Slides of my talk in European BPM Round Table. The video here: www.youtube.com/watch?v=3MxIR-bqQ-s&buffer_share=71f7b&utm_source=buffer#t=44m47s

1. Business
Process
Management
Artificial
Intelligence
Healthcare
Personalized Care Pathways
using BPM and AI techniques
Arturo González-Ferrer, PhD
Department of Information Systems
1 European BPM round table, Nov 5th 2012

2. Summary
 Formalization of Guideline Knowledge
 How can BPMN help
 Enabling Clinical Workflow & Therapy Planning
 Care Pathways
 How can AI planning/scheduling help?
 Mix Physician-view, Patient-view, Organizational-view
 Personalized Care Pathways: Cognocare
 Knowledge-to-Data mapping
 MobiGuide project
2 BPM round table, Eindhoven, Nov 5th,

3. Guideline Knowledge Modeling
+
Computer-interpretable Guidelines (CIGs) are
formalisms developed in the last decade:
- PROforma,
- Asbru,
- GLIF,
- SAGE
- GLARE,
- EON,…
3 BPM round table, Eindhoven, Nov 5th,

4. What BPMN can provide for modeling?
• BPMN able to represent roles/participants
• Temporal Perspective
• time points,
• absolute, periodic, relative
• intervals/durations
• maximum, minimum, estimated
• temporal constraints
• As Soon As Possible (ASAP)
• As Late As Possible (ALAP)
• Start No Earlier Than (SNET)
• Finish No Earlier Than (FNET)
• Start No Later Than (SNLT)
• Finish No Later Than (FNLT)
• temporal dependencies
• Start-to-Finish (SF), Start-to-Start (SS)
• Finish-to-Start (FS), Finish-to-Finish (FF)
Denis Gagné and André Trudel,“Time-BPMN”, First Workshop on BPMN, 2009
“At enactment time, the temporal perspective of the workflow specification leads to the ability to precisely schedule a process
and its resources”
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5. Enabling Organizational Workflow &
Therapy Planning
 Physicians:  Managers:
 Did the patient take medication?
 Are we running out of resources?
 Who did what? Who is in charge of what?
 Don't forget the lab test!  How many nurses do we need next week?
 Am I following evidence during treatment?  Do we have a peak of patients at any moment?
 How many times did I change dosages/plan?  It is safe to reassign resources?
 Provide recommendations compatible with CPOE  Are we following evidence GL?
 Patients:  Show insurance companies that we did according
 Allow them a personalized care to Clinical Guidelines
 Remind them next steps
 Record their recommendations/actions (PHR)
 Personalized CPs adapted to patient’s insurance
coverage
“Hardly any of the existing Clinical Decision Support Systems (CDSS) appear to be
aimed at supporting extended clinical workflows, management of information and
decision-making in plans that unfold over time”
J. Fox et al. Delivering clinical decision support services: there is nothing as
practical as a good theory. Journal of Biomedical Informatics, 43(5), 2010
5 BPM round table, Eindhoven, Nov 5th,

6. Care Pathways
Aim to model a timed process of patient-focused care, by specifying
key events, clinical exams and assessments to produce the best prescribed outcomes,
within the limits of the resources available, for an appropriate episode of care
Figure extracted from R. Lenz, M. Reichert “IT support for healthcare
processes – premises, challenges, perspectives”, Data & Knowledge
Engineering 61, 2007
6 BPM round table, Eindhoven, Nov 5th,

7. How can HTN AI planning help?
HTN: Hierarchical Task Network
Declarative in nature, but able to also express control flow patterns
Able to express knowledge-based heuristics
It is based in first-order logic, but very useful for domains based on expert knowledge
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8. Integrating technologies
 CIGs
 Model the physician view of care process
 Their interpretation can provide single-step decision support
 BPMN
 Model the organization view of care process
 It can represent knowledge about roles, resources that are not
included in CIG
 Artificial Intelligence P&S
 Can use the knowledge provided by CIGs and BPM models
 Provide a treatment plan considering physician, patient, and
organizational views
 Can model heuristics to drive the search of the goal plan
8 BPM round table, Eindhoven, Nov 5th,

