Goal-focused self-modifying workflow in the healthcare domain

This paper introduces the concept of self-modifying workflow in the context of health care planning. Certain tasks in the workflow schema are devoted to modifying the downstream workflow on an instance by instance basis. Such self-modifying schemas provide the necessary flexibility to suit the evolving diagnostic and therapeutic processes encountered in chronic disease management (CDM), particularly in complex areas requiring significant individualization. The management of diabetes mellitus in a community care setting provides an example to illustrate this complexity. Over the past few years, object-oriented modeling tools of inheritance and specialization have been applied to workflow modeling to assist in schema evolution and workflow migration, thereby potentially empowering new workflow management systems (WfMSs) with the functionality to allow the tailoring of guideline-based care plans to individual patient requirements. However, schema evolution is a necessary but insufficient requirement for such tailoring. Healthcare WfMSs need to support a paradigm whereby schema evolution becomes a de facto operation for each workflow instance (i.e. patient episode of care). Self-modifying workflows provide this paradigm. In order to facilitate self-modification of workflow schemas, we annunciate a set of valid operations that can be applied to downstream components of a workflow schema. These operations are primarily concerned with turning abstract subworkflows into concrete ones through completion and alteration of template primitives.