# Question-Driven Methodology for Analyzing Emergency Room Processes Using Process Mining
## 2 Frequently-Posed Questions  
Prior to explaining the aforementioned methodology and data reference models, it is necessary to identify the type of questions posed by ER experts regarding the relevant processes. Accordingly, two types of frequently-posed questions can be identified (Figure 1): first, general questions that are established in a generic manner for the executed process; and second, episode-oriented questions that are based on specific ER characteristics and the executed activities. Figure 1: Frequently-posed questions for ER (Emergency Rooms). We have established the general questions in a previous research work [7], based on the experience of ER experts. The general questions involve understanding how patients are attended to, what activities are executed, how long it takes to attend to patients in accordance with the severity of their particular needs, how resources interact and levels of compliance with associated protocols and standards [19; 20]. Many of the questions fit directly with different generic approaches that recommend process mining. The approaches relate to process discovery, conformance checking, performance analysis and organizational analysis, as defined in the process mining literature [19]. Process discovery is directly related to describing the control flow in which process activities are performed by means of a process model. Diverse algorithms, such as heuristic miner or genetic miner, can be used to create a process model from an event log. An example of this type of question is as follows: What is the process (or how are the activities executed) for treating patients with different diagnoses, for example patients with appendicitis or pneumonia? Conformance checking is based on comparing a process model with an event log to verify whether the process is executed in accordance with that model. An example of this type of question is as follows: Are internal protocols being followed in the care provided in the ER? Performance analysis is based on the analysis of the execution times of specific activities, subprocesses or the complete process. An example of this type of question is as follows: What are the activities that increase the episode duration in the ER for patients over 60 years? Finally, organizational analysis is based on discovering the relationships between the resources that execute the tasks included in the event log, by means of social analysis metrics (e.g., \"handover of work\" or \"doing similar tasks\"). An example of this type of question is as follows: What is the type of interaction between doctors and nurses during patient care in the emergency room? The episode-oriented questions are based on certain clinical characteristics or data obtained when executing the process activities that are specific to ER, for example the color of the triage or the discharge destination of a patient. The questions were obtained from gauging the genuine needs of the ER experts regarding their processes, by means of interviews, literature reviews and the personal ER experience of one of the authors of this article. Three different types have been established, which can be extended to include additional data and activities in order to broaden the analysis, as well as the possible combinations thereof: triage-driven questions, stay duration-driven questions and patient discharge-driven questions. The triage-driven questions are based on the concept of triage, which relates to the process of evaluating patients arriving at ER in order to prioritize attention in accordance with the urgency of their needs and the services required [2]. There are a number of defined systems that establish color-coded classifications according to the needs of the patient, e.g., the Manchester triage system [21]. The Manchester triage system is a five category triage system based on expert knowledge.