9. Deliberative Reactive
AI Planning approaches
BPM Continual
 Fully deliberative approach
 A plan or process is designed hoping that
everything is going to happen as expected and
everything is fully predictable
 Fully reactive approach
 The outcome of some tasks may not be
predicted
 Building processes with conditional branches
 The branch to be executed depends on the
satisfaction of certain conditions (e.g. BPM)
 Continual planning Dwight D. Eisenhower
 Dynamically building a simple process, perhaps
In preparing for battle I
the most likely to be successful until the end or
until an intermediate milestone, try to execute have always found that
it, discard it when it fails, and quickly re-build a plans are useless, but
new one planning is indispensable
9 BPM round table, Eindhoven, Nov 5th,

10. Knowledge Engineering: BPM/CIG to HTN P&S
 Gonzalez-Ferrer, A. et al., From business process models to
hierarchical task network planning domains” 28(2), June 2013,
The Knowledge Engineering Review, Cambridge Journals
 JABBAH : http://sites.google.com/site/bpm2hth/
 González-Ferrer A et al., Automated generation of patient-
tailored electronic care pathways by translating computer-
interpretable guidelines into hierarchical task networks, 2012,
Artificial Intelligence in Medicine, Elsevier
10 BPM round table, Eindhoven, Nov 5th,

11. 11

12. Powered by

13. Cognocare is based on IActive’s
award-wining technology
“How Knowledge Workers Get Things Done:
Real-World Adaptive Case Management”, 2012
Award-winning Artificial Intelligence engine
Global Awards for Excellence in International Conference on
Adaptive Case Management. Gold Planning & Scheduling. Award for
Winner of the Healthcare category. Excellence in Knowledge
Workflow Management Coalition Engineering.
2012, USA. ICAPS 2009. Tesalónica, Greece.
Spain National Informatics Congress. International Conference on
Best Application Using Artificial Planning & Scheduling. Award for
Intelligence. Best Application.
CEDI 2005, Spain. ICAPS 2006. United Kingdom.
13 BPM round table, Eindhoven, Nov 5th,

14. The Cancer Problem
High incidence,
prevalence and cost
High complexity
Evidence-based medicine
is not personalized
Constant change of
patient conditions
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15. What do physicians need?
To design personalized I 0
treatments efficiently
To conform to I 0
evidence-based medicine
To keep up with the I 0
latest practice guidelines
To react to patient’s I 0
changing conditions
At the point of care!
15 BPM round table, Eindhoven, Nov 5th,

16. Physicians may modify the details of the treatment Alerts about scheduled lab tests Detailed explanations about dosages Next scheduled test
Log of every decision made Tentative forecast of the treatment (subject to lab tests)

17. Estimation of Resources
Difficulties
- Integration with EMRs
- Integration of the provided output with CPOEs
17 BPM round table, Eindhoven, Nov 5th,

18. Knowledge-Data: The good & evil simile
to enable this bridge
we need someone smart
18 BPM round table, Eindhoven, Nov 5th,

19. Knowledge Engineering
Turning the process of constructing Knowledge Based
Systems from an Art into an Engineering Discipline,
using better methodological approaches
Studer et. al, Knowledge Engineering: Principles and
Methods,1998
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20. Knowledge-Data Mapping
+
Clinical concept data representation of
(pregnancy) is clear to this concept can be
doctors, and to all of us very different
How to evaluate if a patient is pregnant?
20 BPM round table, Eindhoven, Nov 5th,

21. MobiGuide (www.mobiguide-project.eu)
The MobiGuide project develops an intelligent system for patients with chronic illnesses, such as
cardiac arrhythmias, diabetes, and high blood pressure. The patients wear sensors that can monitor
bio-signals (e.g., heart rate, blood pressure); the signals are transmitted to their Smartphone. The
MobiGuide decision-support tools analyse the data, alert the patient about actions that should be
taken, ask the patient questions (in the case that additional information is needed) and make
recommendations regarding lifestyle changes or contacting care providers. All recommendations
regarding therapy are transmitted to the patients' care providers.
EMR1
PHR CIG
EMR2 Knowledge-Data
mapping
CIG
BAN KB
recommendations
CDSS
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22. my namesake Arthur used to say:
‘There is no worse death than the end of hope’
Thanks! contact me at:
arturogf@gmail.com
22 BPM round table, Eindhoven, Nov 5th,