The TIBCO Blog

… is the title for the replacement to (and presumed superset of) the Case Management OMG specification proposal, per this report from OMG task force co-chair Fred Cummins, albeit within the interesting context of advanced healthcare IT [*1].

Very relevant to the knowledge-driven medical domain (and to case management) is the ability to respond to events (as in event-driven or event-based processes) – events provide new information that extend both the current patient and medical condition knowledgebases, for example. Out-of-sequence and disruptive events need to be handled, and medical deductions and conclusions can certainly be defined as “complex events” (i.e. aggregations and combinations of prior events) … probably with the addition of some probability factor!

Also very relevant is that inference rules are one of the more useful knowledge representation mechanisms – used both in formal logic as well as business rule engines – making rule-driven processes truly declarative, ad hoc and dynamic. Event-driven and rule-driven processes are both areas covered by CEP technologies like TIBCO BusinessEvents. And in OMG inference rules are covered by the PRR extension to UML.

On the other hand, the term “knowledge-driven” [*2] can cover a number of things beyond “event-driven business processes” and “rule-driven business processes”. For example, events can be viewed as documentable and classifiable constructs for use in ontologies (like OWL), and rules can be followed by medical staff, such as via checklists or flowcharts. There is also the domain of “knowledge management” in the form of content or document management  – probably ideal for case note recordings.

Fred’s comments include:

“Knowledge-driven processes for treatment of medical conditions will support intuitive medicine with improved tracking and record-keeping while supporting performance measurement and encoding of insights to improve and streamline practices.” Whenever I read “tracking” and “performance measurement” I think of event tracking and concepts like “track and trace”. When I  read “encoding of insights” I see “situation awareness”. Note these are both key complex event processing indicators!

“Specifications of activities can easily be changed to introduce new technology or to provide guidance in the use of certain procedures or medications. More precise processes can be incorporated using conventional business process modeling technology, but processes can still be adjusted to deal with unforeseen circumstances.” I’m pretty sure Fred doesn’t mean to imply ad hoc processes are imprecise, but in fact may be selected or defined according to current knowledge. Knowledge representation in automated systems usually involves rules – and event-driven rules are typical of CEP technology.

“Both intuitive and precise processes can be interwoven and evolved as improved techniques that are discovered or developed.” This means ad-hoc processes mixing manual and automated processing. Most medical processes involve a health-practitioner-in-the-loop, so this makes perfect sense.

In my humble opinion, knowledge-driven processes (including medical processes), and their associated models, are a very interesting area, with much overlap with the state-of-the-art rule-driven CEP world. Whether there is enough concensus for a standardization effort yet, given (1) only 2 vendors responded to the preceding OMG RFI on “dynamic process activity modeling” and (2) “knowledge-driven process” is such a new term it doesn’t even have an entry on Wikipedia yet (!), is open to debate… which no doubt will occur at the next OMG meeting.

Notes:

[1] Interestingly, advanced medical healthcare support is one of the first use cases in the EPTS Use Cases Working Group.

[2] Possibly the proposed standard is simply misnamed. For example a better fit might be the moniker “Ad hoc Process Modeling” (or somesuch) that would avoid any contentious issues around “knowledge” coverage and representation.