# Use of Process Modelling for Optimization of Molecular Tumor Boards
## 1 Introduction  
The core aim of precision oncology is to identify targetable alterations through the molecular profiling of tumors. Recent developments in sequencing technologies and bioinformatics analysis [1], combined with major advances in molecular biology and cancer immunology research [2], have made precision oncology feasible. To make sense of the acquired data, genetic variants must be classified according to gene function, oncogenicity, druggability, and evidence level, resulting in personalized therapy recommendations that target the specific molecular alterations responsible for the phenotypic expression of cancer [3]. This complex diagnostic process is challenging, time-consuming, and requires the collaboration of a set of experts from different scientific fields such as oncology, pathology, bioinformatics, and genetics.  
To meet this challenge, Molecular Tumor Boards (MTB) have been established. In general, an MTB process includes patient enrolment, sample assessment, bioinformatic analysis, clinical interpretation of the molecular data, and its discussion during the MTB meeting by a multidisciplinary team of experts. After the personalized therapy recommendation has been prepared, it is presented by the molecular oncologist assigned to the particular case, who must merge the patient's prior therapy and diagnosis, the new molecular diagnosis, and its clinical interpretation into one MTB report [4]. The clinical interpretation of the molecular data is commonly the bottleneck of the MTB process, as the physician must research each tumor-driven event in the context of oncogenicity, drug-gene interaction, thecurrent literature, and relevant clinical trials from external knowledge bases [5]. Due to this complex and time-consuming process, the number of patients who can benefit from personalized therapy is limited. Process-optimization with software support for physicians can help mitigate this constraint.  
Service-Oriented Architecture (SOA) is a framework for integrating business processes and supporting IT infrastructure as secure, standardized components (services) that can be reused and combined to address changing business priorities [6]. SOA is an enterprise-wide IT architecture that promotes loose coupling, reuse, and interoperability between systems, which makes it especially suitable for optimizing business processes. While companies have long adopted SOA as a strategy [7], healthcare organizations have only discovered its benefits in recent years [8; 9]. The Object Management Group (OMG) [10] is a standards consortium in the computer industry, with expertise in the development of interoperability standards. OMG's Business Process Modeling and Notation (BPMN) is the preferred standard for business modeling in companies [11], but some in healthcare are still hesitant to use it [12]. It is a formal graphical and computable language, \"designed to be understandable by both business professionals and IT specialists. The explicit design for non-technical users makes it a promising candidate for healthcare process modeling, where medical staff needs to understand and discuss the process models\" [13].  
To support the use of SOA in clinical practice, OMG and Health Level Seven International [14], which provides standards for health data interoperability, collaborated in the Healthcare Services Specification Project, creating solutions for use in clinical processes.  
Here, we describe in detail the current MTB process at the University Cancer Center Hamburg (UCCH) using BPMN as well as a proposed simplified process with software support for the MTB physician.