1. Workflow Stephen Aylward Luis Ibanez

2. Goals Identify 3 main challenges in this area Identify 3 specific problems that can be solved by a collaborative effort between academic and industry partners Identify a problem that the NCIGT can help address in the next year

3. Outline Scope Identify current projects How can NCIGT help –Topics in workflow

4. Wikipedia: Workflow Workflow at its simplest is the movement of documents and/or tasks through a work process. More specifically, workflow is the operational aspect of a work procedure: how tasks are structured, who performs them, what their relative order is, how they are synchronized, how information flows to support the tasks and how tasks are being tracked. As the dimension of time is considered in Workflow, Workflow considers "throughput" as a distinct measure. Workflow problems can be modeled and analyzed using graph-based formalisms like Petri nets.

5. Workflow System 1.The workflow modeling component (sometimes called specification module, design environment or build time system) which enables administrators and analysts to define process and activities, analyze and simulate them, and assign them to people. 2.The workflow execution component, sometimes called the run-time system which most often consists of an –execution interface seen by end-users and –a workflow engine. The workflow engine is an execution environment which assists or performs the coordination of processes and activities.

6. Assumption 1.A small number of workflow templates can capture the majority clinical cases [Paggetti 2001] 2.Workflows are effectively modeled as State Diagrams, Petri Nets and Timed Petri Nets –Each state has associated with it a finite set of events that invoke transitions to new states –They provide an easy transition towards software implementation 3.Workflows are the reality of the way humans perform activities 4.Acknowledging its existence, when designing software, results in more realistic and safer software

7. Why Improved application design Simplified application design Produce safer software, better suited for clinical applications Basis for testing: inputs/outputs/states Encapsulate technologies for research and integration Define a language that spans implementation toolkit –Bridge: IGSTK, Slicer, VolView, …

8. Workflow granularity 1.Effect-level (patient) workflow = Guide probe to tumor 2.Task-level (physician) workflow = Acquire an ultrasound image of tumor 3.Data-level (system) workflow = Record tracker coordinates

9. Outline Scope Identify current projects How can NCIGT help –Topics in workflow

10. What are the current/pending workflow-related projects? Goals Methods Strengths / weaknesses Schedule

11. Outline Scope Identify current projects How can NCIGT help –Topics in workflow

12. Per-topic questions: Where is the field? Where can research have the most impact? Where is industry / academic partnering needed / beneficial? What is the timeline for the research (1 yr, 3 yr, 5 yr)?

13. Topic #1 What do we want from a workflow specification –Non-programmatic description of a system / requirements “Our system does …” Storyboard DICOM Workgroup –Foundation for testing –File format for creating applications –An API standard for states/transitions for method/device sharing e.g., wrap IGSTK, Slicer GUI independent execution model Where is the field? Where can research have the most impact? Industry / academic partnering needed / beneficial? What is the timeline for the research (1, 3, 5 yr)?

14. Topic #2 Users of workflow descriptions –Application development For FDA approval In the clinic In research labs –Testing New applications Existing applications Methods / Devices –Research Developing methods / devices Developing new toolkits Where is the field? Where can research have the most impact? Industry / academic partnering needed / beneficial? What is the timeline for the research (1, 3, 5 yr)?

15. Topic #3 Role of patient safety / flexibility –Solution: do one thing well!! –Error conditions enumerated Complexity vs transparency –Determinism Guarantee each event is handled and transition occurs successfully Certain things should never happen: explicit workflow make possible to forbid some paths –Patient safety Vs ease-of-use (new applications) Vs ease-of-extension (new states) Vs ease-of-specialization (new components/devices) Vs ease-of-development Where is the field? Where can research have the most impact? Industry / academic partnering needed / beneficial? What is the timeline for the research (1, 3, 5 yr)?

16. Topic #4 Technical challenges –Recording events in OR [Lemke/Cleary] Short lasting, repetitive, rapid, multi-parameter, simultaneous Deriving common states from multiple recordings Deriving common states from different procedures Quantifying physicians time and mental effort –Workflow validation System testing using workflows Accruing error / uncertainty Accruing required accuracy Accruing risk to the patient / outcome –Workflows –vs– C++: Not traditional programming style Where is the field? Where can research have the most impact? Industry / academic partnering needed / beneficial? What is the timeline for the research (1, 3, 5 yr)?

17. Meeting Notes

18. Challenge #1 Reference workflows –Include clinicians in the process Use workflow for communication with clinicians Storyboard Recording workflow improved clinician performance –Generating them Collection tools under development Data from Stealthlink directly Data from interviews Identify common workflows –Choose a standard language –“Workflow management system” –Basis for teaching using new technology

19. Challenge #2 Adapting workflows –Specialize for site, physician, physician experience, patient –Workflows should be very specific to balance flexibility with patient safety –Limits creativity/problems in the OR? Dynamic programming?

20. Challenge #3 Workflow for validation and comparison –Workflows carry accuracy and time (outcome) predictions –Workflows validated in the OR –Workflows as a foundation for comparison of systems –Compare workflows Time and accuracy

21. Challenge #4 Implementing workflows –Execution model is GUI independent Bridge IGTK, Slicer, and VolView –C++/QT/FLTK are ineffective for workflow- based programming –Burden on developer –Different models Lemke Service oriented architecture

22. Challenge #5 Data Workflows –No effective solution to process a large number of datasets Loni SIMULINK Kepler / Ptolomy Batchmake