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Case Management Model and Notation (CMMN)

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What is CMMN?

Case Management Model and Notation™ (CMMN™) is an international standard modeling language and graphical notation for case management.

What is case management?
Case management is used for capturing and automating work methods and information to handle unstructured and adhoc processes requiring activities that may be performed in an unpredictable order in response to evolving situations. The CMMN notation combined with an automation engine provides a low-code worldwide standard solution for managing cases in diverse business settings. While using CMMN is easy enough for business people to understand and depict case handling procedures, it is also expressive enough to allow CMMN models to become software process components that can be automated. CMMN has an easy-to-use flowchart-like graphical notation that is independent of any specific implementation environment.

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The CMMN standard is published and supported by OMG, an international, open membership, not-for-profit technology standards consortium.

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BPMN™ (Business Process Model and Notation), DMN™ (Decision Model and Notation™), and CMMN notation are all OMG visual modeling standards that can each be used independently yet were designed to be complementary. BPMN workflows can be embedded directly as process tasks in CMMN models and CMMN can also invoke DMN models to automate business decisions and create or change case file item values.

The CMMN standard utilizes visual models which are standardized, verifiable, and where the model can serve as both the documentation and as the executable source for case management automation engines. A CMMN case can be automated directly from the visual model into case management engines without any translation from IT. CMMN diagrams can be programmatically validated and can be created and maintained by subject matter experts (SMEs) and IT professionals thus eliminating business-to-technical specification handoff issues and errors.

When comparing structured processes versus unstructured processes, we are in fact describing the difference between BPMN and CMMN. Unlike BPMN process management models, adaptive processes are unstructured, so CMMN does not use sequential control flows to describe case activities. A case contains a Case File that holds Case File Items (the case data and information) and is described by a Case Plan, the CMMN model. In CMMN, a model (diagram) could have multiple cases with each case described by a Case Plan. CMMN Case Plan models use a descriptive event-condition-action (ECA) paradigm. That is, when an event occurs, if the condition(s) for the task are fulfilled, the task action is carried out.

The Case Plan is visually captured as a collection of activities (Tasks) that may occur in an unpredictable order where events or workers determine how the case work progresses. Due to how cases are typically managed, not all work that happens during a case is actually modeled in the Case Plan. For example, the interaction of case workers with the Case Plan and Case File Items may not be modeled or be only partially modeled. Typically, how the Case File Items actually get into the Case Plan isn’t modeled. Case data can be added, removed, modified or simply viewed by the case workers at any time during the processing of a case without the need for these data interaction to be modeled specifically.

Adaptive case management uses documents and contextual information to determine the flow of the case at runtime reacting to events and directed by knowledge workers. To facilitate this dynamic case management, the Case Plan can also contain discretionary items modeled to be used only when the case worker decides they are appropriate and needed. Additionally, manually activated Tasks and Stages in a case may have all the conditions met for execution but still will only be executed if the case worker chooses to do so.

A Case File Item can represent information of any kind, both unstructured or structured, and from simple items to complex data structures. Typically, Case File Items represent documents, because organizations usually interact via documents like PDFs and word processor documents, spreadsheets, presentations, images, videos, and other recordings. Usually, these are kept in common file types that are supported by most operating systems and browsers (think PDF, PowerPoint, Word, .png, .jpeg, .gif, .MP3, etc.) The ability to view, add, change, or delete data (Case File Items) from a case at any time while the case instance is active is a main feature of CMMN and causes many of the events that trigger actions like additional Tasks becoming active (the ECA paradigm.)

CMMN gives case workers access to all the relevant case information associated with a case and gives them empowering control to decide how a case evolves while still providing a reusable organizational frame of reference via a non-proprietary international standard modeling notation.

Who Uses CMMN?

Since CMMN is a non-proprietary and software vendor neutral language, it lends itself to solutions in every type of organization. A CMMN Case Plan can provide a reusable organizational frame of reference for resolving cases in a wide range of business situations. CMMN examples include, government services, loan applications, insurance claims, customer complaints, and patient cases in healthcare. CMMN is also being used to manage legal cases, investigate fraudulent activities, administer social programs and other non-profit case activities like charities. CMMN models are also used for specific problem solving that requires human decision making in addition to automation such as automobile roadside assistance, financial planning, compliance tracking, facilities management, and contract management.

