Modeling a Clinical Pathway for Contraception
16 July 2019
21 October 2019
11 December 2019 (online)
Background The Centers for Disease Control and Prevention (CDC) produced a 72-page document titled “U.S. Selective Practice Recommendations for Contraceptive Use” in 2016. This document contains the medical eligibility criteria (MEC) for contraceptive initiation or continuation based on a patient's current health status. Notations such as Business Process Model and Notation (BPMN) and Decision Model and Notation (DMN) might be useful to model such recommendations.
Objective Our objective was to use BPMN and DMN to model and standardize the processes and decisions involved in initiating birth control according to the CDC's MEC for birth control initiation. This model could then be incorporated into an electronic health records system or other digital platform.
Methods Medical terminology, processes, and decisions were modeled in coordination with the CDC to ensure correctness. Challenges in terminology bindings were identified and categorized.
Results A model was successfully produced. Integration of clearly defined data elements proved to be the biggest challenge.
Conclusion BPMN and DMN have strengths and weaknesses when modeling medical processes; however, they can be used to successfully create models for clinical pathways.
Keywordsbusiness process model and notation - decision model and notation - contraception - medical eligibility criteria - clinical pathway - clinical guideline
Protection of Human and Animal Subjects
No human or animal subjects were included in this project.
- 1 Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. Available at: https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6503.pdf . Accessed August 20, 2019
- 2 OMG. Business Process Model and Notation (BPMN) Version 2.0.2, 2014. Available at: https://www.omg.org/spec/BPMN/2.0.2 . Accessed October 5, 2019
- 3 OMG. Decision Model and Notation (DMN) Version 1.2, 2019. Available at: https://www.omg.org/spec/DMN . Accessed October 5, 2019
- 4 Ferrante S, Bonacina S, Pozzi G, Pinciroli F, Marceglia S. A design methodology for medical processes. Appl Clin Inform 2016; 7 (01) 191-210
- 5 Dong W, Huang Z. A method to evaluate critical factors for successful implementation of clinical pathways. Appl Clin Inform 2015; 6 (04) 650-668
- 6 Pope C. Resisting evidence: the study of evidence-based medicine as a contemporary social movement. Health 2003; 7 (03) 267-282
- 7 Kohn LT, Corrigan J, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000
- 8 Brook RH, McGlynn EA, Shekelle PG. Defining and measuring quality of care: a perspective from US researchers. Int J Qual Health Care 2000; 12 (04) 281-295
- 9 Reid RO, Friedberg MW, Adams JL, McGlynn EA, Mehrotra A. Associations between physician characteristics and quality of care. Arch Intern Med 2010; 170 (16) 1442-1449
- 10 Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States?. Milbank Q 1998; 76 (04) 517-563 , 509
- 11 McGlynn EA, Asch SM, Adams J. , et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348 (26) 2635-2645
- 12 Howe JL, Adams KT, Hettinger AZ, Ratwani RM. Electronic health record usability issues and potential contribution to patient harm. JAMA 2018; 319 (12) 1276-1278
- 13 Centers for Disease Control and Prevention. US Medical Eligibility Criteria (US MEC) for Contraceptive Use, 2016 Summary. Available at: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html . Accessed August 20, 2019
- 14 Trisotech. Cloud-based software to Visualize, Innovate, Transform, and Improve your organization, 2019. Available at: https://www.trisotech.com/ . Accessed October 5, 2019
- 15 Scheuerlein H, Rauchfuss F, Dittmar Y. , et al. New methods for clinical pathways-business process modeling notation (BPMN) and tangible business process modeling (t.BPM). Langenbecks Arch Surg 2012; 397 (05) 755-761
- 16 Strasser M, Pfeifer F, Helm E, Schuler A, Altmann J. Defining and reconstructing clinical processes based on IHE and BPMN 2.0. Stud Health Technol Inform 2011; 169: 482-486
- 17 Hasić F, De Smedt J, Vanthienen J. Augmenting processes with decision intelligence: principles for integrated modelling. Decis Support Syst 2018; 107: 1-2
- 18 Hasić F, Devadder L, Dochez M, Hanot J, De Smedt J, Vanthienen J. Challenges in refactoring processes to include decision modelling. In: International Conference on Business Process Management. Springer; 2017: 529-541
- 19 Hasić F, De Smedt J, Vanthienen J. A service-oriented architecture design of decision-aware information systems: decision as a service. In: OTM Confederated International Conferences “On the Move to Meaningful Internet Systems.” Springer; 2017: 353-361
- 20 Hasić F, Vanwijck L, Vanthienen J. Integrating Processes, Cases, and Decisions for Knowledge-Intensive Process Modelling. In: International Workshop on Practicing Open Enterprise Modeling; 2017: 1-12
- 21 Hasić F, De Smedt J, Vanthienen J. An illustration of five principles for integrated process and decision modelling (5PDM). KU Leuven; 2017: 1-8 . Available at: SSRN 3082752. Accessed October 30, 2019
- 22 Combi C, Oliboni B, Zardiniy A, Zerbato F. Seamless design of decision-intensive care pathways. In: IEEE International Conference on Healthcare Informatics (ICHI). IEEE 2016: 35-45
- 23 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 Healthcare Inform Res 2017; 1 (02) 157-217
- 24 Antonacci G, Calabrese A, D'Ambrogio A, Giglio A, Intrigila B, Ghiron NL. A BPMN-based automated approach for the analysis of healthcare processes. In: 2016 IEEE 25th International Conference on Enabling Technologies: Infrastructure for Collaborative Enterprises (WETICE). IEEE 2016: 124-129
- 25 HL7 FHIR. Welcome to FHIR, 2019. Available at: http://hl7.org/fhir/ . Accessed October 5, 2019
- 26 Loya SR, Kawamoto K, Chatwin C, Huser V. Service oriented architecture for clinical decision support: a systematic review and future directions. J Med Syst 2014; 38 (12) 140
- 27 Object Management Group. Field Guide to Shareable Clinical Pathways. BPMN, CMMN & DMN in Healthcare. Version: 1.0. OMG Healthcare Domain Taskforce; 2018
- 28 The Simple Healthcare Terminology Solution. Solor. Available at: http://solor.io/ . Accessed July 10, 2019
- 29 Giacomo GD, Oriol X, Estañol M, Teniente E. Linking data and BPMN processes to achieve executable models. Advanced Information Systems Engineering Lecture Notes in Computer Science. 2017: 612-628 . Doi: 10.1007/978-3-319-59536-8_38
- 30 Combi C, Oliboni B, Weske M, Zerbato F. Conceptual modeling of processes and data: connecting different perspectives. Conceptual Modeling Lecture Notes in Computer Science. 2018: 236-250 . Doi: 10.1007/978-3-030-00847-5_18
- 31 Bazhenova E, Zerbato F, Oliboni B, Weske M. From BPMN process models to DMN decision models. Inf Syst 2019; 83: 69-88
- 32 Hewelt M, Kunde A, Weske M, Meinel C. Recommendations for medical treatment processes: the PIGS approach. Business Process Management Workshops Lecture Notes in Business Information Processing. 2015: 16-27 . Doi: 10.1007/978-3-319-15895-2_2