WARIA course Introduction

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Workflow Process Management and
Enterprise Application Integration in Healthcare
Requirements, Applications, Technology and
Research
Amit Sheth Keynote Address HEALTHCOM99 Sydney,
AU Jan.11, 1999
Large Scale Distributed Information Systems
Lab at University of Georgia http//lsdis.cs.uga.e
du
Thanks gt Krys Kochut, John Miller and METEOR
Teamgt NIST-ATP, IONA Technologies, Informix, ...
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Introduction

• Comprehensive Healthcare IT solutions require
• broad variety of process management
  applications, and
• enterprise application integration
• in a rapidly changing, distributed, and
  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
Nurse Coordinator
Neonatologist
Nurse
Server
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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
Users in different labs worldwide
Georgia
Solaris Server
SGI Server
Legacy App
Legacy App
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Data Analysis in a Multi-institution Genome
Sequencing Enterprise
Task 1
Task 2
Task i
Raw output from DNA sequencing machines from
multiple institutions
Fully sequenced and annotated genome
...
Automatic and human-computer data 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
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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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Schematic of Immunization Tracking
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Implementation Testbed Immunization Tracking
Demoask us for a demo
Admit Clerk
Triage Nurse
Doctor/ NP
Maternity Ward
Administrator
Case Worker
(Solaris)
DBMS
(Windows NT)
CORBA
Hospital Info System
Web Server
MPI
MEI
Web Server
(Solaris)
Immunization Database
DBMS
(Solaris)
Encounter Database
Hospital
CHREF
EDI
Clinic
CHREF/SDOH
Office Practice Mgmt System
(Solaris)
DBMS
Admit Clerk
Triage Nurse
Doctor/ NP
Web Server
Encounter Files/Databases
Insurance Eligibility Database
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Web-based Implementation
Triage Nurse Task
Admit Clerk Task
Update Personal Data
Update Local Database
Start
. . . .
Start
Stop
Collect Vitals
Generate Alerts
Enter Patient Info.
Check Eligibility
Workflow Design
Updated Results
Implementation
Generate Triage Nurses Page
Update Personal Data
N
Generate Alerts
CGI
CGI
Display Worklist
Enter Patient
Update Local Database
CGI
CGI
CGI
CGI
PULL
N
Add to Worklist
DBMS
HTTP
WORKLIST HANDLER
N
N
CGI
Machine Boundary
Alert Results
Eligibility Results
Check Eligibility
Worklist File
N
Web Page
Submit Button
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Web-based Implementation
Triage Nurse Task
Admit Clerk Task
Update Personal Data
Update Local Database
Start
. . . .
Start
Stop
Collect Vitals
Generate Alerts
Enter Patient Info.
Check Eligibility
Workflow Design
Updated Results
Implementation
Generate Triage Nurses Page
Update Personal Data
N
Generate Alerts
CGI
CGI
Display Worklist
Enter Patient
Update Local Database
CGI
CGI
CGI
CGI
PULL
Add to Worklist
DBMS
HTTP
N
N
CGI
Machine Boundary
Alert Results
Eligibility Results
Check Eligibility
N
Web Page
Submit Button
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Provider InterfaceImmunization Recos
List of overdue vaccinations
Link to contraindication info obtained from the
Internet
Clinical update to administer vaccination
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CORBA-based Implementation
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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

standard test
get blood
write report
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
Internet
ORB
e-mail
workgroup/ collaborative
document mgmt.
imaging
database
TP-monitoring
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Key conclusion from DocuLabs 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
• METEORs 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
Database Management/ Information Systems
Distributed Computing/Systems
Software Engineering, HCI, etc.
MIS/ Reengineering/ Methodology
Software Process
CSCW
Quantitative and Formal Methods/Modeling
Organizational Science
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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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Message/Data Tools/Architecture of current EAI
products/solutions
Business Object/Process Tool/Architecture of the
METEOR Enterprise Application Development
Integration
METEOR Component
METEOR Component
User Task
HOST 1
HOST 4
Adapter
Adapter
Broker
METEOR Component
METEOR Component
METEOR Component
Adapter
Adapter
Application
EDI
Database Transaction
HOST 2
HOST 3
Services and Business Objects
Publish/Subscribe event-based messaging
Distributed Object Management (ORB)
Enterprise Java Beans
DCOM
Messaging/PersistentQueue Middleware
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METEOR EAppS Enterprise Application Suite of
Services and Tools
Enterprise Application Integration
CORBA
Adaptive and Scalable Workflow
Java
Internet/Web
E-Commerce
database middleware
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METEOR Architecture
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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 graphical tools for building
  workflow process applications
• Map Designer
• Data Designer
• Task Designer
• Web Form Designer
• Exception Designer