Because CMMN supports defining case diagrams at different levels of abstraction, it can be used in different ways to meet varying organizational needs. CMMN can be used to create only a graphical depiction that visualizes and documents case activities. Adding more details to models enable their use as the source code of an automation engine to create case applications. Using the Trisotech case management system, models can be created by non-IT personnel and enriched for execution by subject matter experts, power users, or IT.

According to OMG, Quote Applications of Case management include licensing and permitting in government, application and claim processing in insurance, patient care and medical diagnosis in healthcare, mortgage processing in banking, problem resolution in call centers, sales and operations planning, invoice discrepancy handling, maintenance and repair of machines and equipment, and engineering of made-to-order products.Unquote

Not many tool vendors fully support the CMMN standard, known as “Complete Conformance.” For example, most tools do not support the full compliance infrastructure required to automate cases or interact with BPMN and DMN.

Case Management Model and Notation in Financial Services

CMMN in Financial Services

In addition to an ever-increasing demand for mobile and online banking services, financial services organizations including retail and commercial banking, insurance, mortgage, investments, etc. need to constantly re-engineer existing business processes.

More info on Finance

Process agility and continuous improvement are required to stay competitive so nearly every financial services business uses various forms of process automation. More and more of these organizations are turning to case management to improve activities where human decision making must often supplement or replace procedural workflows. This is especially true with customer-facing activities where a customer-centric human touch adds value. Using CMMN modeling software and automation engine, one can document, track, and orchestrate the activities of administrators, users, systems, and customers while allowing human judgement to control the pace and path of interactions.

Standards play a big part in the financial services world. Using an international standard like CMMN is supported through multiple CMMN modeling tools and makes finding modeling and automation workers easier as the talent pool of trained and certified staff is globally available.

CMMN is being used to document and automate the management of hundreds of financial case types including:

  • On-boarding New Customers
  • Customer Retention
  • Know Your Customer (KYC) Reviews
  • Wealth Management
  • Portfolio Management
  • Records Management/Archiving
  • Risk Management
  • Regulatory Reviews
  • Content Management & Distribution
  • Customer Document Requests
  • Credit Card & Other Dispute Management
  • Digital Mortgages
  • Fraud Detection
  • Underwriting
  • Account Reviews & Servicing
  • Document/Transaction Tracking
  • Cross-selling & Up-selling
  • Off-boarding Customers
Case Management Model and Notation in Healthcare Services

CMMN in Healthcare

On the adoption of CMMN (as well as BPMN and DMN) as a standard at Mayo Clinic from the press release for Field Guide to Shareable Clinical Pathways:

More info on Healthcare

Mayo Clinic is committed to managing clinical knowledge as a strategic asset. The use of OMG process standards plays an important role in faithfully representing and sharing clinical knowledge to enable the rapid dissemination and adoption of best practices.

Healthcare is one of the fastest-growing sectors in the world economy and many healthcare organizations are undergoing one or more digital transformation initiatives. As part of these transformations, there is an increased need for technology innovation and increased reliance on evidence-based medicine. Healthcare automation needs have become so critical and pervasive that to address these concerns head-on, a community of practice, BPM+ Health, has been created. BPM+ Health was established based on the use of open standards-based notations including CMMN (case management) and other open IT standards which allows for all types of health organizations, professional societies, and vendors to document their care pathways, cases, and workflows, so they are sharable, discoverable, and automatable. By applying standard CMMN to healthcare practice patterns, the information becomes computer-consumable and automatable, giving doctors and clinicians evidence-based information at the point of care.

