Process mining and data mining applications in the domain of chronic diseases: A systematic review.

The widespread use of information technology in healthcare leads to extensive data collection, which can be utilised to enhance patient care and manage chronic illnesses. Our objective is to summarise previous studies that have used data mining or process mining methods in the context of chronic diseases in order to identify research trends and future opportunities. The review covers articles that pertain to the application of data mining or process mining methods on chronic diseases that were published between 2000 and 2022. Articles were sourced from PubMed, Web of Science, EMBASE, and Google Scholar based on predetermined inclusion and exclusion criteria. A total of 71 articles met the inclusion criteria and were included in the review. Based on the literature review results, we detected a growing trend in the application of data mining methods in diabetes research. Additionally, a distinct increase in the use of process mining methods to model clinical pathways in cancer research was observed. Frequently, this takes the form of a collaborative integration of process mining, data mining, and traditional statistical methods. In light of this collaborative approach, the meticulous selection of statistical methods based on their underlying assumptions is essential when integrating these traditional methods with process mining and data mining methods. Another notable challenge is the lack of standardised guidelines for reporting process mining studies in the medical field. Furthermore, there is a pressing need to enhance the clinical interpretation of data mining and process mining results.

Sequence-oriented sensitive analysis for PM2.5 exposure and risk assessment using interactive process mining.

The World Health Organization has estimated that air pollution will be one of the most significant challenges related to the environment in the following years, and air quality monitoring and climate change mitigation actions have been promoted due to the Paris Agreement because of their impact on mortality risk. Thus, generating a methodology that supports experts in making decisions based on exposure data, identifying exposure-related activities, and proposing mitigation scenarios is essential. In this context, the emergence of Interactive Process Mining-a discipline that has progressed in the last years in healthcare-could help to develop a methodology based on human knowledge. For this reason, we propose a new methodology for a sequence-oriented sensitive analysis to identify the best activities and parameters to offer a mitigation policy. This methodology is innovative in the following points: i) we present in this paper the first application of Interactive Process Mining pollution personal exposure mitigation; ii) our solution reduces the computation cost and time of the traditional sensitive analysis; iii) the methodology is human-oriented in the sense that the process should be done with the environmental expert; and iv) our solution has been tested with synthetic data to explore the viability before the move to physical exposure measurements, taking the city of Valencia as the use case, and overcoming the difficulty of performing exposure measurements. This dataset has been generated with a model that considers the city of Valencia's demographic and epidemiological statistics. We have demonstrated that the assessments done using sequence-oriented sensitive analysis can identify target activities. The proposed scenarios can improve the initial KPIs-in the best scenario; we reduce the population exposure by 18% and the relative risk by 12%. Consequently, our proposal could be used with real data in future steps, becoming an innovative point for air pollution mitigation and environmental improvement.

How to Design Successful Participatory Design Workshops for Digital Health Solutions?

Participatory design (PD) is increasingly used to support design and development of digital health solutions. The involves representatives of future user groups and experts to collect their needs and preferences and ensure easy to use and useful solutions. However, reflections and experiences with PD in designing digital health solutions are rarely reported. The objective of this paper is to collect those experiences including lessons learnt and moderator experiences, and to identify challenges. For this purpose, we conducted a multiple case study to explore the skill development process required to successfully design a solution in the three cases. From the results, we derived good practice guidelines to support designing successful PD workshops. They include adapting the workshop activities and material to the vulnerable participant group and considering their environment and previous experiences, planning sufficient time for preparation and supporting the activities with appropriate material. We conclude that PD workshop results are perceived as useful for designing digital health solutions, but careful design is very relevant.

Assessment of distance to primary percutaneous coronary intervention centres in ST-segment elevation myocardial infarction: Overcoming inequalities with process mining tools.

Objectives: In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The "Centro" region of Portugal has heterogeneity in PCI assess due to geographical reasons. We aimed to explore time delays between regions using process mining tools. Methods: Retrospective observational analysis of patients with STEMI from the Portuguese Registry of Acute Coronary Syndromes. We collected information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We built a national and a regional patient's flow models by using a process mining methodology based on parallel activity-based log inference algorithm. Results: Totally, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model. Most patients (73%) had primary PCI, with the median time between admission and treatment <120 minutes in every region; "Centro" had the longest delay. In the regional model corresponding to the "Centro" region of Portugal divided by districts, only 61% had primary PCI, with "Guarda" (05:04) and "Castelo Branco" (06:50) showing longer delays between diagnosis and reperfusion than "Coimbra" (01:19). For both models, in-hospital mortality was higher for those without reperfusion therapy compared to PCI and fibrinolysis. Conclusion: Process mining tools help to understand referencing networks visually, easily highlighting its inefficiencies and potential needs for improvement. A new PCI centre in the "Centro" region is critical to offer timely first-line treatment to their population.

