Supporting the Systematic Assessment of Clinical Processes: the MedFlow Method

Summary

Objectives: Healthcare is characterized by complex cooperation between highly specialized healthcare departments. This often leads to inefficient clinical processes. In orderto improve these processes, a systematic assessment method is needed. Such methods are still missing. The objective of this paper is to propose and evaluate a method to support the systematic and semi-automatic assessment of clinical processes, with special focus on the quality of information logistics.

Methods: Criteria for the quality of information logistics were collected based on literature research and system analysis. Appropriate quality checks for these criteria were developed. An extended process modelling notation was developed. The method was evaluated in a pilot study.

Results: An own model integrates four sub-models with each concentrating on distinct process aspects (i.e., control flow, data flow, tool usage, organizational information). In orderto assess the quality of a process, selected process details are combined in “views”. Weak points are then detected by applying specific rule-sets on these views. Each rule-set represents a pattern of critical cross-points which are searched for in the appropriate view-matrix. The MedFlow method was evaluated in a first pilot study in radiological departments – applying quality checks for the detection of e.g. media cracks or testing the transcription of information objects.

Conclusion: The MedFlow method is best used to assess clinical processes regarding their control flow and information handling. The latter directly influences the quality of communication and thusthe quality of whole processes. However, this must be evaluated in further studies.

Keywords

Process assessment (healthcare) - process measure - health informatics - information system