According to members of BPM+ Health and the OMG Healthcare Domain Task Force who publish the Field Guide to Shareable Clinical Pathways, Quote Certain clinical pathways and activities can be prescribed (deterministic) at design time – during the process of designing the model, such as making a doctor’s appointment for the flu – but other processes are more ad hoc and non-deterministic. These ad hoc processes may be due to sudden and unexpected events that occur in the real world or due to known events that are unpredictable in their timing. Often the environment requires care providers to adapt to unexpected, emerging and/or changing environmental conditions (e.g., no fetal heartbeat is observed during a regular prenatal care exam). As such, the traditional method of representing clinical pathways using BPMN is difficult at best. An agile ad hoc environment cannot be easily represented with BPMN and requires an adaptive “case management” style of representation. This is the role of CMMN: specifying clinical responses to ad hoc events based on the state of the particular case. CMMN allows real-time response to the unfolding of sudden and unforeseen events in the form of flexible choices/selection of activities as the care provider determines necessary.Unquote

Today, most healthcare organizations use textual descriptions, diagrams, and flow charts to document clinical processes. CMMN is a proven international standard and as part of many transformation efforts, CMMN is being used to create automatable graphical representations of healthcare cases and clinical pathways. CMMN case diagrams are visual, unambiguous, intuitive, and easily understood by both providers and IT professionals thus making them superior to text documents.

Well designed and documented CMMN case models are also easy to maintain which is important in healthcare where constantly changing regulations, rapid advances in medications and treatment, and frequently changing policies all contribute to high-volume and constant maintenance.

According to Wikipedia, The American Case Management Association (ACMA), a non-profit professional membership organization supporting the practice of hospital case management through education, networking, publications, bench-marking, and research describes a hospital Case Manager’s responsibilities to include the following functions:

  • Advocacy & Education – ensuring the patient has an advocate for needed services and any needed education.
  • Clinical Care Coordination/Facilitation – coordinating multiple aspects of care to ensure the patient progresses.
  • Continuity/Transition Management – transitioning of the patient to the appropriate level of care needed.
  • Utilization/Financial Management – managing resource utilization and reimbursement for services.
  • Performance & Outcomes Management – monitoring, and if needed, intervening to achieve desired goals and outcomes for both the patient and the hospital.
  • Psychosocial Management – assessing and addressing psychosocial needs including individual, familial, environmental, etc.
  • Research & Practice Development – Identifying practice improvements and using evidence-based data to influence needed practice changes.

CMMN can be used to create healthcare-case models and automation in hundreds of ways. Here are some representative CMMN examples:

  • Create/improve clinical guidelines
  • Planning & delivery of care
  • Evaluate patient results & adjust care plan
  • Verify coverage/benefits with insurers
  • Prior authorization
  • Referrals to specialists
  • Coordinate claims with multiple benefit plans
  • Coordinate insured services with community services
  • Coordinate discharge/return home services
  • Provide post-care follow-up
  • Clinical decision support (CDS)
  • Catastrophic & large claim management
  • Maternity case management
  • Recommend coverage exceptions
  • Arrange special services
  • Coordinate services with other providers
  • Transitional care management
  • Negotiate rates with out of network providers
  • Provide patient education
  • New patient referrals

Trisotech and CMMN

Digital Enterprise Suite

Trisotech is a world leader in business automation solutions and an active contributor to the CMMN standard. Trisotech’s Case Modeler is known as the reference implementation for CMMN modeling tools and supports all CMMN symbols (shapes) ,a.k.a. “Complete Conformance.” Trisotech also supports and integrates the BPMN and DMN standards into its Case Modeler and in the Trisotech Case Management Automation Engine for automating CMMN models.

CMMN model creation, administration, and management as well as automation, library management, administration, configuration, debugging, simulation, and audit logging are all visual and browser based and can be hosted in public or private clouds – making Trisotech’s offering a complete case management and automation solution.

Trisotech provides free case management tools through self-service trial subscriptions and Visio templates.

CMMN in Financial Services

Trisotech also provides CMMN extended modeling support in the form of drag-and-drop “Accelerators” for the MISMO™ and FIBO® (Financial Industry Business Ontology®) standard data structures that can be assigned as Case File Items in CMMN case models. Trisotech financial clients include governments, insurance organizations, mortgage finance organizations, loan originators, retail and commercial banks, stock trading exchanges, credit card organizations, real estate brokers, investment brokerage houses and more.

