Workflow Process Management and Enterprise Application Integration in Healthcare

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06/16/22 1 Large Scale Distributed Information Systems Lab at University of Georgia http://lsdis.cs.uga.edu Requirements, Applications, Technology and Requirements, Applications, Technology and Research Research Amit Sheth Amit Sheth Keynote Address Keynote Address HEALTHCOM99 HEALTHCOM99 Sydney, AU Jan.11, 1999 Sydney, AU Jan.11, 1999 Thanks: > Krys Kochut, John Miller and METEOR Team > NIST-ATP, IONA Technologies, Informix, ...

description

Amit Sheth, Keynote Address at HEALTHCOM99, Sydney, Australia, Jan.11, 1999.

Transcript of Workflow Process Management and Enterprise Application Integration in Healthcare

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Large Scale Distributed Information Systems Labat University of Georgia

http://lsdis.cs.uga.edu

Requirements, Applications, Technology and ResearchRequirements, Applications, Technology and Research

Amit ShethAmit Sheth

Keynote AddressKeynote Address

HEALTHCOM99HEALTHCOM99Sydney, AU Jan.11, 1999Sydney, AU Jan.11, 1999

Thanks: > Krys Kochut, John Miller and METEOR Team> NIST-ATP, IONA Technologies, Informix, ...

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Introduction

Comprehensive Healthcare IT solutions require Comprehensive Healthcare IT solutions require broad variety of process management broad variety of process management

applications, and applications, and enterprise application integration enterprise application integration

in a rapidly changing, distributed, and in a rapidly changing, distributed, and heterogeneous computing environments.heterogeneous computing environments.

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Reprsentative Healthcare Applicationsfor which the METEOR EAppS has been used

Application• NeoNatal Clinical

PathWays• Genome

Sequencing

• Eligibility-Referral• Immunization

Tracking

Key Characteristics• Clinical, single site/server• Non-medical, multiple user

organizations, two servers• Administrative, two

participating organizations• Clinical and Administrative,

multiple servers, multiple organizations

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Neonatal Clinical Pathways

Server

Nurse Nurse Coordinator Neonatologist

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Neonatal Clinical Pathways

• Multiple inter-related clinical pathways or treatment plans for premature, underweight babies (head ultrasound, metabolic screen, nutrition, immunizations, etc.)

• Alert on test to be ordered, enter tests and review results, update database, print reports

• Users: nurse coordinator, nurse, neonatologist• single server, Web-based clients

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Head Ultrasound Workflow

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Multi-institutional Genome Sequencing

SolarisServer

Users in different labs worldwide

SGIServer

Legacy App Legacy App

Georgia

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Data Analysis in a Multi-institution Genome Sequencing Enterprise

Raw output fromDNA sequencing machinesfrom multiple institutions

Fully sequencedand annotated genome

Task 1 Task 2 Task i

...

Automatic and human-computerdata analysis tasks running on heterogeneous servers

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Characteristics of Data Analysis Tasks

• Many existing legacy data analysis applications and new applications running

• different servers (SGI and Solaris)

• Each human-computer task performed by an expert who specializes in that task; experts are located at different institutions throughout the world

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Eligibility and Referral

Sending organization

Receivingorganization

Insurancecompany

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Eligibility and Referral(i.e., “patient dumping”)

• Sending Organization -- Receiving Organization -- (optionally insurance company and ambulance services)

• Two independent workflows with interoperability, optionally EDI with other organizations

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Sending Organization

Receiving Organization

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An Example of Mission-criticalEnterprise Application

Developed using METEOR EAppS

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CLINICAL SUBSYSTEM

Generates:• Alerts to identify

patient’s needs.• Contraindications to

caution providers.

