Interplay between clinical guidelines and organizational workflow systems: Experience from the mobiguide project

Amnon Shabo Shvo, Mor Peleg, Enea Parimbelli, Silvana Quaglini, Carlo Napolitano

Research output: Contribution to journalArticlepeer-review


Background: Implementing a decision-support system within a healthcare organization requires integration of clinical domain knowledge with resource constraints. Computerinterpretable guidelines (CIG) are excellent instruments for addressing clinical aspects while business process management (BPM) languages and Workflow (Wf) engines manage the logistic organizational constraints. Objectives: Our objective is the orchestration of all the relevant factors needed for a successful execution of patient’s care pathways, especially when spanning the continuum of care, from acute to community or home care. Methods: We considered three strategies for integrating CIGs with organizational workflows: extending the CIG or BPM languages and their engines, or creating an interplay between them. We used the interplay approach to implement a set of use cases arising from a CIG implementation in the domain of Atrial Fibrillation. To provide a more scalable and standards-based solution, we explored the use of Cross-Enterprise Document Workflow Integration Profile. Results: We describe our proof-of-concept implementation of five use cases. We utilized the Personal Health Record of the MobiGuide project to implement a loosely-coupled approach between the Activiti BPM engine and the Picard CIG engine. Changes in the PHR were detected by polling. IHE profiles were used to develop workflow documents that orchestrate cross-enterprise execution of cardioversion. Conclusions: Interplay between CIG and BPM engines can support orchestration of care flows within organizational settings.

Original languageEnglish
Pages (from-to)488-494
Number of pages7
JournalMethods of Information in Medicine
Issue number6
StatePublished - 2016

Bibliographical note

Publisher Copyright:
© Schattauer 2016.


  • Business processes
  • Clinical guidelines
  • Computer-interpretable guidelines
  • Interoperability standards
  • Workflow management systems

ASJC Scopus subject areas

  • Health Information Management
  • Health Informatics
  • Advanced and Specialized Nursing


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