Master Thesis defense by Maarten Kooijman on GameBus

On Monday, February 15th, 2016, Maarten Kooijman will defend his master thesis entitled “The potential of a mobile health rewarding app (GameBus) for people with  Intellectual disabilities”.  Everyone is cordially invited to join to learn, ask questions and give feedback.

Where: TU/e, Paviljoen building, room K10

When: 13:00-14:00


  • Supervisors TU/e: Dr. P.M.E. (Pieter) Van Gorp, Prof. Dr. J.H.D.M (Joyce) Westerink
  • Supervisors Lunet Zorg (the home care organization at which the practical work was performed): P. (Patrick) Leijte, R. (Ruud) Kavelaars, H.J. (Henk) van Heffen


Abstract: This research describes the results of a six-month graduation project within the GameBus project. GameBus is a novel app, developed within a multinationality collaboration. The app engages families and friends to stay active physically, cognitively and socially via an enjoyable personalized gaming experience. GameBus connects children, colleagues, the elderly and other family members to join physical, cognitive and social challenges, and it is unique because it crosses the boundaries of existing health apps. The app was not designed explicitly for people with intellectual disabilities. However, some issues (e.g., social isolation, insufficient physical exercise, etc.) play a role in the care for people with intellectual disabilities, as they do in care for the elderly. Therefore, it is worthwhile to investigate if health-rewarding apps like GameBus can play a role within healthcare organizations for people with intellectual disabilities. Via this master thesis project, it has been examined which clients are eligible for GameBus and how the app might be used in the future. The findings and experiences of clients and client supervisors with the application of GameBus are presented. Three promising use cases were found in which GameBus can play a role. GameBus is a valuable way to motivate and stimulate clients to perform physical, social, cognitive and other (e.g., domestic) activities.

Master Thesis project of Tim Kleinloog featured in ChipSoft’s magazine “Mediair”


Professor Uzay Kaymak van de TU Eindhoven leidt het team dat onderzoek doet naar de toepassing van dataonderzoek in de zorg. Gertruud Krekels zorgt samen met haar collega Milan Tjioe voor de zorginhoudelijke input, het team bestaat daarnaast uit een groep onderzoekers van de universiteit. Een belangrijke rol is weggelegd voor Tim Kleinloog, die bij ChipSoft op dit onderwerp afstudeert.

Tim (24) studeert Technische Bedrijfskunde aan de TU Eindhoven en volgt de master ‘Innovation Management’. De titel van zijn onderzoek is ‘A data driven approach to evaluate guidelines for non-melanoma skin cancers (NMSKs)’. “Ik ontwikkel en test de manier waarop Getruud Krekels en Milan Tjioe informatie uit HiX halen om te evalueren hoe de klinische richtlijnen worden gevolgd. Een mooi project, want het is een ideale combinatie tussen ICT, zorg, wetenschappelijk onderzoek, analyseren en programmeren. Heel boeiend om er op deze manier aan bij te dragen dat HiX zorgverleners nóg beter kan ondersteunen.”

Master Thesis Defense Sven Bastianen: Towards an architecture for the support of integrated Personal Health Records

Pieter Van Gorp is proud to announce the very successful completion of the master thesis project of Sven Bastianen.  Sven has worked closely with SAP NL and for the final presentation the large number of attendees confirmed that he tackled a very relevant problem.

MTP Defense Sven Bastianen (web)
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Master Thesis Completed: From paper-based care pathway to executable workflow process model

On Tuesday, 3/12/2013, Wesley van Renswouw has defended his master thesis on deriving Workflow Management Support from Care Pathway Protocols.
Supervisors TU/e:

  • Dr. P.M.E. Van Gorp, TU/e, Information Systems
  • Dr. O. Türetken, TU/e, Information Systems

Supervisor Philips Research:

  • Dr. R. Vdovjak

Management Summary

Nowadays there are major issues in the healthcare related to quality, performance and costs. Even in countries where the healthcare is well developed and resourced there is clear evidence that the quality remains a serious concern. Too many errors and incidents happen in the clinical working practices, resulting in unnecessary suffering, use of resources, and even deaths. In the USA at least 210,000 deaths each year are a result of preventable hospital errors. In National Health Service hospitals in the UK this number is estimated on 40,000 deaths a year due to medical errors. On top of that the cost of healthcare is increasing each year. It is clear that something has to change in the way healthcare is currently practising its business.

In the 1980s care pathways were introduced for the first time. A care pathway is a description of a care process from an organization point of view for a specific disease and for a specific group of patients. It is based on evidence and on (clinical) guidelines and it is designed to improve efficiency and patient outcomes. The aim of care pathways is to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. That this aim is getting achieved is demonstrated by many studies on this subject. Using care pathways can significantly improve the quality of care, shorten the length of stay of a patient, and lower the costs of care.

