=Paper=
{{Paper
|id=Vol-1418/paper3
|storemode=property
|title=ACaPlan - Adaptive Care Planning
|pdfUrl=https://ceur-ws.org/Vol-1418/paper3.pdf
|volume=Vol-1418
|dblpUrl=https://dblp.org/rec/conf/bpm/KaesMSVR15
}}
==ACaPlan - Adaptive Care Planning==
https://ceur-ws.org/Vol-1418/paper3.pdf
ACaPlan - Adaptive Care Planning
1
Georg Kaes, 1 Juergen Mangler, 1 Florian Stertz,
2
Ralph Vigne, 1 Stefanie Rinderle-Ma
1
University of Vienna, Faculty of Computer Science, Austria; 2 CERN, Switzerland
{georg.kaes, juergen.mangler, florian.sterz,
stefanie.rinderle-ma}@univie.ac.at, ralph.vigne@cern.ch
Abstract In the elder care domain, a very strong requirement is the
meticulous documentation of all treatment activities for every patient.
This legally binding obligation turns out to be very tiring for the nurses,
takes away time that they could spend with their patients, and is error-
prone as the documentation is typically done at the end of the work-day.
To solve this problem we proposed the introduction of adaptive process
management into the care domain, which constitutes a paradigm shift,
as currently the planning and operation of elder care is data-centric, not
process centric. The advantages of care as a process are (1) automatic
documentation while care activities are carried out, and (2) the process
per patient directly represents the treatment and thus makes it very
transparent.
In this demo we will show a fully integrated prototype that demonstrates
flexible and adaptive processes management in order to plan and enact
therapy plans in elder care homes. Leveraging process technology lets us
access the wealth of tools and techniques available in this area, such as
resource management through worklists, and process mining for assessing
common treatment strategies.
1 Introduction
Effective elder care is a growing concern of nowadays society. Traditionally, pa-
tients are seen as a loose collection of diagnoses, treatment plans, and lab re-
sults in a folder. This data-centric view was directly translated into tools. Every
patient is a record which has several documents attached; e.g. anamnesis, lab
results, treatment plan, and documentation.
Conceptually, these documents are strongly connected, as, e.g., lab results
are typically connected to steps in a treatment plan.
In reality, this connection exists implicitly in the heads of the care personal,
and not explicitly in the user interface of the tools. There is typically a stronger
focus on chronological dependencies than on logical connections.
Copyright c 2015 for this paper by its authors. Copying permitted for private and
academic purposes.
Documentation of the care activities is attached to the patient in the form
of reports which are typically compiled in the evening, long after the actual care
activities. This leads to the following problems (as the reports are often compiled
from memory): care activities can be missing, documented incorrectly, or added
without having been conducted.
We propose using business processes as a basis for planning and enacting
therapy plans in elder care homes, in order to facilitate planning and automatic
documentation. Since business processes are very well understood and researched
we are able to transfer some of the advantages of this domain to the elder care
domain:
– The documentation can be done semi-automatically: Whenever a therapy
task (i.e., a process step) is carried out the correct documentation can at
least be initialized by the system, if not completed.
– The system can remind the care personnel about upcoming therapy steps
which they have to complete.
– Based on process log analysis, a variety of possibilities for analyzing the
effectiveness of therapies is possible.
The ACaPlan (Adaptive Care Planning) project is built upon long running,
highly adaptive processes which drive the patients therapy plan. For each patient
there exists an individual therapy process instance containing the care tasks
which are required for the patient. This process instance is started when the
patient is admitted into the elder care home and keeps running until the patient
leaves the elder care home, so it can potentially run for several years. During this
time, whenever a new therapy is required for this patient, new process steps are
added to his therapy process instance (runtime adaptation). Thus each process
instance has a unique schema, which leads to interesting research questions for
the BPM community.
In the ACaPlan prototype we want to cover all aspects of a nurse’s daily
working routine. Therefore, the following features were required:
– Decision support by providing structured high quality nursing knowledge for
current and potentially to be added treatment steps.
– Automated documentation support by providing the care personnel with
hardware that completes process steps with minimal interaction.
– Different views for the different roles that exist in a elder care home (doctors,
nurses, administration). Especially for nurses an intuitive UI for guiding
them through their daily routine for many concurrent patients is crucial.
– A system architecture for scaling up to thousands of concurrently long run-
ning process instances (one per patient).
In [1], flexibility requirements of care processes have been discussed and a pre-
liminary realization in ACaPlan has been introduced. This demo paper presents
the prototype in detail, together with new interfaces, functionalities, and exten-
sions.
