Modelling and implementation of correct by construction healthcare workflows Petros Papapanagiotou Jacques Fleuriot This research is supported by EPSRC grant EP/J001058/1 and the College of Sciences and Engineering, University of Edinburgh. ProHealth 2014

Healthcare Processes Long, complicated guidelines or sometimes complete lack of documentation! Medical staff employ informal, error-prone practices, such as: – Post-it notes – Oral handovers Result: miscommunications, delays, errors, omissions, repetitions, …

Correct-by-construction workflows Workflows (BPM) F ormal Methods (Theorem Proving) WorkflowFM

WorkflowFM Focus Focus less on: Clinical guidelines Knowledge management Decision making Focus more on: Information flow Resource tracking Communication Process dependencies Facilitating administrative tasks (e.g. documentation) Procedure optimisation

Methodology in Healthcare

Assumptions 1.Set of atomic healthcare processes with IOPE specifications, that can interface: – EMRs, equipment/instruments, HPSs (eForms), etc. 2.“Black-boxes” 3.Always terminate

WorkflowFM Combined Value Workflows (BPM) Management and governance Flexibility and scalability Effectiveness and separation of concerns Integration of technology Simulation Maintainability Formal verification Explicit, verified information/resource flow Systematic resource management (including exception handling) Concurrency and freedom of deadlocks and livelocks Type correctness during composition Automated workflow deployment

Applications Patient handovers (Assignment/Delegation). Intra-hospital patients’ transfers. (St Mary’s Hospital, London) Integrated Care Pathways for HIV patients. (NHSGGC, NHSL)

logical proofs  concurrent processes CLL  π-calculus  Proofs-as-processes theory

Diagrammatic Interface Simple mouse gestures to apply actions. Minimum interaction with CLL or theorem proving.

Example of resource management ?

Architecture

Assignment / Delegation 1.GP diagnoses patient with Acute Renal Failure. 2.GP assigns treatment to nephrologist Dr. John. 3.Dr. John settles on hæmodialysis treatment. 4.Dr. John delegates hæmodialysis to APN Anna.

Requester Provider Request Provide Requester Provider Request Provide Assignment / Delegation GP assigns treatment to nephrologist Dr. John.. Dr. John delegates hæmodialysis to APN Anna.

Requester Provider Request Provide Requester Provider Request Provide Assignment / Delegation GP assigns treatment to nephrologist Dr. John.. Dr. John delegates hæmodialysis to APN Anna. Handle exceptions + Check outcome

Patient handover (Assignment)

Deployment

DigiHealth prototype

WorkflowFM in Healthcare: Lessons learned A lot of stakeholders, a lot of resources. Tracking of information, resources, and people is highly important (time, cost, safety). Workflow technicalities are challenging for clinical staff. Trust on the correctness of the deployed system is a requirement. Formal approach opens doors to further analysis and verification.

Conclusion WorkflowFM aims to improve healthcare processes by eliminating errors, inconsistencies, redundancies, lack of specifications/guidelines, etc. Formally verified process workflows. – Logical engine uses Proofs-as-processes paradigm Two stages: – Modelling: close collaboration with experts – Deployment: automated – facilitated integration Interface hides underlying logical engine. Prototype implementation is actively being applied in real-world cases in collaboration with clinicians. Still quite a few open challenges.