However the majority of care pathways that are developed and implemented are used manually by filling predefined paper documents. In this day and age where other industries have adopted workflow management systems with e.g. automated tasks, decision support, and compliance checking, the usage of paper-based documents seems obsolete. The few studies that are performed
on workflow applications that integrate the care pathways show promising results. Key performance indicators like quality of care, length of stay of patient, use of resources, and costs of care are improved by these new systems.

As mentioned these systems are still in development and mature systems are not yet widely introduced and adopted in the market. The current mismatch between medical research and research done within the field of Information Systems might be the problem. Where the medical research is aimed primarily at developing the care pathways on a clinical level, the research in the

Information Systems field is mainly focused on specific technical aspects of implementing care pathways into executable workflow applications. The part which describes how text-based care pathways can be modelled into executable workflow process models in a structured way is still missing in current research. Therefore in this thesis a methodology is derived which can be followed to transform paper-based care pathways to executable workflow process models in a structured and reproducible way.

The intention behind this methodology is to increase the usability of and compliance with care pathways in the healthcare field. By using the steps proposed in this methodology it is easier for hospitals and industrial partners to develop workflow process models based on paper-based care pathways. Also the developed process models will have a similar structure which would make the models more understandable in the long run since stakeholders will recognise the structure of the models.

The methodology consists of three phases. In phase one the paper-based care pathway is annotated in order to extract the information that is presented in the paper-based care pathway.

Phase two describes the steps how the annotated paper-based care pathway can be modelled in a conceptual process model in a structured and reproducible way. First the sunny day scenario is modelled in the main process. Next the subprocesses are modelled. It is likely that there are multiple child levels in the process model; therefore it is important to follow the structured approach, given in the methodology, to get a consistent model. Business rules should be added in order to comply with the procedures stated in the care pathway. Next extended BPMN constructs and exception handling patterns can be used to model the variance that can occur in the care pathway.

Finally the third phase provides a step-by-step description on how to perform the transformation from a conceptual process model to an executable workflow process model. Topics that are included in these steps are: the soundness and correctness of the conceptual model, the link between the two modelling languages, adjusting the conceptual model, modelling the required data, flexibility, roles and users, forms, business rules, integration with health information systems, and verification and execution of the process.

In order to give a proof of concept the methodology is used in a case study which uses the paper-based unstable angina care pathway as starting point. This care pathway is distributed by the Chinese Ministry of Health and its use is mandatory for all Chinese hospitals. In this case study first the care pathway is annotated. Next the whole case pathway is modelled to a conceptual model. In the last phase a section of the conceptual model is transformed to an executable workflow model.

An internal evaluation by Philips Research states that the annotation phase is an essential step in the methodology because it helps the modeller to get better acquainted with the care pathway he/she wants to model. The annotation steps provide a deeper understanding of information and the structure of the care pathway. The conceptual model is quite suitable for clinical practice and particularly useful for understanding the care pathway and communicating the necessary details among the relevant stakeholders. However the case study performed on the third phase of the methodology is quite limited; therefore the executability of the workflow process model should be tested more extensively and the outcomes should be communicated with the stakeholders before the real value of this phase can be determined. Also the intended use of the workflow process model needs to be further investigated.

Thesis Text

Available from the TU/e library

Pictures from the Thesis Ceremony

03-Dec-2013 15:02, HUAWEI HUAWEI G700-U10 , 2.4, 3.5mm, 0.02 sec, ISO 91
03-Dec-2013 15:03, HUAWEI HUAWEI G700-U10 , 2.4, 3.5mm, 0.02 sec, ISO 91
03-Dec-2013 16:53, HUAWEI HUAWEI G700-U10 , 2.4, 3.5mm, 0.1 sec, ISO 721
03-Dec-2013 16:53, HUAWEI HUAWEI G700-U10 , 2.4, 3.5mm, 0.1 sec, ISO 721
05-Dec-2013 09:32, HUAWEI HUAWEI G700-U10 , 2.4, 3.5mm, 0.03 sec, ISO 105

Master Thesis Defense by Anouk Suntjens on Knowledge Maintenance for Clinical Rules

On Friday, September 27th 2013, Anouk Suntjens has defended her master thesis. The thesis relates to a project conducted in collaboration with the hospital pharmacy of the Catharina Ziekenhuis Eindhoven (CZE).

Thesis title

Knowledge Translation and Maintenance in health care: Identification of the requirements for tool support.


This study investigates the requirements for a tool supporting Knowledge Translation and Maintenance (KT&M) in the health care sector. The process is currently inefficient, resulting in a suboptimal level of care. An overview of practical support options and tool requirements is derived from a case study in a Dutch hospital. In addition, theoretical tool requirements are obtained via a literature review. These support options and tool requirements are validated with different process stakeholders from the hospital. As a result, useful insights are obtained in the perceptions of process actors with respect to knowledge translation and maintenance and their preferences for tool support during the CR process. Tools should demonstrate their practical usefulness and focus on supporting collaboration between different stakeholders, automatic filling of artefacts, and traceability between sources and their usage.

