Representing Business Processes Through a Temporal Data-Centric Workflow Modeling Language: An Application to the Management of Clinical Pathways

Workflow technology has emerged as one of the leading technologies in modeling, redesigning, and executing business processes in several different application domains. Among them, the representation and management of health and clinical processes have been attracting a growing interest. Such processes are in general related to the way each health organization provides the required healthcare services. Health and clinical processes underlie the specification and application of clinical protocols, clinical guidelines, clinical pathways, and the most common clinical/administrative procedures. Current workflow systems are lacking in effective management of three general key aspects that are common (not only) in the clinical/health context: data dependencies, exception handling, and temporal constraints. For example, a laparoscopic intervention may need the results of the concurrent bioptic analysis to be properly concluded while exceptional recovery activities have to be performed in case of emergency evidence during standard treatment; however, the successful application of a fibrinolytic therapy requires a maximum delay of 30 min after the admission into the emergency department. In this paper, we propose TNest, a new advanced, structured, and highly modular workflow modeling language that allows one to easily express data dependencies and time constraints during process design, in addition to exception handling and compensation activities. As for temporal constraints, we focus here on temporal controllability which is the capability of executing a workflow for all possible durations of all tasks satisfying all temporal constraints. Moreover, we analyze the computational complexity of the temporal controllability problem in TNest, and we propose a general algorithm to check the controllability. All the features of TNest that have been considered to model clinical pathways from classical clinical guidelines, i.e., those features for the management of STEMI patients, p- blished by the American College of Cardiology/American Heart Association, will be used throughout the paper as a motivating scenario.