Dr. John Svirbely's blog post - Clinical Models at Scale
Dr. John Svirbely, MD

Clinical Models at Scale

By Dr. John Svirbely, MD

Read Time: 3 Minutes

If you need to create a large number of clinical models – either for a new project or to replace outdated software – then you are probably (or should be) feeling a bit overwhelmed. Such a project may take thousands of hours of coding, several informaticians, and many resources. Faced with such a daunting task it is no wonder that so many legacy systems persist for decades. However, there are ways to ease the burden and give you some control.

Working Smart

Sometimes people feel an urge to jump into model building right off the bat. This often results in working hard all through the project. Spending some time to plan and prepare can often to prove to be more efficient in the long run.

When building process or decision models, there are several ways to work smarter, such as:


Standardization is something that many people push back on. There are various reasons for this. Sometimes people feel that their domain is unique, and each solution must be individually crafted. While this attitude has some merits, it also increases the work needed to program your solution. The more that you standardize, the fewer the models that you need to develop and maintain, thereby increasing efficiency.

Sometimes you can standardize almost everything, but there are still a few variations between implementation sites that remain. A solution to this problem is to create what Trisotech calls a model “template”, which allows different versions of a model to be tweaked for a specific site, while leaving most of the overall model otherwise unchanged.

Controlling Data and Terminology Proactively

Proactive control of data and terminology may seem insignificant compared to all the other tasks, However, if you do not have control of terminology and data when you start, then later stages of development can become a nightmare with a lot of wasted effort. For example, if you have multiple informaticians, then you will probably have multiple variable names all pointing to the same data object. Each name is interpreted by the software as being unique, and as such each must be linked to your data source. If you have control on your terminology, then you can reduce your data integration challenges by 50% or more.

Making Use of Patterns

When building clinical models, you may notice that the same tasks appear together over and over again. This is termed a pattern.

To illustrate this, let us look at preauthorization, which has 4 main decision tasks:

All of these must be cleared before approval is granted. These tasks can be modeled in BPMN as follows:

If you are a payer faced with preauthorizing drugs or services, then this one pattern can be used over and over again with minor variations. Using patterns can speed development when compared to treating each situation as a unique problem. In addition, users can better understand what you are trying to do.


Once a model has been created, it can be used repeatedly. One goal of process and decision modelers is to create a library of models that can be re-used as building blocks in future projects.

When copying a model into another, the copy can occur in 2 ways:

Each approach has their pros and cons. Reuse by reference has many benefits since you do not have to go to each model that uses a particular decision to make any changes. However, to achieve this a good deal of standardization is needed.

Other ways to reuse a previously created knowledge include services or business knowledge models (BKMs).


Several strategies can be used to reduce the burden of programming burden without compromising quality. These require some careful thought and planning upfront, but they pay dividends over the long haul, speeding development and simplifying maintenance.

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Dr. John Svirbely's blog post - Do Healthcare Process Models Need Attended Tasks?
Dr. John Svirbely, MD

Do Healthcare Process Models Need Attended Tasks?

By Dr. John Svirbely, MD

Read Time: 2 Minutes

Several challenges may be encountered when creating process models in healthcare:

All of these challenges can be addressed using attended tasks.

What is an attended task?

An attended task is a task or decision that has an attribute which:

The review, changes, and user are recorded, confirming with timestamp that a person has approved the task or decision results.

In a Trisotech BPMN model, an attended task is indicated by the presence of a small check box in the lower left corner, as shown in Figure 1. This example shows a decision task for the diagnosis of anemia based on criteria from the World Health Organization that uses three data inputs (age, sex, and hemoglobin).

Figure 1

What happens in an attended task?

As mentioned above, when execution of a process comes to an attended task or decision, it stops and allows the provider to interact with it in ways that have been configured by the model developer. The settings for the attended task are shown in Figure 2.

Figure 2

The users able to make changes can be restricted. This allows a provider who is familiar with the patient to individualize the patient’s care based upon information known or observed about the patient. For example, the significance of a hemoglobin value may vary depending on whether or not the patient was transfused prior to the specimen being collected. Similarly, a certain pattern of clinical findings may not fully capture the patient’s current state, while a clinician at the bedside can observe it. Things in life may look different than they do on paper.

Since data and decisions are all recorded, retrospective analysis of decisions relative to outcomes can be performed. This gives insights into care and interventions, supporting the development of a learning health system.

Caveats in Using Attended Tasks

Attended tasks are useful at key decision points that can significantly impact the patient. Not every task in a process should be an attended task, since an attended task requires interaction with a user, thereby slowing the process. Deciding which tasks should be treated as an attended task requires weighing the pros and cons of the choice.


Healthcare process models may seem like a black box to users. An attended task can shed light on the process and allows clinicians to interact with a model at key decision points. If used judiciously they can improve healthcare, as well as provide insights into how clinical decisions impact outcomes.

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