Both the TU/e supervisors as well as the CZE contacts were very pleased with the end-result as well as by Anouk’s professionalism throughout the thesis project execution.

The full thesis text can be downloaded from the TU/e library.

Master Thesis defense by Willem Dalinghaus


An Introduction to Reference Process Modeling in Healthcare


In this master thesis project a research is described providing an introduction to reference modeling in healthcare. The goal is to provide a design approach to automatically create reference models based on existing process models. This master thesis focuses on healthcare; a complex domain, where little knowledge about business process management is applied. Due to the economic crisis healthcare must reduce costs without decreasing quality of care. The use of business process management could help the healthcare domain to achieve this. One way to create business processes is the use of reference process models. The research described in the thesis is about creating a reference model concerning the intake process based on several existing process models from a single hospital.

Online Access

Get the PDF from the TU/e library.

Master Thesis defense by Steven Dassen


BPMN 2.0 in practice: The usefulness of extended constructs in a business environment.


Many studies are devoted to the theoretical capabilities of the workflow language BPMN, but not much is known about the actual practical use of BPMN in a business environment. Recker’s research (2010) concluded that business analysts barely use extended constructs in their business models, so they only use a core set of constructs (basic constructs). He questioned whether the extended constructs have an added value when used in industrial business process models. The research
objective of this study is to examine the influence of the extended constructs in BPMN 2.0 with regard to the understandability and correctness of a process model for practitioners in the healthcare domain.

To investigate this objective a theoretical analysis and an experiment were conducted. The theoretical analysis was based on the peri-operative process in hospitals. NICTIZ1, an organisation which focuses on process optimisation in the healthcare domain, delivered the textual description (guidelines) of this process. A part of the process (pre-operative process) was already modelled by business practitioners with BPMN (NICTIZ model). To examine the influence of the different
constructs, two different versions of the peri-operative process were modelled by the researcher, a model with only basic constructs (basic version) and a model with the full set of constructs (extended version). To measure and compare the understandability of the models, the complexity metrics for business process models were used (Gruhn & Laue, 2006). The correctness (level of correct behaviour) of the models was analysed by reproducing the state spaces of the models and illustrating
the behaviour of the models via tokens. These state spaces were compared with the guidelines.

The theoretical analysis showed that the models with the full set of constructs were more understandable than the models with only basic constructs based on the results of the complexity metrics. Moreover, the state spaces showed how the extended constructs can improve the correctness of a model. The experiment measured the actual effectiveness of the various constructs in BPMN based on the Method Evaluation Model (Moody, 2003). The experiment contained a test that consisted of
different questions related to the extended constructs to assess the factors of interest empirically. The purpose of the test was to examine the participants’ understandability and modifiability (ability to modify a model correctly) regarding the constructs (basic/extended). The focus in the experiment was solely on the constructs, not the process. The participants of the experiment were business analysts from the healthcare domain. A workshop, which explained the behaviour of several constructs, was constructed to examine whether training improved the results of the participants. Two different versions of the test were constructed to see whether the results were not test specific. The results of the tests were analysed and hypotheses were tested using the independent t-test. The experiment showed that the results of the test were not test specific (hypothesis 1). Also, it showed that the workshop did not have a significant effect on the results of the participants (hypothesis 2). Furthermore, it showed that practitioners do not encounter more difficulty understanding (hypothesis 3) or modifying (hypothesis 4) models with extended constructs compared to similar models with only basic constructs.

Online Access

Get the PDF from the TU/e library

Master Thesis Defense by Michel Koeken on HIS/EHR Procurement

Today, Michel Koeken has defended his master thesis. The thesis relates to a project conducted in collaboration with Siemens and provides valuable insights into the HIS procurement methods of Dutch academic hospitals.

Thesis title

Identifying and ranking the selection criteria in European tenders regarding the procurement of HIS/EHR systems in Dutch academic hospitals.

Management summary (excluding tables)

The thesis focused on the procurement of Hospital Information System / Electronic Health Record (HIS/EHR) systems at Dutch academic hospitals. As Dutch academic hospitals are considered to be a public institution and the value of the procurement of a HIS/EHR system exceeds the threshold value of €200,000 they are obliged by the BAO (Besluit Aanbestedingsregels voor Overheidsopdrachten) to conduct a European tender. The BAO is the Dutch implementation of the European guideline 2004/18/EG.