Building Process-Oriented Data Science Solutions for Real-World Healthcare.

The COVID-19 pandemic has highlighted some of the opportunities, problems and barriers facing the application of Artificial Intelligence to the medical domain. It is becoming increasingly important to determine how Artificial Intelligence will help healthcare providers understand and improve the daily practice of medicine. As a part of the Artificial Intelligence research field, the Process-Oriented Data Science community has been active in the analysis of this situation and in identifying current challenges and available solutions. We have identified a need to integrate the best efforts made by the community to ensure that promised improvements to care processes can be achieved in real healthcare. In this paper, we argue that it is necessary to provide appropriate tools to support medical experts and that frequent, interactive communication between medical experts and data miners is needed to co-create solutions. Process-Oriented Data Science, and specifically concrete techniques such as Process Mining, can offer an easy to manage set of tools for developing understandable and explainable Artificial Intelligence solutions. Process Mining offers tools, methods and a data driven approach that can involve medical experts in the process of co-discovering real-world evidence in an interactive way. It is time for Process-Oriented Data scientists to collaborate more closely with healthcare professionals to provide and build useful, understandable solutions that answer practical questions in daily practice. With a shared vision, we should be better prepared to meet the complex challenges that will shape the future of healthcare.

Process mining for healthcare: Characteristics and challenges.

Process mining techniques can be used to analyse business processes using the data logged during their execution. These techniques are leveraged in a wide range of domains, including healthcare, where it focuses mainly on the analysis of diagnostic, treatment, and organisational processes. Despite the huge amount of data generated in hospitals by staff and machinery involved in healthcare processes, there is no evidence of a systematic uptake of process mining beyond targeted case studies in a research context. When developing and using process mining in healthcare, distinguishing characteristics of healthcare processes such as their variability and patient-centred focus require targeted attention. Against this background, the Process-Oriented Data Science in Healthcare Alliance has been established to propagate the research and application of techniques targeting the data-driven improvement of healthcare processes. This paper, an initiative of the alliance, presents the distinguishing characteristics of the healthcare domain that need to be considered to successfully use process mining, as well as open challenges that need to be addressed by the community in the future.

Analytical exploratory tool for healthcare professionals to monitor cancer patients' progress.

Introduction: Cancer is a primary public concern in the European continent. Due to the large case numbers and survival rates, a significant population is living with cancer needs. Consequently, health professionals must deal with complex treatment decision-making processes. In this context, a large quantity of data is collected during cancer care delivery. Once collected, these data are complex for health professionals to access to support clinical decision-making and performance review. There is a need for innovative tools that make clinical data more accessible to support cancer health professionals in these activities. Methods: Following a co-creation, an interactive approach thanks to the Interactive Process Mining paradigm, and data from a tertiary hospital, we developed an exploratory tool to present cancer patients' progress over time. Results: This work aims to collect and report the process of developing an exploratory analytical Interactive Process Mining tool with clinical relevance for healthcare professionals for monitoring cancer patients' care processes in the context of the LifeChamps project together with a graphical and navigable Process Indicator in the context of prostate cancer patients. Discussion: The tool presented includes Process Mining techniques to infer actual processes and present understandable results visually and navigable, looking for different types of patients, trajectories, and behaviors.

Design and Evaluation of a Solo-Resident Smart Home Testbed for Mobility Pattern Monitoring and Behavioural Assessment.

Aging population increase demands for solutions to help the solo-resident elderly live independently. Unobtrusive data collection in a smart home environment can monitor and assess elderly residents' health state based on changes in their mobility patterns. In this paper, a smart home system testbed setup for a solo-resident house is discussed and evaluated. We use paired Passive infra-red (PIR) sensors at each entry of a house and capture the resident's activities to model mobility patterns. We present the required testbed implementation phases, i.e., deployment, post-deployment analysis, re-deployment, and conduct behavioural data analysis to highlight the usability of collected data from a smart home. The main contribution of this work is to apply intelligence from a post-deployment process mining technique (namely, the parallel activity log inference algorithm (PALIA)) to find the best configuration for data collection in order to minimise the errors. Based on the post-deployment analysis, a re-deployment phase is performed, and results show the improvement of collected data accuracy in re-deployment phase from 81.57% to 95.53%. To complete our analysis, we apply the well-known CASAS project dataset as a reference to conduct a comparison with our collected results which shows a similar pattern. The collected data further is processed to use the level of activity of the solo-resident for a behaviour assessment.

Dynamic Models Supporting Personalised Chronic Disease Management through Healthcare Sensors with Interactive Process Mining.