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WebWork Application Development
.wil
.spec
Workflow Designer
Workflow Generator
Application Prototype
source
Task Customizer
Page Customizer
Specification Customizer
Workflow Application
.spec
.html
.cc
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Web Enabled and Web Based Engines
Web Based
Web Enabled
Centralized
Distributed
Front End
Enactment, monitoring, administration
Vendor1
Vendor2
Vendor3
OzWeb
Endeavors
WebWork
Error handling Recovery (Transactional Support)
Distributed Scheduling
EJB
CGI
Tcl, Java, XML
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OVERVIEW
Host A
Host B
Workflow Monitor
GRM
Cleanup Task
Workflow Administrator
GPS
Host C
Object Request Broker (CORBA)
Host E
LRM
LRM
Web
TTM
Database Task
LPS
DBMS
LRM
LPS
Web Server
Activate Message
Data Object
GPS Global Persistence Store GRM Global
Recovery Manager LPS Local Persistence
Store LRM Local Recovery Manager NtTM
Non-transactional Task Manager TM Task
Manager TTM Transactional Task Manger UTM
User Task Manager
UTM
NtTM
Application Task
User Task
Watchdog
Host D
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ORBWork Enactment Service

• Designed to address a variety of shortcomings
  found in todays 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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Schedulers and Task Managers

• Activation (scheduling) start, termination
• Error Handling
• Recovery
• Task (Application) Invocation
• Note that automatic code generation means all
  task managers are automatically generated! At
  run-time, they are started when needed.

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Task Schedulers

• A Task Scheduler performs the scheduling of all
  workflow instances flowing through it.
• Task schedulers differ, depending on the type of
  task they manage.
• Task schedulers form a hierarchy.

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Task Schedulers(continued)

• Upon detecting an enabled task
• an AutoTaskScheduler activates an associated Task
  Manager to oversee the execution of the task
• a UserTaskManager prepares a form with the
  instance-specific data and places the task on the
  worklist.
• The worklist is managed by the scheduler.
• The next task (instance) is then picked up by the
  end-user from a Web browser.

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Task Scheduler Details
Monitor
Recovery System
Transition1
Input Dependency
Output Dependency
Data Objects
AND
Task
Transition2
Scheduler
OR
Transition3
Task invocation
Task Manager
Task
Data Objects
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Task Scheduler Managing Multiple Workflow
Instances
Monitor
Recovery System
Transition1
Data Objects
Task
AND
Transition2
Scheduler
Task Manager
Task Manager
Task Manager
Task Manager
...
Task Manager
...
Task Manager
Pending
Done
Task invocation
Task
Task
Running
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Task Managers

• A Task Manager oversees the execution of an
  automatic task in the workflow.
• Task Managers differ, depending on the type of
  task they manage.
• Task Managers form a hierarchy.

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Handling of Automated Tasks

• Newly developed tasks
• typically implemented as CORBA objects
• Existing (legacy) tasks
• wrapped as CORBA objects
• invoked directly by the task manager which
  prepares the input data and handles the results

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Handling of User Tasks

• User tasks use a Web browser and an HTML form.
• Communication between a CORBA task scheduler and
  the browser
• access data objects to retrieve necessary
  attribute values
• generate a form instance (for the current
  workflow instance)
• place the form on the worklist.

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Handling of User Tasks

• The scheduler provides a rudimentary
  implementation of the HTTP protocol.
• The end-users browser connects directly to the
  task scheduler.
• The scheduler receives the GET method from the
  browser.
• The task scheduler sends to the browser the
  worklist with the enabled task instances and/or
  the individual task forms.

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ORBWorks 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 implementationUtilizing ORBIXs
features
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Why METEOR?

• Generation shift (from first generation to
  second) and high-end market needs
• client-server to distributed and network-centric
  (trend, scalability, flexibility, robustness
  requirement)
• new generation of distributed computing
  infrastructure (WWW, CORBA and Java) and new
  standards some companies are going for CORBA
  standard (E.g. various CORBAmed and defense
  companies)
• new standards OMG Workflow Facility is being
  proposed with METEOR as the prime example

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Why METEOR?

• Workflow management system can become an
  enterprise-wide and inter-enterprise application
  integration platform if it is open and
  standards-based most products do nothing to deal
  with heterogeneity commonly found in most
  enterprises
• METEOR is the first and currently only
  implementation using distributed Web and CORBA
  infrastructures, and Java

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Why METEOR?

• Many products are seen as consultant-ware with
  complex toolkits
• METEOR offers advanced code generation capability
  which can provide 60 to 80 saving in generating
  distributed workflow application in heterogeneous
  environments
• METEOR has a significant edge in ease of use,
  deployment and management

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Features, capabilities and benefits
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Emergent New Market for Enterprise Application
Development
Workflow
EAI
E-Commerce
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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
METEOR EAppS (Technology/ Product Licensing)

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

Infocosm, Inc. http//infocosm.com