Each European tender contains a Research For Proposal (RFP). The RFP provides a detailed set of requirements of what the academic hospital wants to acquire and the score model that the academic hospital will use to evaluate the proposals of the vendors. The detailed set of requirements is divided into subtopics and these subtopics are considered as the selection criteria. The score model states how much points can be scored by the vendors by fulfilling a specific selection criterion. The vendor with the highest score and therefore the most economically advantageous offer (i.e. best price-quality ratio) wins the tender. In The Netherlands are three European tenders conducted by the Dutch academic hospitals in order to acquire a HIS/EHR system. All three European tenders were won by different vendors and this is interesting when one take into account that:

  • a vendor had to be selected through a strict tendering process which is based on the three principles (equal treatment, transparency, and non-discrimination) and therefore ensures for total transparency since all decisions are open for involved parties, no possibility for negotiation, and an equally review of every vendor;
  • the Dutch academic hospitals did not differ that much;
  • and there were only five (six at the time of the first two European tenders) available vendors from which the Dutch academic hospitals could choose from.

One would expect that at least two out of the three European tenders were won by the same vendor, but this was not the case. Therefore it is interesting to analyze these European tenders to investigate how Dutch academic hospitals used the European tenders to come to their results.

To answer the raised issue the thesis started with analyzing the three score models in the RFPs in order to identify and rank the selection criteria in terms of importance. The three included RFPs were those from the European tenders conducted by Leiden University Medical Center + University Medical Center Utrecht, University Medical Center St. Radboud, and Erasmus Medical Center + University Medical Center Groningen. This analysis showed that the three European tenders could not be compared one on one as they used slightly different terminology and wording for their selection criteria. This problem was tackled by selecting one European tender as the reference tender and the selection criteria of the other two European tenders were matched with the selection criteria of the reference tender. This matching was done by two vendor experts and followed the two round Delphi method (Skulmoski, Hartman, & Krahn, 2007). Now the three European tender could be compared as they contained the same selection criteria. The comparison showed that the European tenders scored their selection criteria differently.

As academic hospitals are often an example for general hospitals this identification and ranking could be an important insight for general hospitals. It is even possible that general hospitals use this as a blueprint for determining their own selection criteria. Obviously also other academic hospitals can use this insight to their advantage and consultancy companies can use it in advising their clients.

The differences between the percentages were analyzed with the help of a vendor expert and as the tenders occurred sequentially trends were determined. It is important to state that the trends could be based on coincidence as there were only three available data sets. Nonetheless it is interesting and useful to discuss the possible trend and especially the most important ones.

The possible trends can be beneficial for every stakeholder in The Netherlands or elsewhere as they show which topics are hot or not. Vendors could use it to determine their business strategy, the consultancy companies can advise their clients about it, and the hospitals can take it into account in their procurement processes.

The full thesis text can be downloaded here. Michel also provided a Powerpoint file with an embedded audio recording of his (trial) presentation.

Master Thesis Graduation: Pieter Dat

On November 22nd, Pieter Dat defended his master thesis entitled “Business process simulation in healthcare: the applicability of general-purpose and application-oriented simulation software”.

In this thesis, Pieter compared FlexSim HealthCare against CPNTools based on two case studies.  FlexSim HC provides healthcare-specific 3D animations as well as widgets for conveniently modeling agenda’s of human resources involved in health processes.  CPNTools does not provide such features but provides opportunities for modeling the overall process more explicitly.

Pieter’s first case study relates to patient flows while his second case study relates to goods logistics.

Pieter used Moody’s Method Evaluation Model in combination with a framework specific to simulation tool evaluation.  The thesis concludes that FlexSim HC has advantages for simulation studies related to patient flows while the two approaches are comparable when in comes to goods logistics.

Update (14/02/2013): A related blog post has been published on the official FlexSim website.

Master Thesis defense by Robert Janssen


Increasing accessibility and reproducibility of process mining research in healthcare


The goal of this thesis was to develop a set of best practices for process mining research in healthcare. Process mining in healthcare has been studied by several researchers already, but these studies suffer from disappointing results, which may be partly to blame to the low accessibility and reproducibility of the process mining research methodologies. Therefore, in this thesis we aimed to synthesize the most common and best research steps, or best practices, of previous process mining research by means of a multiple case study and expert interviews into one process mining methodology for healthcare which would show increased accessibility, reproducibility and results that are better, or at least comparable, to present process mining research. Pattern language was identified as the most suitable method to report the best practices and as a result, 22 best practices patterns that cover a variety of process mining research steps have been developed. Subsequently, 11 patterns were selected as recommendations for use in healthcare, as they showed the most promising results and highest accessibility. In addition, we have introduced the concepts of virtual machines and screencasts to the field of process mining as means to increase accessibility and reproducibility of the best practices pattern language. The results of the best practices and recommendations have been validated by experts at two Dutch healthcare institutions and showed that the process mining best practices pattern language is indeed able to produce process models which are of similar or superior quality compared to process models created
with conventional methodologies.

Online Access

Get the PDF from the TU/e library