Rich streams of continuous data are available through Smart Sensors representing a unique opportunity to develop and analyse risk models in healthcare and extract knowledge from data. There is a niche for developing new algorithms, and visualisation and decision support tools to assist health professionals in chronic disease management incorporating data generated through smart sensors in a more precise and personalised manner. However, current understanding of risk models relies on static snapshots of health variables or measures, rather than ongoing and dynamic feedback loops of behaviour, considering changes and different states of patients and diseases. The rationale of this work is to introduce a new method for discovering dynamic risk models for chronic diseases, based on patients' dynamic behaviour provided by health sensors, using Process Mining techniques. Results show the viability of this method, three dynamic models have been discovered for the chronic diseases hypertension, obesity, and diabetes, based on the dynamic behaviour of metabolic risk factors associated. This information would support health professionals to translate a one-fits-all current approach to treatments and care, to a personalised medicine strategy, that fits treatments built on patients' unique behaviour thanks to dynamic risk modelling taking advantage of the amount data generated by smart sensors.

What Role Can Process Mining Play in Recurrent Clinical Guidelines Issues? A Position Paper.

In the age of Evidence-Based Medicine, Clinical Guidelines (CGs) are recognized to be an indispensable tool to support physicians in their daily clinical practice. Medical Informatics is expected to play a relevant role in facilitating diffusion and adoption of CGs. However, the past pioneering approaches, often fragmented in many disciplines, did not lead to solutions that are actually exploited in hospitals. Process Mining for Healthcare (PM4HC) is an emerging discipline gaining the interest of healthcare experts, and seems able to deal with many important issues in representing CGs. In this position paper, we briefly describe the story and the state-of-the-art of CGs, and the efforts and results of the past approaches of medical informatics. Then, we describe PM4HC, and we answer questions like how can PM4HC cope with this challenge? Which role does PM4HC play and which rules should be employed for the PM4HC scientific community?

A Process Mining Application for the Analysis of Hospital-at-Home Admissions.

This article proposes the analysis of the admissions to hospital-at-home service within the framework of process mining. In addition to conventional modeling in standard languages, relying on interviews and continuous improvement, we propose the adoption of an automatic process discovery technique based on data collected by the hospital information system. We focus on the patient admission process, in which staff discriminate cases of interest for the service. Our methodological framework starts with the extraction of process information from the existing dataset. Once obtained meaningful data for an event log analysis, we propose the adoption of a process discovery algorithm by using a specific tool for process mining. In the context of Business Process Management, we suggest a practical application to be explored in order to improve standard modeling, opening the way to perform business process simulation with scenario analysis.

Recommendations for enhancing the usability and understandability of process mining in healthcare.

Healthcare organizations are confronted with challenges including the contention between tightening budgets and increased care needs. In the light of these challenges, they are becoming increasingly aware of the need to improve their processes to ensure quality of care for patients. To identify process improvement opportunities, a thorough process analysis is required, which can be based on real-life process execution data captured by health information systems. Process mining is a research field that focuses on the development of techniques to extract process-related insights from process execution data, providing valuable and previously unknown information to instigate evidence-based process improvement in healthcare. However, despite the potential of process mining, its uptake in healthcare organizations outside case studies in a research context is rather limited. This observation was the starting point for an international brainstorm seminar. Based on the seminar's outcomes and with the ambition to stimulate a more widespread use of process mining in healthcare, this paper formulates recommendations to enhance the usability and understandability of process mining in healthcare. These recommendations are mainly targeted towards process mining researchers and the community to consider when developing a new research agenda for process mining in healthcare. Moreover, a limited number of recommendations are directed towards healthcare organizations and health information systems vendors, when shaping an environment to enable the continuous use of process mining.

Toward Value-Based Healthcare through Interactive Process Mining in Emergency Rooms: The Stroke Case.

The application of Value-based Healthcare requires not only the identification of key processes in the clinical domain but also an adequate analysis of the value chain delivered to the patient. Data Science and Big Data approaches are technologies that enable the creation of accurate systems that model reality. However, classical Data Mining techniques are presented by professionals as black boxes. This evokes a lack of trust in those techniques in the medical domain. Process Mining technologies are human-understandable Data Science tools that can fill this gap to support the application of Value-Based Healthcare in real domains. The aim of this paper is to perform an analysis of the ways in which Process Mining techniques can support health professionals in the application of Value-Based Technologies. For this purpose, we explored these techniques by analyzing emergency processes and applying the critical timing of Stroke treatment and a Question-Driven methodology. To demonstrate the possibilities of Process Mining in the characterization of the emergency process, we used a real log with 9046 emergency episodes from 2145 stroke patients that occurred from January 2010 to June 2017. Our results demonstrate how Process Mining technology can highlight the differences between the flow of stroke patients compared with that of other patients in an emergency. Further, we show that support for health professionals can be provided by improving their understanding of these techniques and enhancing the quality of care.

