Guideline Models, Process Specification, and Workflow

Abstract

Many clinical practice guidelines use flowcharts to aid the description of recommendations specified in the guidelines. Similarly a number of computer-interpretable guideline formalisms use graphical task networks to organize knowledge formalized in these models. However, the precise meaning encoded in these graphical structures is often unclear. In this presentation, I will survey some of the computer-interpretable formalisms and analyzed the graphical representations that are used to express process information embodied in clinical guidelines and protocols. I will argue that we can distinguish a number of process types: (1) flowcharts for capturing problem-solving processes, (2) disease-state maps that link decision points in managing patient problems over time, (3) plans that specify sequences of activities that contribute toward a goal, (4) workflow specifications that model care processes in an organization, and (5) computational processes that generates recommendations for specific clinical situations. These process types may be related to each other. A plan of actions, for example, may be mapped to a workflow process when its actions are assigned to healthcare providers playing different roles. A flowchart may depict decisions and actions that are performed over time. Furthermore, a guideline formalism may not make a commitment to the nature of processes being modeled. Its process-specification language may be used to encode different types of processes. Nevertheless, understanding the nature of process being modeled is crucial when it comes to enacting the encoded guidelines and protocols to provide decision support in clinical workflow. A process description that models the problem-solving steps depicted in a narrative guideline, for example, may contain steps that are not appropriate as part of human-computer interactions in a busy clinic.