93. Mulyar at al (2007)
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94. GLIF
guideline
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95. Sage flowchart example
 P. Ram (2004)
 “Executing Clinical Practice Guidelines
Using the SAGE Execution Engine,”
Medinfo, pp. 251-5, 2004
 SAGE’s decision maps
 subflows.
 Rule-in and Rule-out
contructs
 Linking workflow engine
with a rule engine
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96. Summary
 Part 1: Basic terms, history, use
 Part 2: Standards
 Part 3: Tools demonstration
 Cross-industry modeling
and execution platform structured
process
production workflow
with growing vendor and
tool base and healthcare ad-hoc workflow
use examples
unstructured computer-supported
process collaborative work
 http://healthcareworkflow.wordpress.com
 huser.vojtech@marshfieldclinic.org
information process
centric centric
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97. Questions ?
 http://healthcareworkflow.wordpress.com
 huser.vojtech@marshfieldclinic.org
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105. WT vendors
 Gartner:
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106. Standards
 Key standards
 XPDL = XML Process Definition Language
 Delivered as: XSD file
 BPMN = Business Process Modeling Notation
 Delivered as: PDF file
 Key organizations
 Workflow Management Coalition
 www.wfmc.org
 Object Management Group
 www.omg.org (www.bpmn.org)
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107. Other standards
 BPEL
 Business process execution language
 Origins: XLANG (Microsoft) + WSFL (IBM) = BPEL4WS
 Also known as WS-BPEL
 Efforts to link BPEL to BPMN
 YAWL
 Yet another workflow language
 Research project
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108. Standards Timeline - Releases
1994 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
WfMC
Ref
Wf-XML 1.0 Wf-XML 1.1 Wf-XML-R
Model
WPDL XPDL 1.0 XPDL 2.0 XPDL 2.1 XPDL 3.0
BPMI BPAF
BPMN 1.0
XML
OMG
BPMN BPMN BPMN
BPMN 1.0
1.1 1.2 2.0
OASIS
BPEL BPEL4People
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109. GLIF
guideline
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110. Workflow editors and engines

111. Wofkflow software components

112. WT software components
 Core components
 Editor
 Engine
 Additional components
 Administration application (deplay, terminate, versioning)
 Worklist handler
 User management (LDAP, MS, other)
 Organizational roles
 Monitoring/Analytical application
 Simulation tools
 Worfklow mining
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114. Interesting analyses
 Improving processes
 Allocation of tasks
 Push (human decides)/pull (machine) strategy
 (push to all or to one and then escalate)
 Earliest due date, first-in first-out
 Rules: (1)let a resource practice its specialty; (2) do similar
task in succession; (3) flexibility of staff (“save the
generalist”)
 Bottlenecks
 Number of cases in progress
 Case completion time
 Level of service (customers)
 Resource based indicators
 BPR = business process re-engineering
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115. 115
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116. 116
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117. 117
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118. Computer Supported Collaborative Work
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119. 119
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120. Workflow mining
 Traditional approach
 model your process, pilot, deploy
 Alternative
 Take existing event data
 Mine process definition
 Delta analysis
 Discovered process (current) vs. Human modelled process (goal,
dream design)
 Migration strategy
www.processmining.org
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121. 121
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122. 122
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123. Conclusion

124. How does it affect my coding ?
 Worklow technology is coming to your desktop
 Code will be split into small pieces (SOA)
 Manipulation / customization via flowchart
 CSCW vs. Structured processes
 WT future
 similar impact to IT as database technology in 1980s
 Worklow enabled IT system
 Ability to send and receive data to a worklow server
 Worklist handler rather then full system
 No need for designated monitoring pieces
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125. Summary
 Workflow technology
 Terms
 History
 Software components
 Theory
 Future of WT
 Bright (IT users will require it, ipod generation)
 Gradual adoption
 Maturation of standards, software
 WT here in Marshfield
 Phase 1: research use
 Phase 2: dev use within IT (provisioning, QI, CDSS)
 Phase 3: production use within Cattails sw
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126. Questions / Comments
126
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127. EXTRA SLIDES