• References

• 1 Coiera E. When conversation is better than computation. JAMIA 2000; 7 (03) 277-286.
• 2 Ammenwerth E, Ehlers F, Kutscha U, Kutscha A, Eichstädter R, Resch F. Supporting patient care by using innovative information technology – A case study from clinical psychiatry. Dis Manage Health Outcomes 2002; 10 (08) 479-487.
• 3 Bhasale A, Miller G, Reid S, Britt H. Analysing potential harm in Australian general practice: an incident-monitoring study. MJA 1998; 169 (02) 3-6.
• 4 Mosley C. Coordination of care in disease management: opportunities and financial issues. Semin Dial 2000; 13 (06) 346-350.
• 5 Deming W. Out of the Crisis.. Cambridge: University Press; 1986
• 6 Gocke P, Debatin J, Dürselen L. Prozessmanagement und Controlling in der Diagnostischen Radiologie im Krankenhaus. Der Radiologe 2002; 42: 332-343.
• 7 Hammer M, Champy J. Reengineering the corporation. A manifest for business revolution.. New York: Harper Business; 1993
• 8 Luo W, Tung Y. A framework for selecting business process modeling methods. Industrial Management and Data Systems 1999; 99 (07) 312-319.
• 9 OMG. UML Resource Page. 2006 (cited 2006 Dec). Available from: http://www.uml.org/#uml2.0.
• 10 Scheer AW ARIS – Modellierungsmethoden, Metamodelle, Anwendungen.. 4th ed. Berlin/Heidelberg, Germany: Springer; 2001
• 11 Hoffmann I, Bergmann J, Bott O, Pretschner D. Einsatz einer rechnergestützten Modellierungsund Simulationsumgebung für den Entwurf telemedizinischer Systeme am Beispiel von MOSAIK-M. G S, editor. Tagungsband Telemed 2005.. Berlin: Aka-Verlag; 2005: 198-211.
• 12 MLDesign T. MLDesign Technologies – MLDesign. 2004 (cited 2007 Apr). Available from: http://www.mldesigner.com/mldesigner.html.
• 13 Ammenwerth E, Ehlers F, Eichstadter R, Haux R, Pohl U, Resch F. Systems analysis in health care: framework and example. Methods Inf Med 2002; 41 (02) 134-140.
• 14 Ehlers F, Ammenwerth E, Hirsch B. Design and development of amonitoring system to assess the quality of hospital information systems: concept and structure. Stud Health Technol Inform 2005; 116: 575-580.
• 15 Haux R, Winter A, Ammenwerth E, Brigl B. Strategic Information Management in Hospitals.. New York, USA: Springer-Verlag; 2004
• 16 Donabedian A. Exploration in quality assessing and monitoring, Vol 2: The criteria and standards of quality:. Ann Arbor: Health Administration Press; 1982
• 17 Augustin S. Information als Wettbewerbsfaktor: Informationslogistik – Herausforderung an das Management.. Köln: 1990
• 18 Sens B, Fischer B, Bastek A, Eckhardt J, Müller A, Paschen U. et al. Begriffe und Konzepte des Qualitätsmanagements. Informatik, Biometrie und Epidemiologie in Medizin und Biologie 2003; 34 (01) 1-61.
• 19 Nguyen JM, Six P, Antonioli D, Glemain P, Potel G, Lombrail P. et al. A simple method to optimize hospital beds capacity. Int J Med Inform 2005; 74: 39-49.
• 20 Dadam P, Reichert M, Kuhn K. Clinical Workflow-The Killer Application for Process-oriented Information Systems. Ulmer Informatik-Berichte. 1997
• 21 Masson J. Workflow-Management im Krankenhaus.. Schaffhausen: IMAG Information Management AG; 2000
• 22 van der Aalst WMP. Challenges in Business Process Management: Verification of business processes using Petri nets. Bulletin of the EATCS 2003; 80: 174-199.
• 23 Dayal U, Hsu M, Ladin R. Business Process Coordination: State of the Art, Trends and Open Issues. Proceedings of the 27th VLDB Conference, Rome, 2001.. Rome: Springer; 2001
• 24 Teichgräber U, Gillessen C, Neumann F. Methoden des Prozessmanagements in der Radiologie. RöFo 2003; 175: 1627-1633.
• 25 Krallmann H, Wiener K, Wood G. Tools for Analysis and Simulation: BONAPART. Handbook on Architectures of Information Systems. 1998: 625-648.
• 26 Junginger S, Kühn H, Strobl R, Karagiannis D. Ein Geschäftsprozessmanagement-Werkzeug der nächsten Generation – ADONIS: Konzeption und Anwendungen. Wirtschaftsinformatik 2000; 42 (05) 392-401.
• 27 Brücher H, Endl R. Erweiterung von UML zur geschäftsregelorientierten Prozessmodellierung. Heidelberg. Germany: Physica-Verlag; 2002
• 28 Loos P, Allweyer T. Process Orientation and Object Orientation – An Approach for Integrating UML and Event-Driven Process Chains (EPC). Veröffentlichungen des Instituts für Wirtschaftsinformatik 1998; 144: 1-17.
• 29 Scheer AW, Nüttgens M, Zimmermann V. Objektorientierte Ereignisgesteuerte Prozeßkette (oEPK) – Methode und Anwendung. Veröffentlichungen des Instituts für Wirtschaftsinformatik 1997; 141: 1-25.
• 30 Winter A, Brigl B, Wendt T. Modeling hospital information systems. Part 1: The revised three-layer graph-based meta model 3LGM² . Methods Inf Med 2003; 42 (05) 544-551.
• 31 Ehlers F, Ammenwerth E, Haux R. Process Potential Screening: An Instrument to Improve Business Processes in Hospitals. Methods Inf Med 2006; 45 (05) 506-514.
• 32 Brook R. Changes in the healthcare system. Goals, forces, solutions. Pharmacoeconomics. 1998
• 33 Marrin C, Johnson L, Beggs V, Batalden P. Clinical process cost analysis. Ann Thorac Surg 1997; 64 (03) 690-694.
• 34 Rosen L. Applying industrial engineering practices to radiology. Radiol Manage 2004; 26 (06) 32-35.
• 35 Gospodarevskaya E, Churilov L, Wallace L. Modelling the Patient Care Process of an Acute Care Ward in a Public Hospital: A Methodological Perspective. In: Proceedings of the 38th Hawaii International Conference on System Sciences (HICSS’05). 2005: 145a.
• 36 Lenz R, Buessecker F, Herlofsen H, Hinrichs F, Zeiler T, Kuhn K. Demand-driven Evolution of IT Systems in Healthcare – A Case Study for Improving Interdisciplinary Processes. Methods Inf Med 2005; 21 (03) 141-153.
• 37 Alexopoulos C, Goldsman D, Fontanesi J, Sawyer M, De Guire M, Kopald D. et al. Healthcare I: a discrete-event simulation application for clinics serving the poor. Winter Simulation Conference – Proceedings of the 33rd conference on Winter simulation. 2001: 1386-1391.
• 38 Pezzé M, Gargiulo A, Catarci T, Di Paola M. A formal model for quality assurance in coloproctologic surgery. Greenes R, Peterson H, Protti D. MEDINFO 1995, Proceedings of the 8th World Congress on Medical Informatics.. Amsterdam: North Holland; 1995: 1037-1041.
• 39 Quetsch J. Defining and measuring clinical processes using a dynamical systems approach. Proc AMIA Symp. 2000: 665-669.
• 40 Blake J, Carter M, O’Brien-Pallas L, McGillis-Hall L. A formal model for quality assurance in coloproctologic surgery. Greenes R, Peterson H, Protti D. MEDINFO 1995, Proceedings of the 8th World Congress on Medical Informatics.. Amsterdam: North Holland; 1995: 527-531.
• 41 Chimiak-Opoka J, Giesinger G, Breu R, Saboor S, Ammenwerth E. Tool-supported analysis of clinical processes. In: Proceedings of the 24th IASTED International Multi-Conference on Biomedical Engineering; 2006 February 15-17. 2006: 56-59.