Adaptive Case Management

Teamwork, collaboration and coordination are key aspects of the patient-centric approach taken by modern healthcare. Although many projects have been and are currently being undertaken to improve support for health care professionals, adequate support for teamwork, communication and coordination has yet to be achieved. The delivery of the healthcare service is very challenging as it involves heterogeneous distributed systems, multi-professionals and dependent tasks among each. In addition, the treatment journey of each patient is unique, as decisions are usually made according to several constraints related to the patient, medical condition, patient’s choice, available resources and\or feedback from doctors’ consultation.
We believe that, in order to provide the required support, it is necessary to explicitly acknowledge the patient’s medical state within their treatment journey. This project proposes the use of a Business Process Management (BPM) system that uses associations between patients, health care professionals, and the Integrated Care Pathway (ICP) to provide improved support for healthcare professionals as individuals and as members of integrated care teams. Moreover, mapping the ICP onto the BPM system will help support the implementation of the best practice according to the national guidelines. By leveraging the information contained in these associations, and understanding the patient progress along the dynamic care pathway this proposal indicates and supports tailored context-based actions. This includes automated notifications, alerts, scheduling and timers as well as support for change management as the patient progresses throughout their treatment journey. Clinicians and developers feedback on this proposal has been very positive.

This paper suggests a theoretical underpinning of Adaptive Case Management and Business Process Management based on the tenet that neurobiological functions enabling human action are reflected in the structure of the community the individual is acting in. This tenet is sustained by the Theory of Functional Systems proposed by Anokhin in the 1930s, and the conceptualization of innate, neurobiological capabilities for action as Activity Modalities. Implications of this underpinning are discussed. Prospects for pursuing research in this direction are evaluated.

Adaptive Case Management (ACM) implies a shift from the process centric view in Business Process Management (BPM) to an information centric view. The shift is motivated by the need for organizations to become more responsive to changes. Such a shift should be guided by some kind of framework in order to be manageable. To this end, the construct of the activity modalities is proposed. These modalities – objectivation, contextualization, spatialization, temporalization, stabilization, and transition – stand for innate predispositions that humans employ to coordinate and carry out actions. A central tenet of this position is that all modalities need to be employed in activity. This is used to analyse the Business Process Modeling Notation, the shift from BPM to ACM, and to propose a research road map. Some alternative modelling approaches from the Ericsson telecom company are suggested as forerunners to an integrated modelling suite that supports all activity modalities