128. 128
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129. Workflow / BPM Reference Model
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130. Workflow / BPM Reference Model
BPMN
XPDL
BPAF Wf-XML
BPEL
SOAP
REST
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131. Standards Timeline - Releases
1994 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
WfMC
Ref
Wf-XML 1.0 Wf-XML 1.1 Wf-XML-R
Model
WPDL XPDL 1.0 XPDL 2.0 XPDL 2.1 XPDL 3.0
BPMI BPAF
BPMN 1.0
XML
OMG
BPMN BPMN BPMN
BPMN 1.0
1.1 1.2 2.0
OASIS
BPEL BPEL4People
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132. Timeline
1993 1994 1995 1996 1997 November 2000 October May October
1998 2002 2004 2005
WFMC
Glossary
Reference
Wf-XML Wf-XML 2.0
Model
WPDL XPDL 1.0 XPDL 2.0
BPMI OMG
XML BPMN 1.0
OASIS
BPEL
ASAP
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133. 133
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134. XPDL Support in Market
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135. Over 70 XPDL Implementations…
 Adobe – • Enhydra JaWE • OpenPages
Adobe LiveCycle Workflow • Finantix Studio (FXS) • Oracle - 9i Warehouse Builder
 ADVANTYS - WorkflowGen • Fujitsu - Interstage BPM • Pentaho
 Amazonas Workflow • Projekty Bankowe Polsoft –
• FileNet - Process Manager
 Appian - Enterprise BPB Workflow
• GA Communications
 Arachnea - EverSuite • Proforma Corporation - ProVision
• Global 360 –
 Ascentn - AgilePoint Server Business Optimzation Server • Rodan Systems - OfficeObjects®
 Aspose Pty Ltd - • HOGA.PL
Workflow
Aspose.Workflow • Simprocess
• IBM - FileNet
 BOC - ADONIS 3.7 • Software AG- crossvision BPM
• IDS Scheer –
 BEA - Fuego Business Architect • SpeechCycle - LevelOne
 Brein BV - InProces • Integic – • TIBCO iProcess™ Suite
 Bonita v2.0 e.POWER WorkManager • Together Workflow Editor
 Box UK - Amaxus • Interwoven - WorkRoute MP • Transware - Ambassador
 Canto - CanFlow • Infor - SSA Baan, SSA BPCS, • Vignette –
 CapeVisions SSA MANMAN, SSA Process Workflow Modeler
 CARNOT - Process Engine • Masterpiece • W4 - BPM Suite
 CHALEX - BPM Framework • ITP-Commerce – • WfMOpen
 ComActivity Process Modeler Professional • Workflow::Wfmc
 Cubetto Toolset • IT Pearls • Workflow4r
 Dessault Systems - ENOVIA • jawFlow • ZAPLET 3 - PROCESS BUILDER
 Eclaire Group – • Jenz & Partner GmbH • Zynium - Byzio
Lynx Flow Designer • Kaisha-Tec - Avantage
 EMC Documentum - • Metoda S.p.A - OpenMet
ApplicationXtender Workflow BPMF
 Empresa Solutions - Kinnosa • Mindfire Solutions
Workflow • Nautica
 Enhydra Shark • Open Business Engine
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136. 136
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137. 137
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138. Six Standard BPMN / XPDL
Examples
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139. Six Standard BPMN / XPDL
Examples
 As of Feb 17, 2007, these vendors had
implemented:
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140. 140
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141. 141
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142. Workflow standards

143. Workflow vs. Java
 Workflow is basically graphical coding
 Workflow language offers contructs for
branching
 AND split
 AND joint
 OR split
 OR joint
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144. 144
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145. 145
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146. 146
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147. 147
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148. 148
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149. Conditions
 Pre-condition
 Post-condition
 Transition condition
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150. Tools

151. Tools
 Workflow editor
 Workflow Engines
 Commercial
 Oracle Workflow
 Open Source
 Shark
 OpenWFE (does not use XPDL, but it’s own format)
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152. 1. Editor - JaWE
 XPDL Editor
 http://jawe.objectweb.org
 written in Java
 Open Source
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154. 2. Engine - Shark
 Workflow Engine
 Open Source
 In beta stage
 http://shark.objectweb.org/
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155. 155
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156. Conclusion/Questions
 How can we best separate logic of a protocol
from workflow?
 Can HealthCare be automated using same
approach as Business Processes?
 Are the workflow standards and tools mature
enough?
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157. 157
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158. 158
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159. 159
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160. 160
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161. Workflow engine project