Analyzing of Gender Behaviors from Paths Using Process Mining: A Shopping Mall Application.

The study presents some results of customer paths' analysis in a shopping mall. Bluetooth-based technology is used to collect data. The event log containing spatiotemporal information is analyzed with process mining. Process mining is a technique that enables one to see the whole process contrary to data-centric methods. The use of process mining can provide a readily-understandable view of the customer paths. We installed iBeacon devices, a Bluetooth-based positioning system, in the shopping mall. During December 2017 and January and February 2018, close to 8000 customer data were captured. We aim to investigate customer behaviors regarding gender by using their paths. We can determine the gender of customers if they go to the men's bathroom or women's bathroom. Since the study has a comprehensive scope, we focused on male and female customers' behaviors. This study shows that male and female customers have different behaviors. Their duration and paths, in general, are not similar. In addition, the study shows that the process mining technique is a viable way to analyze customer behavior using Bluetooth-based technology.

Process Mining Dashboard in Operating Rooms: Analysis of Staff Expectations with Analytic Hierarchy Process.

The widespread adoption of real-time location systems is boosting the development of software applications to track persons and assets in hospitals. Among the vast amount of applications, real-time location systems in operating rooms have the advantage of grounding advanced data analysis techniques to improve surgical processes, such as process mining. However, such applications still find entrance barriers in the clinical context. In this paper, we aim to evaluate the preferred features of a process mining-based dashboard deployed in the operating rooms of a hospital equipped with a real-time location system. The dashboard allows to discover and enhance flows of patients based on the location data of patients undergoing an intervention. Analytic hierarchy process was applied to quantify the prioritization of the dashboard features (filtering data, enhancement, node selection, statistics, etc.), distinguishing the priorities that each of the different roles in the operating room service assigned to each feature. The staff in the operating rooms (n = 10) was classified into three groups: Technical, clinical, and managerial staff according to their responsibilities. Results showed different weights for the features in the process mining dashboard for each group, suggesting that a flexible process mining dashboard is needed to boost its potential in the management of clinical interventions in operating rooms. This paper is an extension of a communication presented in the Process-Oriented Data Science for Health Workshop in the Business Process Management Conference 2018.

Clustering Cardiovascular Risk Trajectories of Patients with Type 2 Diabetes Using Process Mining.

Patients with type 2 diabetes have a higher chance of developing cardiovascular diseases and an increased odds of mortality. Reliability of randomized clinical trials is continuously judged due to selection, attrition and reporting bias. Moreover, cardiovascular risk is frequently assessed in cross-sectional studies instead of observing the evolution of risk in longitudinal cohorts. In order to correctly assess the course of cardiovascular risk in patients with type 2 diabetes, we applied process mining techniques based on the principles of evidence-based medicine. Using a validated formulation of the cardiovascular risk, process mining allowed to cluster frequent risk pathways and produced 3 major trajectories related to risk management: high risk, medium risk and low risk. This enables the extraction of meaningful distributions, such as the gender of the patients per cluster in a human understandable manner, leading to more insights to improve the management of cardiovascular diseases in type 2 diabetes patients.

Optimisation of children z-score calculation based on new statistical techniques.

BACKGROUND: Expressing anthropometric parameters (height, weight, BMI) as z-score is a key principle in the clinical assessment of children and adolescents. The Centre for Disease Control and Prevention (CDC) growth charts and the CDC-LMS method for z-score calculation are widely used to assess growth and nutritional status, though they can be imprecise in some percentiles. OBJECTIVE: To improve the accuracy of z-score calculation by revising the statistical method using the original data used to develop current z-score calculators. DESIGN: A Gaussian Process Regressions (GPR) was designed and internally validated. Z-scores for weight-for-age (WFA), height-for-age (HFA) and BMI-for-age (BMIFA) were compared with WHO and CDC-LMS methods in 1) standard z-score cut-off points, 2) simulated population of 3000 children and 3) real observations 212 children aged 2 to 18 yo. RESULTS: GPR yielded more accurate calculation of z-scores for standard cut-off points (p<<0.001) with respect to CDC-LMS and WHO approaches. WFA, HFA and BMIFA z-score calculations based on the 3 different methods using simulated and real patients, showed a large variation irrespective of gender and age. Z-scores around 0 +/- 1 showed larger variation than the values above and below +/- 2. CONCLUSION: The revised z-score calculation method was more accurate than CDC-LMS and WHO methods for standard cut-off points. On simulated and real data, GPR based calculation provides more accurate z-score determinations, and thus, a better classification of patients below and above cut-off points. Statisticians and clinicians should consider the potential benefits of updating their calculation method for an accurate z-score determination.