CMMN in Healthcare

Trisotech is a founding member of BPM+ Health which promotes usage of CMMN, as well as BPMN and DMN, as an integral standards technology. Trisotech healthcare clientele include international and U.S. acute care hospitals, healthcare insurance organizations, HMOs, renowned teaching hospitals, PPOs, and healthcare professional organizations.

The Trisotech extends the Case Modeler (CMMN) with healthcare-specific additions. Through a combination of features and functions, healthcare organizations can now access FHIR® data structures and APQC Health Care Provider tasks, in their modeling and automation of CMMN cases. Predefined FHIR Data types (simple, complex, and special purpose) are provided as reusable drag and drop data structures that can be assigned as Case File Items in CMMN case models and APQC Health Care Provider tasks from the APQC Health Care Provider accelerator can be used as tasks in CMMN models.

free pre-built evidence-based workflow and decision models

As part of its Healthcare Feature Set (HFS), Trisotech also provides nearly 1,000 free pre-built evidence-based workflow and decision models including care pathways, clinical guidelines, and healthcare calculators in the BPM+ Health standard (CMMN, BPMN and DMN). These models are human-readable, machine automatable, and embeddable in most medical encounter systems. Healthcare organizations can use these models, created under the direction of Trisotech CMIO John Svirbely, MD, as they are, or quickly and easily modify them to fit the exact nature of their organization’s policies and procedures. Healthcare organizations can also create their case models from scratch with the easily understood CMMN visual modeler that can be shared by practitioners, IT, SMEs, and business people.

Case Modeler Differentiators

Trisotech’s adaptive case management software is a CMMN-based business automation architecture built upon SaaS cloud technologies including API-first design which allows for the invocation of cases from practically any programming language in mobile, cloud, and on-premise server environments. These automated CMMN case models are scalable high-performance services. The automated case (Case Management) services and case automation engine are also structured to provide full support for today’s complex availability needs including containerization and docker technologies. The Trisotech CMMN offering, including modeling and automation, is completely browser based and can be run in any modern browser environment including Chrome, Edge, Safari, Firefox, etc. Automation servers can be hosted by Trisotech, or Clients including on-premise and public/private clouds like AWS, Azure, Google, etc. Advanced configurations allow for 24 X 7 operation, concurrent geographic dispersion and failover, and containerization operating environments.

The Trisotech Case Modeler offers many features other CMMN modelers do not. These include:

  • Complete “Conformance Level” modeling support
  • Single click integration with BPMN and DMN
  • Import of CMMN, MS Visio files
  • CMMN Method and Style Validation
  • Issue tracking and management by model
  • Multimedia model animator
  • Diagram Overlays (tags, flags, attachments, comments, time, cost, etc.)
  • Versioning of models
  • Dependency view of re-use and where-used
  • FEEL expression language from DMN for Low code automation (condition specifications in “If Part” on sentries for entry and exit criterion)
  • Heatmap visualizations
  • Drag & drop re-use by copy and re-use by reference (DEG: Digital Enterprise Graph)
  • Single Click deployment to execution library
  • Export to CMMN (XML) & images
  • CMMN Standard Validation
  • Threaded commenting down to element level
  • Lean/Six Sigma analysis
  • Configurable Documentation in Word or HTML including Overlays on models
  • Complete model element search
  • Deep Model diff to compare models to one another
  • Scope view of multi-diagram elements in a single CMMN model
  • Support for Custom attributes

OMG®, BPMN™, (Business Process Model and Notation™), Decision Model and Notation™, (DMN™), CMMN™, (Case Management Model and Notation™), BPM+ Health™, and FIBO®, (Financial Industry Business Ontology®) are either registered trademarks or trademarks of Object Management Group, Inc. in the United States and/or other countries. MISMO™ is a registered trademark of Mortgage Industry Standards Maintenance Organization, Inc.

Trisotech is an active contributor to the CMMN standard.

Trisotech Case Modeler and Automation are known as the reference implementations for CMMN.

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