Web-based Health Service Flow Management System

Objectives

We designed and build a prototype of a Service Flow Management System. It is guided by formal contract definitions representing expected needed to deliver the health service at the level of quality negotiated between health service consumers (patients) and providers (health care professionals). The system is able to manage the overall care delivery process by establishing a tight link between different organizational units and professionals without mutual knowledge about their work processes (by means of the contract). It allows a single organization to deliver the required services and it fosters patient self-management supporting his/her journey into a complex net of service points. From the patient point of view there should be only an organization. All the actors involved in the care process create the so called Virtual Health Care Organization. The whole care process is managed through Virtual or Face-to-Face Visit. The system is based on an organizational ontology which provides a formal representation of human agent roles and activities as well as material resources needed to manage the service she/he is willing to receive.

Description of the work

Service Point and Service Flow:

The service consumer and the service provider meet at Service Point. Here on the basis of previous agreement the service consumer asks for a service and waits the producer to fulfill it don’t taking into account how the request is processed. The successive interrelation of service points is a service flow. Each service point defines a specific service to be carried out, and it is characterized by pre- and post-conditions. Pre-conditions are input parameters enabling the service points while post-conditions are output parameters determining the activity success. Service Point aim is to manage the communication between participants preserving and ensuring agreements and privacy. It must coordinate the work activities monitoring the work during its execution, validating the executed activities and managing dynamic process changes and exceptions. All this information is contained into a contract.

Contract:

The relations between participants are formalized in a contract which represents the result of a negotiation process through which the partners agreed upon the service attributes. The contract model is composed of four main parts:

  • LEGAL part, which contains general agreements and conditions
  • WHO part, which defines the involved partners (a partner can be represented by a person or an organization with a given role)
  • WHAT part, which describes the contract subject and the relationships to be satisfied
  • HOW part, which describes the execution steps of the contract.

We define the contract in a formal way as an XML document and it defines:

  1. Virtual Visits plan
  2. Face-to-face visits plan
  3. Temporal constraints for executing actions by physician and patient according to the plans.

1. Virtual Visits plan: it defines what kind of information must be requested to the patient, and when he must communicate it through the Web-based Health Service System. For example, she/he must measure her/his blood pressure once a day, and communicate the values twice a week.

2. Face-to-face Visits plan: it defines the period of time between two consecutive face-to-face visits. Once a visit has occurred, the patient must wait for this period to elapse before undergoing the next visit. For this reason, the system must be able to remind the patient the date of the next visit.

3a. Physician’s Temporal Constraints: She/he must analyze data sent through a virtual visit within a given time and must never ignore them. She/he must certify that the data reading is complete and she/he must do it every time after reading the data. She/he must also communicate to the patient the result of any visit (face-to-face or virtual) within a prescribed maximum time.

3b. Patient’s Temporal constraints: it is allowed that the patient undergoes a visit (either face-to-face or virtual visit) within a maximum time after the scheduled one.

Organizational ontology:

The organizational model of the Service Flow Management System is based on an ontology, which formally represent the resources, human and material, involved into the Service Flow and the relationship between them. The system exploits this ontology to exploit the information necessary to correctly execute the activities needed to provide the service. It is also possible to update the information “on the fly”, for example to add a new physician registered into the system.

Prototype

We design a Service Flow for the treatment of chronic patients. The prototype, based on formal contracts, is able to represent each point of contact (service points) between the actors involved into a telemedicine system for home care management. The telemedicine system uses innovative voice-recognition technology to support the continuous interaction between a patient and her/his physician.


The Service Flow manages the activities of two different kind of visit:

  • “Face-to-face Visit” - the patient and his physician have a face-to-face (traditional) meeting (for acquiring health information, planning and adapting therapy)
  • “Virtual Visit” - the patient communicates his clinical data to a call center, answering to some question automatically generated. (Sending data and receiving recommendations)

We identified the patient, the physician and the call center as the actors involved into the process.

Technology

The process definition and control flow are realized with the YAWL editor. The data flow is added by hand, modifying the XML file resulting from the “export” function. The contract definition and the ontology are formalized in XML language: the contract is formalized with the language defined in the project Esprit E/28635 (Crossflow), while the ontology is formalized in XOL (XML-Based Ontology Exchange Language). Parts of them have been directly integrated in the process definition, to use the data necessary for the execution of the prototype.