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.”

IS-HEART presentation June 5th: Dynamic Clinical Checklist Support Systems

Also see the online agenda item for this session.

Speakers: Lonneke Vermeulen (TU/e – IS) and Ashley De Bie Dekker (Catharina Ziekenhuis Eindhoven)
Title: The first pilot study of DCCSS Tracebook, from idea to results

Abstract: Atul Gawandas’ Checklist Manifesto made the medical world realize the high potential of clinical safety checklists in reducing medical errors and improving patient safety. As the current computerized checklist support systems were too static, the Brainbridge II program (a collaboration between the Eindhoven University of Technology, Zhejiang University, Philips Research and Catharina Hospital Eindhoven) developed a system that can individualize checklists based on information from the patient’s medical record while also considering the context of the clinical workflows. By the end of last year (2014) the first pilot study of the Dynamic Clinical Checklist Support System (DCCSS) Tracebook took place in the hospital. In this presentation we will guide you from the beginning of this project to the results of the first pilot study.

After a short introduction of the Tracebook system, we will describe how we developed these dynamic checklists, which research design we followed and how the pilot study was set up. We will conclude with the promising results from the study and afterwards there is time for discussion.

IS-HEART Presentation by Juby Joseph Ninan

Title: Integrating simulation and enactment models: a reality check

See Agenda Item


As organizations grow larger and the complexity of their business processes increases, it becomes important to use information systems that can use software tools to control, coordinate, execute and monitor their processes. There are different vendors that offer such business process management software and services to automate a company’s business processes, enhance their visibility and control, and provide support for continuous improvement. Business process simulation plays an important role for analyzing processes for continuous improvement. Here simulation is used to study the dynamic behavior of processes over time, thereby showing how the performance of processes or resources can be influenced by changes in the system or environment.

Business Process Simulation is usually used to support strategic decision making in companies, where the objective is to move the organization towards achieving its long term goals. Here simulation helps to understand how a particular decision affects long term behavior of the process. However, these kinds of simulation experiments are not useful to support management or operational decision making, where short term behavior of processes is to be analyzed.

For short term simulations, we can use information readily made available from the business process management system itself, without the need for additional modeling. The BPMS will have knowledge of the process structure definition, the current state of the process instances and the history records of the process execution, all of which can be used to run short- term simulation experiments. The process structure definition will contain information about the control flow and the data flow. The current state of process instances can be used to load the initial state of the simulation model, and analyzing history records may give us simulation relevant properties such as arrival rate of instances, execution time of activities, etc.

This thesis is an attempt to explore the current simulation capabilities in the BPM Suite jBPM (whose core is a light weight, extensible workflow engine that allows execution of business processes using the BPMN 2.0 specification) and also investigate whether such short term simulation experiments can be supported by the tool.

Executable Modeling

This semester, students of the TU/e course “Executable Models of Operational Processes” will make executable models for two healthcare case studies. One case is on skin cancer treatment (regarding the logistic approach of a “one stop shop”) while the other case is on dialysis (regarding the use of home dialysis equipment, etc.). Students will analyze the effect of process redesigns on key performance indicators by means of simulations in CPNTools.

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