162. Agenda
 Workflow project: people contacts, resources
 Fujitsu go/no go criteria
 ability of Fujitsu to acknowledge current limitations
 Improvements to the editor (close collaboration vs. one-of-many-
customer)
 Long term plan (phase 2, phase 3)
 If Fujitsu is chosen
 If other vendor is chosen
 Small items
 Longer workflow technology talk (taped)
 (scientific seminar (Wed), grand rounds (Fri), IT brown bags)
 Shadowing
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163. Workflow project
 Phase 1: Research use: BIRC, Vojtech+BIRC is the
main developer
 Scenarios: clinical scenarios based on Vojtech’s work on RetroGuide (e.g., osteoporosis,
diabetes, chronic kidney disease)
 Phase 2: dev use in IT within CattailsMD suite, Vojtech
+ IT workflow person/team
 Scenarios: Provisioning (assigning user rightes, managing users), Decision Support
(JohnF), Ancilarry services (TammyF), Radiology (preping prior imaging studies)
 Phase 3: production use in IT, many IT
developers/managers involved
 Transforming dev processes to production systems
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164. Current status
 Fujitsu’s visit of July 28th
 Early experiments on VMWare Fujitsu’s image (dev image)
 Focus on breath of features (rather then full working scenario)
 Counting with future support
 MC’s server full install only finished on the last day at noon
 After the visit
 MC server
 Transport of tested features from dev image to MC’s server
 Demo access
 Mike’s flowchart
 Workflow follow-up meeting #1 (Aug 1st)
 Rule systems in current CattailsMD suite (
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165. Evaluation
 See separate document
 Advantages
 Disadvantages
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166. Key Benefit of Wf Technology
 Ability for non-expert to review or author
processes (strong editor)
 Level 1: processes developed via consulting
 Level 2: processes developed by MC’s workflow person
 Level 3: processes developed by chief of Pediatrics
 Using Wf Engine will decrease development cost
 Basic functions (no need to develop them)
 Advanced analytical/monitoring functions
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167. Requirements for Wf Editor/Flowchart
 Complexity: Ability to express all my
processes
 Complexity (it can support MC’s business, clinical
processes (DSS, QI), daily administrative processes
(coordinating staff and clinicians, departments)
 User-friendliness: Ability to express them
in a level 3 friendly way
 User-friendliness (buy in of MC’s users)
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168. Requirements for the flowchart
 The flowchart can be read without
additional drill down
 Can become quite complex and have many extra nodes
(split, join, conditions)
 Readability of the flowchart is most
important.
 Certain elements are hidden to improve readability
 Mousing-over, drill-down click reveals additional detail
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169. Choice of Wf vendor
 Feature set
 Price
 Special relationship
(partnership)
 TIBCO
 Fujitsu
 Lombardi
 BEA
 Global 360
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170. Evaluation perspectives
 data perspective
 deals with the passing of information , scoping of
variables
 resource perspective
 deals with resource to task allocation, delegation
 exception handling perspective
 deal with the various causes of exceptions and the
various actions that need to be taken as a result of
exceptions occurring
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171. WfMC glossary
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172. Terms
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173. Terms
[X]OR or AND split
Always
or if not (A or B or C)
If A If B If C
“Otherwise” route
Route A Route B Route C
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174. Flowchart and execution
 Complexity decision
 Flowchart will have everything (no drill-downs necessary)
 Flowchart will be a simplified view
 Type of process specific knowledge
 Design time
 Run time
 Deadlock situation
(how bullet-proof is your process definition)
 Flowchart level
 Engine level (default behavior) (simpler flowchart)
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175. Petri Nets (PN)

176. Screenshots of Wf editor/engine
(Fujitsu and some TIBCO)
(will be commented orally)

177. 177
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178. 178
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179. 179
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180. 180
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181. 181
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182. 182
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183. 183
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184. Theory

185. Petri Nets
 Petri net consist two types of nodes:
places and transitions.
 A place may have zero or more tokens.
 Graphically, places, transitions, arcs,
and tokens are represented respectively
by: circles, bars, arrows, and dots.
p1 t1 p2
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186. Definition of Petri Net
 C = ( P, T, I, O)
 Places
P = { p1, p2, p3, …, pn}
 Transitions
T = { t1, t2, t3, …, tn}
 Input
I : T  Pr (r = number of places)
 Output
O : T  Pq (q = number of places)
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187. Vector of places’ states
 Below is an example Petri net with two places
and one transaction.
 Transition node is ready to fire if and only if
there is at least one token at each of its input
places
p1 t1 p2
state transition of form (1, 0)  (0, 1)
p1 : input place p2: output place
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188. 188
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189. 189
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190. Screenshot tour
HealthcareWorkflow.wordpress.com

191. HealthFlow: RetroGuide, FlowGuide
Workflow Workflow
mining editor
(ProM) (JaWE)
EHR System layer: Additional Components:
Notifications
Prospective mode Host EHR Passive
Knowledge Base Workflow Event (FlowGuide): Interaction Model
(workflow process
definitions) Execution Listener
EHR system Host EHR Active
Engine Interaction Model
(Shark) Actions
Retrospective mode
Additional External Services
(Terminology services, NLP services, Data Inquiry (RetroGuide):
Statistical Analysis) Data Visualization
Data Warehouse
Event Data Model
Workflow log analysis Reports
Ontology Model
191
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192. 192
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193. 193
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194. Code Layer (node; right click properties)
194
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195. code.google.com/p/HealthFlow
195
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196. HealthFlow: RetroGuide, FlowGuide
Workflow Workflow
mining editor
(ProM) (JaWE)
EHR System layer: Additional Components:
Notifications
Prospective mode Host EHR Passive
Knowledge Base Workflow Event (FlowGuide): Interaction Model
(workflow process
definitions) Execution Listener
EHR system Host EHR Active
Engine Interaction Model
(Shark) Actions
Retrospective mode
Additional External Services
(Terminology services, NLP services, Data Inquiry (RetroGuide):
Statistical Analysis) Data Visualization
Data Warehouse
Event Data Model
Workflow log analysis Reports
Ontology Model
196
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197. Together Workflow Engine
(Community edition)
197
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198. Together Workflow Engine
(Community edition)
198
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