SDOH andCHREF maintaindatabases,support EDI transactions

Hospitals and clinics update centraldatabases after encounters

Health providers can obtain up-to-dateclinical and eligibility information

TRACKING SUBSYSTEM

State and HMO’s can update patient’s eligibility data

Health agencies canuse reports generated to trackpopulation’s needs

CT

Hospitals andcase workerscan reach out to the population

HMOs can keep track of performance

Reports to state

Reminders to parents

Schematic of Immunization Tracking

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CORBADBMS

ImmunizationDatabase

Web Server

(Solaris)

Administrator Case Worker AdmitClerk

TriageNurse

Doctor/NP

Maternity Ward

(Solaris)Encounter DatabaseHospita

lCHREF

AdmitClerk

TriageNurse

Doctor/NP Encounter

Files/Databases

Office PracticeMgmt System

ClinicCHREF/SDOH

Insurance Eligibility Database

(Solaris)

Implementation Testbed: Immunization Tracking Demo

ask us for a demo

EDI

(Solaris)

MPI MEI Web Server

Web ServerDBMS

DBMS

(Windows NT)Hospital

Info System

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Web-based Implementation

Start. . . . Start

PULL

CGI

NN

NN

NN

NN

NN

CGI

CGI

CGI

CGICGI CGI

Enter PatientGenerate

Alerts

Update PersonalData

Check Eligibility

Update Local Database

HTTP

WorklistFile

Generate TriageNurse’s Page

Display Worklist

NN

EnterPatient Info.

GenerateAlerts

Enter PatientInfo.

Update PersonalData

Check Eligibility

Update LocalDatabase

Stop

Implementation

Triage Nurse Task

Submit Button

Alert Results EligibilityResults

Admit Clerk Task

Workflow Design

Mac

hin

e B

ou

nd

ary

CollectVitals

Add toWorklist

Web Page

DBMS

Updated Results

WORKLISTHANDLER

NN

EnterPatient Info.

Verify patient eligibility

Generate medical alerts

Insert into clinic/hospitalEncounter database

NN

EnterPatient Info.

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Start. . . . Start

PULL

CGI

NN

NN

NN

NN

CGI

CGI

CGI

CGICGI CGI

Enter PatientGenerate

Alerts

Update PersonalData

Check Eligibility

Update Local Database

HTTP

Generate TriageNurse’s Page

Display Worklist

NN

EnterPatient Info.

GenerateAlerts

Enter PatientInfo.

Update PersonalData

Check Eligibility

Update LocalDatabase

Stop

Implementation

Triage Nurse Task

Submit Button

Alert Results EligibilityResults

Admit Clerk Task

Workflow Design

Mac

hin

e B

ou

nd

ary

CollectVitals

Add toWorklist

Web Page

DBMS

Updated Results

NN

WorklistFile

WORKLISTHANDLER

NN

WorklistFile

WORKLISTHANDLER

NN

WorklistFile

WORKLISTHANDLER

Web-based Implementation

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Provider Interface:Immunization Reco’s

List of overdue vaccinations

Link to contraindication info obtained from the Internet

Clinical update to “administer vaccination”

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CORBA-based Implementation

Check Eligibility

. . . .

Workflow DesignGenerate

AlertsEnter Patient

Info.

Update PersonalData

Check Eligibility

Update LocalDatabase

Start Stop

Triage Nurse Task

Start

Admit Clerk Task

CollectVitals

Enter PatientGenerate

Alerts

UpdatePersonal

Data

Check Eligibility

UpdateLocal

Database

HTTP

Worklist Handler

Enter Patient Info.

Implementation

Submit Button

Alert Results Eligibility Results

Mac

hin

e B

ou

nd

ary

CORBA CORBA

CORBA

CORBA

CORBANN

Add toWorklist

NN Web Page

DBMS

Updated Results

NN

NNNN

CORBA

Patient Data (CORBA)

Control Flow

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Requirements of mission-critical healthcare applications

that METEOR supports

Some of the important requirements for this application include:

Support for a distributed architecture in a heterogeneous computing environment. At the level of any user of the system, this distribution should be transparent

Support for inter- and intra-enterprise wide coordination of tasks

Provision of a standard user-friendly interface to all users of the system

Support for a variety of tasks: transactional and non-transactional, user and application

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Requirements of mission-critical healthcare applications

that METEOR supports

Capability of using existing DBMS infrastructure and databases across organizations

Low cost of system for the providers and user organizations

Ease of modification (re-design), scalability, extensibility and fast design-to-implementation

Open architecture, use of standards (e.g., CORBA, CORBAmed, OMG WF, WfMC, SWAP) and middleware (JDBC)

Security authorization for users and secure communication (required as patient data is typically confidential)

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Adaptive Workflow Example 1

If initial exam identifies needs for additional procedure in the blood test, the task/subprocess component is obtained from the repository and added to the subprocess

get blood

standard test

write report

WorkflowComponent

Repos.

special test

This example is from Han et al.

