MedicalFlows

Executable medical workflows | #ClinicalPathways #ClinicalGuidelines | #BPMPlusHealth | #openEHR

[MedicalFlows @MedicalFlows]

@joostholslag That would be great. To start, any modeling approach that produces executable clinical guidelines would be great.

This is a challenge even without constraints on the used modeling approach.

With experience of executable clinical pathways the standard would eventually emerge 🤞

[MedicalFlows @MedicalFlows]

@ppazos openEHR schemas could be generated. Similar to how they are for OpenAPI by @pieterbos82 @sebast_iancu and you.

You are lucky to have your own CDR to test this with.

[MedicalFlows @MedicalFlows]

@ppazos I know. I'm also @NeoEHRcom from the Discourse 😉

[MedicalFlows @MedicalFlows]

@ppazos The schema in my case is provided by Camunda. It is the way to communicate with their engine.

#openEHR part is using RM inside BPMN.

I might use openEHR proto messages for frontend (for tasks list app and an app for adapting care plans).

For CDR I'll have to use REST API.

[MedicalFlows @MedicalFlows]

@ppazos @BHaarbrandt @joostholslag @docpaulmiller @ResusCouncilUK I would rather pay somebody who took time to learn #openEHR basics doing my frontend apps then pay 3 others who expect me to hand-hold them through writing vanilla web apps they are comfortable with.

Some apps are focused on CDR. Why not spend some time reading about #openEHR?

[MedicalFlows @MedicalFlows]

@ppazos @BHaarbrandt @joostholslag @docpaulmiller @ResusCouncilUK Since I'm handling both backend and frontend, I appreciate frontend components that are “aware” of the #openEHR DV_ structures that map directly to the openEHR DV_ classes.

I use such components even if the form is completely generated and I could care less about their code 😊

[MedicalFlows @MedicalFlows]

@joostholslag @ppazos @Nedaphealthcare @pieterbos82 Maybe some frontend apps use only your CDR API which simplifies it for the developers. If CDR API and Ruby API are used at the same time, I would rather use only Ruby API (which talks with CDR). 3/3

[MedicalFlows @MedicalFlows]

@joostholslag @ppazos @Nedaphealthcare @pieterbos82 Talking to a CDR directly from a frontend app feels like directly inserting into a database. However since you put an API in front of the CDR it is just a 2nd backend (like the one in Ruby). 1/3

[MedicalFlows @MedicalFlows]

@joostholslag @ppazos @Nedaphealthcare @pieterbos82 I would still rather have a single backend per frontend app which talks to other APIs/backends. User authentication/authorization is simpler that way. 2/3

[MedicalFlows @MedicalFlows]

@ppazos Thank you for these thoughts. I'm starting to work on such an architecture and made the same notes just a few hours ago 😊

It feels good you think the same about the architecture and use of #CDR, #frontend, #backend, #workflow.

[MedicalFlows @MedicalFlows]

Research papers propose #BPMN extension to limit temporal distance between any non-consecutive process elements.

That is visually appealing but the engine doesn’t execute it.

So I created an inter-activity duration constraint that #Camunda can execute:

https://t.co/7MwWFPAU4d

[MedicalFlows @MedicalFlows]

@Camunda Lets use patterns instead of extending the standard 😊

I implemented 4 groups of patterns in Camunda #Modeler:
✅ Temporal
✅ Repeat
✅ Parallel
✅ Exclusive resource lock

They are all executable on a standard #Camunda engine.

https://t.co/pi7YYsJRV8

[MedicalFlows @MedicalFlows]

I implemented "Exclusive Resource Lock" pattern for #BPMPlusHealth.

It is used in the #BPMN example for “Catheter Related Bloodstream Infections”:

https://t.co/T2Et8lF0O5

#ClinicalPathways #ClinicalDecisionSupport #ClinicalGuidelines #BPMPlus #Camunda

[MedicalFlows @MedicalFlows]

@ErikSundvall @bjornna @DIPSASA Nice UI!

My first attempt was Node-RED: https://t.co/Iu5mHCwleX - similar but open-source.

I switched to #BPMN and #Camunda (also open-source): https://t.co/xWTbBW3rfa

If we manage to convert clinical guidelines into executable form, we should use non-proprietary tools.

[MedicalFlows @MedicalFlows]

@GeoffCardwell @Trisotech @BPMPlusHealth The BPMN Quick Guide is meant as a simple introduction for those without any BPMN experience.
I couldn’t find a PDF version of it but it doesn’t take a long time to read its online version (maybe on a tablet).

Here is a short introduction from #ChatGPT:

[MedicalFlows @MedicalFlows]

I implemented "Differential Time to Positivity (DTP)" pattern for #BPMPlusHealth.
It is the most complex one so far.

#BPMN process for Catheter Related Bloodstream Infections.

https://t.co/AlfIZVSHIm

#ClinicalPathways #ClinicalDecisionSupport #ClinicalGuidelines #camunda

[MedicalFlows @MedicalFlows]

When something is expected to be #hard it turns out it is #simple 😊

I implemented #parallel pattern for #BPMN:

https://t.co/AjihVzU3Oh

#ClinicalPathways #ClinicalDecisionSupport #ClinicalGuidelines #camunda #BPMPlusHealth

[MedicalFlows @MedicalFlows]

I implemented #repeat pattern for #BPMPlusHealth:

https://t.co/Ss9YdJcHgm

#ClinicalPathways #ClinicalDecisionSupport #ClinicalGuidelines #camunda #bpmn

[MedicalFlows @MedicalFlows]

@BHaarbrandt Since everybody has been chatting with ChatGPT (instead of working), I decided to ask it to do some work for me. It wrote the introduction for #BPMN patterns:
https://t.co/TSDijBdlMR

I only changed "business processes" to "processes" since they are for clinical processes.

[MedicalFlows @MedicalFlows]

@atthatmatt @wolands_cat @rikrenard To do all that, it would need to know what “the correct” pathway should be.

ChatGPT can't do it:
https://t.co/dCkqd6S9nW

The LLMs at this stage need somebody to teach them how the correct clinical pathway(s) looks like. They need examples first.

[MedicalFlows @MedicalFlows]

Human #ClinicalModelers are still needed to create #BPMPlusHealth clinical process diagrams.

#ChatGPT doesn’t want to do it 🥲