2 Maturity and Significance to the BPM Field
The ACaPlan project provides a novel approach for supporting elder care based
on business process technology, thus demonstrating the power of business process
technologies in a human-centric field. It has been developed in cooperation with
several Austrian elder care facilities and is currently evolving as a showcase for
adaptive process technology1 . ACaPlan supports the most important features a
tool for nurses has to offer.
As the patients’ process instances are constantly adapted at runtime, the
ACaPlan demo is of high significance for the BPM field, as it demonstrates sev-
eral concepts regarding process evolution and adaptation. Especially interest-
ing is the user support during therapy planning, which is important to prevent
the execution of process instances that are not consistent or even contradicting
nursing standards. This includes mining for common treatments and treatment
patterns.
ACaPlan furthermore is used as the stable basis for the ANTS (ACaPlan
NFC Treatment Support)2 project. The goal of ANTS is to connect patient
beds as well as a variety of NFC tagged care utilities to treatments through on-
tologies. By applying semantic reasoning techniques and fuzzy matching of care
utilities to patients treatment plans, we hope to achieve a significant reduction
in administrative load for the nursing staff.
3 Screencast, Documentation and Demo
In the ACaPlan project we have implemented the following features in order to
provide process based support to nursing personnel:
1. A nursing knowledge repository [2] based on NANDA3 , NIC4 and NOC5 .
This repository contains an in nursing science well researched classification
for diagnoses containing the symptoms, causes, tasks which can be done
in order to help the patient, and possible outcomes [3]. The tasks defined
in each diagnosis are the basic building blocks for our therapy process. By
implementing a standardized nursing process which can be found in
nursing literature [4], ACaPlan supports nurses in finding good therapies for
the current situation. This nursing process defines a standardized approach
for finding a patient’s needs by thoroughly analyzing his or her symptoms.
Based on this information, possible diagnoses, required nursing tasks and
possible outcomes of a therapy are defined.
1
http://cs.univie.ac.at/project/apes
2
http://cs.univie.ac.at/project/ants
3
North American Nursing Diagnosis Association, http://www.nanda.org
4
Nursing Interventions Classification, http://www.nursing.uiowa.edu/cncce/nursing-
interventions-classification-overview
5
Nursing Outcomes Classification, http://www.nursing.uiowa.edu/cncce/nursing-
outcomes-classification-overview
2. A user interface based on HTML, CSS and JavaScript, which is optimized
for smartphones and tablets.
3. Near Field Communication (NFC) devices, which are added to the
patient’s bed. One of our goals is to keep the additional technical burden for
the nurses as low as possible. Nurses should not be forced to use a tablet or
a smartphone to document process steps. Instead, we want to incorporate
NFC tags to commonly used artifacts, such as a set of medications which is
administered to the patient every morning. Whenever the nurse administers
the drugs to the patient, all he has to do is to register the NFC tag at the
patient’s bed, and the documentation is completed automatically.
4. Personalized views on care activities (worklists) based on roles.
5. A single therapy process per patient which serves as the patient’s therapy
plan. It contains all therapy tasks which have been completed or are sched-
uled for one single patient. It is responsible for logging and documenting
executed therapy tasks and supporting the planning of upcoming tasks.
While the ACaPlan concepts are generic, the demonstrated implementation
has the following properties:
– The implementation is composed of multiple microservices which commu-
nicate with each other over a RESTful API. Thus all advantages of microser-
vices apply, including that the system is easy to scale whenever bottlenecks
appear.
– The implementation uses the CPEE [5] as a flexible process engine, thus
making it easy to initialize, adapt and execute the required processes.
The project website of ACaPlan with a working demo, a description of the
technical details and the screencast can be found at:
http://cs.univie.ac.at/project/acaplan
Figure 1. Who cares? - ACaPlan Cockpit
Figure 2. Who cares? - Solution Designer
The user interface of the ACaPlan project as depicted in Fig. 1 is based on
JavaScript and HTML, and can therefore be tested on a multitude of different
devices, including desktop computers, laptops, smartphones and tablets.
It hides the complexity of the underlying process instances from the nurses,
who are not supposed to interact with them on a technical level. Instead, the
nurses use to-do lists (as seen in Fig. 1) and a solution designer (Fig. 2) to plan,
enact and execute therapy plans.
Bibliography
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2014 Workshops. (2014) 55–64
2. Kaes, G., Mangler, J., Rinderle-Ma, S., Vigne, R.: The NNN formalization: Review
and development of guideline specification in the care domain. Technical report,
arXiv.org (2014)
3. Marlies Ehmann, Ingrid Völkel: Pflegediagnosen in der Altenpflege. 2 edn. URBAN
& FISCHER, München (2004)
4. Harald Stefan, Josef Eberl, Kurt Schalek, Hubert Streif, Harald Pointner: Praxis-
handbuch Pflegeprozess. 1 edn. SpringerWienNewYork, Wien (2006)
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