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Adaptive Workflow Example 2

• Comorbidity: new lab result identifies previously unknown illness or health condition that requires additional health management in addition to the current condition.

• New related workflow (or subworkflow) is kicked off.

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State of the art technology, products and research

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Market Approaches to Workflow

e-mail

document mgmt.workgroup/collaborative

imaging

Internet ORB

databaseTP-monitoring

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Key conclusion from DocuLab’s workflow product comparison study

Products that allow development of complex applications, provide flexibility and support integration are very hard to use, take too long and require experience programmers (and are still not quite comprehensive)

Easy to use products are too restrictive --and are useful for small or standard applications only

METEOR’s objective is to avoid significant compromise.

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What is lacking from state of the art in Workflow Technology

• Primarily centralized, client/server architectures• Difficulty in integrating with existing applications

and databases, not meant for heterogeneous, multi-server environments

• Static workflows that can be fully defined before enactment starts

• Focus on repetitive processes

Most products are, however, suitable for many office automation and other human oriented processes.

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Research Disciplines Contributing to to Workflow Management

Quantitative andFormal Methods/Modeling

Software Engineering,HCI, etc.

OrganizationalScience

CSCW

Database Management/Information Systems Distributed

Computing/Systems

MIS/Reengineering/Methodology

Software Process

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Enterprise Application Integration [EAI]

• The average Fortune 2000 company relies on 49 enterprise-level applications to run its business and spends 25 to 33 percent of its IT budget just to get tem to talk to each other [Dan Sholler, Meta Group]

• Systems integration costs in many cases amount of 40 percent of IT costs

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Messaging/PersistentQueue Middleware

DistributedObject Management

(ORB)

EnterpriseJava Beans

DCOM

Publish/Subscribe;event-based messaging

PackagedApp

Broker

METEORComponent

HOST 1

HOST 2HOST 3

HOST 4

ApplicationDatabase Transaction

EDI

UserTask

UserTask

METEORComponent

METEORComponent

METEORComponent

METEORComponent

Services and Business Objects

Message/Data Tools/Architectureof current EAI products/solutions

Business Object/Process Tool/Architectureof the METEOR Enterprise Application Development & Integration

Adapter

Adapter

Adapter

Adapter

App

App

LegacyApp

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METEOR Architecture

Builder REPOSITORY

AUTOMATIC CODE GENERATION

MONITOR

AND

TASKTASK TASK

TASKWEB /

CORBA

DB

TASKMgr.

TASKMgr.

TASKMgr.

TASKMgr.

Application

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METEOR2 EAppS [Enterprise Application Suite of Tools and Services]

End Users

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METEOR Model

• Integral support for human and application tasks– transactional and non-transactional tasks– human tasks: forms, collaborative tasks– automated tasks: database access, legacy

applications

• Complex control and data dependencies• much more

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METEOR Workflow Builder Service

Comprehensive set of Comprehensive set of graphical tools for graphical tools for building workflow building workflow process applicationsprocess applications

Map DesignerMap Designer Data DesignerData Designer Task DesignerTask Designer Web Form DesignerWeb Form Designer Exception DesignerException Designer

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WebWork Application Development

WorkflowDesigner

TaskCustomizer

WorkflowGenerator

ApplicationPrototype

PageCustomizer

Specification

Customizer

WorkflowApplication

.wil .spec

source

.spec.html.cc

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Web Enabled and Web Based Engines

Web Enabled

WebBased

Centralized Distributed

Vendor1 Vendor2 Vendor3 OzWeb Endeavors WebWork

DistributedScheduling

Error handlingRecovery

(Transactional Support)

