Towards a Conceptual Framework Fostering Process Comprehension in Healthcare [original]

Towards a Conceptual Framework Fostering Process Comprehension in Healthcare

Michael Zimoch1, R¨

udiger Pryss1, Thomas Probst1, Winfried Schlee2, Manfred Reichert1

1Institute of Databases and Information Systems, Ulm University, Germany

2Department of Psychiatry and Psychotherapy, Regensburg University, Germany

{michael.zimoch, ruediger.pryss, thomas.probst, manfred.reichert}@uni-ulm.de

winfried.schlee@googlemail.com

Abstract—Despite the widespread use of process models in

healthcare organizations, there are many unresolved issues

regarding the reading and comprehension of these models by

domain experts. This is aggravated by the fact that there exists

a plethora of process modeling languages for the graphical do-

cumentation of processes, which are often not used consistently

for various reasons. Hence, the identification of those factors

fostering the comprehension of process models becomes crucial.

We have developed a conceptual framework incorporating

measurements and theories from cognitive neuroscience and

psychology to unravel factors fostering the comprehension of

process models within organizations. We believe that a better

comprehension of process models will enhance the support of

healthcare processes significantly.

Keywords-Process model comprehension, conceptual frame-

work, healthcare processes

I. INTRODUCTION

Healthcare professionals are facing numerous challenges

as they are involved in complex processes everyday [4]. As a

consequence, any IT support for healthcare scenarios consti-

tutes a complex endeavour. To capture respective scenarios,

process models serve as a major artifact in modern health-

care information systems [1]. Usually, healthcare processes

are specified in terms of different modeling languages (e.g.,

BPMN [5], Petri Nets [6], Flow Charts [7], or IDEF0 [8]),

which aggravates model comprehension significantly.

Generally, a process model accumulates tasks, decisions, and

resources related to a particular process, i.e., it provides

abstractions of procedures and is represented as text or

graphical diagram. Besides the creation of process models,

their understanding and correct interpretation (i.e., process

model comprehension) is of utmost importance to introduce

process-awareness in healthcare. Research in this field has

shown that the use of graphical process models is beneficial

when analyzing and optimizing processes [2]. However, only

few experimental settings focus on the factors fostering

process model comprehension. To be more precise, cognitive

aspects are less understood in this context [3].

Fig. 1 exemplarily presents the results from an eye tracking

experiment, illustrating that many factors can be evaluated

with respect to process model comprehension. Taking these

factors into account and to efficiently compare results of

different experiments, we have developed a conceptual fra-

mework focusing on the comprehension of process models

by adopting concepts from cognitive neuroscience and psy-

chology.

Saccade:

Velocity, Acceleration,

Diameter, ...

Area of Interest:

Sequence, Hit Ratio,

Entry Time, Revists, ...

Fixation:

First Fixation, Fixation

Count, Dwell Time, ...

Main Gaze Path

Figure 1: Evaluation of Eye Tracking Results

II. CONCEPTUAL FRAMEWORK

By applying cognitive neuroscience and psychology, the

approach focuses on the cognitive processes of individuals

when reading and understanding process models. We analyze

how this information is processed by individuals (e.g., physi-

cians, nurses) in order 1

to improve existing process models

as well as 2

to identify rules fostering their comprehension.

The latter is a cognitive process trying to establish relations

between available information on objects and events in

the long term memory, together with information perceived

at the moment from the sensory, working, or short term

memory. Concerning process models, individuals must cope

with the complexities involved in parsing the relevant syn-

tactic, semantic, and pragmatic information of a modeling

language. There exist several measurements and theories,

which ease the comprehension of a subject, e.g., Cognitive

Load Theory (CLT). Fig. 2 illustrates the conceptual frame-

work and its components:

(1) Reference process models in different notations. For

graphically documenting business processes, there exists a

variety of process modeling languages. Still, the usage of

these languages is not always consistent as standardized

modeling procedures do not exist. Therefore, the conceptual

framework considers various modeling languages.

Experimental Results and ConclusionsExperimental Settings for Process

Model Comprehension

Process Model Characteristics

Subject

Categorize Model

Difficulty based on

Experiment Data

Create Better

Process Models

directly influences

2 3 4

Cognitive Neuroscience and Psychology

Measurements and Theories

Derive Process

Modeling Rules

Business Process

Modeling Expert

Data Scientist

a b

Statistical and

Empirical Evaluation

Reference Process Models

in Different Notations

Experiment

Designer

Business Process

Modeling Expert

...

BPMN 2.0 Petri Nets

EPCs

A X

X Y

Figure 2: Conceptual Framework

(2) Process model characteristics. There are factors related

to process modeling that influence an individual’s capability

to comprehend process models, e.g., the chosen graphical

representation or level of complexity. Such factors must be

carefully considered when designing experiments.

(3) Experimental settings for process model compre-

hension. Individuals perceive graphical representations dif-

ferently, depending on personal factors (e.g., expertise).

Throughout a series of experiments, which make use of

concepts from cognitive neuroscience and psychology (e.g.,

CLT), the identification of stumbling blocks and obstacles

as well as aspects fostering process model comprehension

will be addressed by the conceptual framework.

(4) Experimental results and conclusions. Findings obtai-

ned from the experiments are analyzed by scientists using

different methods (e.g., similarity matching). The results are

used to rate and classify individuals with respect to process

model comprehension (cf. Fig. 1 a

). This classification

reflects the perceived difficulty of an individual regarding

process model comprehension and the importance of perso-

nal factors. Taking these results into account, further steps

can be derived (cf. Fig. 1 b

). Tab. 1 depicts approaches,

for which the conceptual framework has been used so far as

well as numbers of subjects and analyzed models.

Approaches No. Subjects No. Models

Construal Level Theory 136 262

Eye Tracking 36 432

Electrodermal Activity 7 112

Heart Rate 3 72

Table I: Experiments using the Conceptual Framework

III. SUMMARY AND OUTLOOK

The use of cognitive neuroscience and psychology as

basic pillar of the conceptual framework offers promising

perspectives with respect to process model comprehension.

The goal is to provide optimized rules enabling a better

process model comprehension as well as directives for

creating better process models. Currently, we conduct a

series of experiments with different concepts originating

from cognitive neuroscience and psychology to unravel the

factors facilitating process model comprehension.

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