Abstract
Purpose
Medical processes can be modeled using different methods and notations. Currently used modeling systems like Business Process Model and Notation (BPMN) are not capable of describing the highly flexible and variable medical processes in sufficient detail.
Methods
We combined two modeling systems, Business Process Management (BPM) and Adaptive Case Management (ACM), to be able to model non-deterministic medical processes. We used the new Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN).
Results
First, we explain how CMMN, DMN and BPMN could be used to model non-deterministic medical processes. We applied this methodology to model 79 cataract operations provided by University Hospital Leipzig, Germany, and four cataract operations provided by University Eye Hospital Tuebingen, Germany. Our model consists of 85 tasks and about 20 decisions in BPMN. We were able to expand the system with more complex situations that might appear during an intervention.
Conclusion
An effective modeling of the cataract intervention is possible using the combination of BPM and ACM. The combination gives the possibility to depict complex processes with complex decisions. This combination allows a significant advantage for modeling perioperative processes.










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Anderson BO, Braun S, Carlson RW, Gralow JR, Lagios MD, Lehman C, Schwartsmann G, Vargas HI (2003) Overview of breast health care guidelines for countries with limited resources. Breast J 9(s2):S42–S50
Bernd Rücker (2015) Case management and CMMN for developers. http://www.irmconnects.com/wp-content/uploads/2015/06Bernd_Rucker_Case_Management_and_CMMN_for_Developers.pdf. Accessed 19 Jan 2016
Braun R, Schlieter H, Burwitz M, Esswein W (2015) Extending a business process modeling language for domain-specific adaptation in healthcare. Wirtschaftsinformatik Proceedings 2015
Buzink SN, van Lier L, de Hingh Ignace H J T, Jakimowicz JJ (2010) Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool. Surg Endosc 24(8):1990–1995
Fink E (2015) Ein Framework zur nutzerzentrierten Visualisierung perioperativer Prozesse. Master-Thesis, Hochschule Reutlingen, Medien- und Kommunikationsinformatik
Fink E, Hlavac M, Wirtz CR, Burgert O (2013) Workflow, ergonomics and new concepts in surgery. Conceptual design of an intraoperative user interface for a workflow management system for surgical planning and intraoperative support. Int J CARS 8(S1):171–179
Fischer L (ed) (2012) How knowledge workers get things done. Real-world adaptive case management. Excellence in practice series. Future Strategies, Lighthouse Point
Fischer L (ed) (2015) Thriving on adaptability. Best practices for knowledge workers. Excellence in practice series. Future Strategies, Lighthouse Point
Forestier G, Lalys F, Riffaud L, Louis Collins D, Meixensberger J, Wassef SN, Neumuth T, Goulet B, Jannin P (2013) Multi-site study of surgical practice in neurosurgery based on surgical process models. J Biomed Inf 46(5):822–829
Freund J, Rücker B (2010) Praxishandbuch BPMN 2.0. Hanser, München
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MCM, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499
Neumann J, Rockstroh M, Franke S, Neumuth T (2016) BPMNSIX—A BPMN 2.0 surgical intervention extension. In 7th workshop on modeling and monitoring of computer assisted interventions (M2CAI), 19th international conference on medical image computing and computer assisted interventions (MICCAI 2016), Athens, Greece
Jannin P, Morandi X (2007) Surgical models for computer-assisted neurosurgery. NeuroImage 37(3):783–791
Kohn LT, Corrigan J, Donaldson MS (2000) To err is human building a safer health system. Quality chasm series. National Academy Press, Washington, DC
Lalys F, Jannin P (2014) Surgical process modelling: a review. Int J Comput Assist Radiol Surg 9(3):495–511
Neumann J, Rockstroh M, Vinz S, Neumuth T (2015) Technical report: surgical workflow and process modeling. Universität Leipzig, ICCAS
Neumann J, Wiemuth M, Burgert O, Neumuth T (2017) Application of activity semantics and BPMN 2.0 in the generation and modeling of generic surgical process models. In Submitted at: Computer Assisted Radiology and Surgery
Neumuth T (2012) Surgical Process Modeling - Theory, Methods, and Applications. https://www.iccas.de/wp-content/uploads/2012/12/Neumuth-Surgical-Process-Modeling.pdf. Accessed 09 Jan 2017
Neumuth T, Jannin P, Schlomberg J, Meixensberger J, Wiedemann P, Burgert O (2011) Analysis of surgical intervention populations using generic surgical process models. Int J Comput Assist Radiol Surg 6(1):59–71
Neumuth T, Pretschner A, Trantakis C, Fischer M, Lemke HU, Burgert O (2005) An approach to XML-based description of intraoperative surgical workflows. In: XML-Tage 2005 in Berlin [Tagungsband], Rainer Eckstein, Ed. 12.–14. September 2005 in Berlin. Universität Berlin. Berlin: Humboldt-Univ, pp 147–152
Niederlag W (ed) (2014) Der digitale Operationssaal. Health academy 2. De Gruyter, Berlin
Object Management Group (2014) Case Management Model and Notation. Version 1.0. http://www.omg.org/spec/CMMN/1.0/PDF/. Accessed 19 Jan 2016
Object Management Group (2015) Case Management Model and Notation. Version 1:1. http://www.omg.org/spec/CMMN/1.1/PDF/. Accessed 19 Jan 2016
Object Management Group (2015) Decision Model and Notation. Version 1.0. http://www.omg.org/spec/DMN/1.0/PDF/. Accessed 19 Jan 2016
Object Management Group (2016) Decision Model and Notation. Version 1:1. http://www.omg.org/spec/DMN/1.1/PDF/. Accessed 19 Jan 2016
Padoy N, Blum T, Ahmadi S-A, Feussner H, Berger M-O, Navab N (2012) Statistical modeling and recognition of surgical workflow. Med Image Anal 16(3):632–641
Simpson DD (2004) A conceptual framework for drug treatment process and outcomes. J Subst Abuse Treat 27(2):99–121
Swenson KD (2010) Mastering the unpredictable. How adaptive case management will revolutionize the way that knowledge workers get things done. Landmark books. Meghan-Kiffer Press, Tampa
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG (2000) New guidelines to evaluate the response to treatment in solid tumors. JNCI J Natl Cancer Inst 92(3):205–216
Acknowledgements
We would like to thank Martin Schmollinger for many fruitful discussions on ACM and the best practices for modeling.
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Wiemuth, M., Junger, D., Leitritz, M.A. et al. Application fields for the new Object Management Group (OMG) Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN) in the perioperative field. Int J CARS 12, 1439–1449 (2017). https://doi.org/10.1007/s11548-017-1608-3
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DOI: https://doi.org/10.1007/s11548-017-1608-3