CGI Tcl, Java, XML

Front End Enactment, monitoring, administration

EJB

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Workflow MonitorGRM

Object Request Broker(CORBA)

TTM

LRM

LPS

ApplicationTask

Web Server

GPS

Web

WorkflowAdministrator

Database Task

User Task

DBMS

Host E

Host D

Host C

Host A Host B

UTM

LPS

LPS

LRM

NtTMGPS Global Persistence StoreGRM Global Recovery ManagerLPS Local Persistence StoreLRM Local Recovery ManagerNtTM Non-transactional Task ManagerTM Task ManagerTTM Transactional Task MangerUTM User Task Manager

Cleanup Task

Watchdog

Data Object Activate Message

LRM

OVERVIEW

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ORBWork Enactment Service

Designed to address a variety of shortcomings found in today’s component middleware, enterprise integration, and workflow process management systems, it supports the following capabilities:Integration of application components and databases

on disparate distributed and heterogeneous computing environments across enterprise intranet and extranet boundaries

A fully distributed and highly scalable enterprise application process enactment system capable of supporting dynamic business processes

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ORBWork (continued)

Utilization of open and industry standards such as CORBA/IIOP, Java, JDBC, HTTP, and OMG Workflow Facility for developing open, distributed, object-based, interoperable enterprise applications

Support for cross-platform portability of tasks in business processes (by exclusively developing them in Java)

Provision for a browser-based Web user interface for the end-users and the administrators.

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ORBWork’s fully distributed scheduling and flexible placement

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Achieving Scalability

• Use of a fully distributed scheduler.• Component task schedulers “mirror” the

workflow map design.• Natural distribution of scheduling and task

activation functions among participating hosts.

• Task schedulers can be replicated to increase the load handling potential.

• Task managers can be distributed among many hosts to balance the load.

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Dynamic Changes

Dynamic changes both to the enterprise application or workflow process schema and to the individual workflow process instances.

Administrator can easily modify the schema at runtime by acquiring the new information from the repository, or even by modifying the specification by HTTP-based direct interaction with the scheduler.

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ORBWork implementation:

Utilizing ORBIX’s features

Feature Application

Dynamic ObjectActivation

Allows for automatic activation and deactivation ofORBWork components, reducing the load on the hostsystem(s)

Dynamic InvocationInterface (DII)

Only object references are transferred; data object areaccessed dynamically, according to their interfaces

Object Loaders Data objects, task schedulers, and other ORBWorkcomponents use loaders to automatically save/restorestate

Naming Service Task schedulers are located with the use of the NameService; this allows for flexible and transparentplacement of the schedulers and their possiblemigration at runtime

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Features, capabilities and benefits Graphical building of complexapplications

Ability to visualize all application components; reducedneeds for expert developers; rapid deployment

Support for heterogeneous,distributed computingenvironment, open-systemsarchitecture

Seamless deployment over networked heterogeneous(Solaris and NT) server platforms; ease of integration oflegacy/existing applications

Automatic code generation Significantly reduced coding and corresponding savings indevelopment cost; reduced need for expert developers;rapid deployment

Integration of human andautomated activities, includingtransactions

Natural modeling of complex business activities/proesses

Fully distributed scheduling High scalability and performance, minimal single point offailure,

Dynamic changed Rapidly adapt to changes in business processes

Exception-handling andrecovery, survivability

Mission-critical, robust applications

Traditional security, multi-levelsecurity

Support for roles, security on open Internetworking;commercial to defense applications

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Summary

Enterprise Healthcare applications need more than what most workflow products and “consultantware” systems have to offer.

METEOR EAppS uses CORBA, Web, and Java offers unique solutions to realize the promise of recent advances in distributed computing infrastructure, middleware and Web, by quickly integrating applications and information systems, to support complex and dynamic business process management.

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Additional information

http://lsdis.cs.uga.edu(METEOR Research)

Infocosm, Inc. http://infocosm.com

METEOREAppS(Technology/Product Licensing)