# Process-Aware Enactment of Clinical Guidelines through Multimodal Interfaces
###### Abstract  
Healthcare is one of the largest business segments in the world and is a critical area for future growth. In order to ensure efficient access to medical and patient-related information, hospitals have invested heavily in improving clinical mobile technologies and spreading their use among doctors towards a more efficient and personalized delivery of care procedures. However, there are also indications that their use may have a negative impact on patient-centeredness and often places many cognitive and physical demands on doctors, making them prone to make medical errors. To tackle this issue, in this paper, we present the main outcomes of the project TESTMED, which aimed at realizing a clinical system that provides operational support to doctors using mobile technologies for delivering care to patients, in a bid to minimize medical errors. The system exploits concepts from Business Process Management (BPM) on how to manage a specific class of care procedures, called clinical guidelines, and how to support their execution and mobile orchestration among doctors. To allow a non-invasive interaction of doctors with the system, we leverage the use of touch and vocal user interfaces. A robust user evaluation performed in a real clinical case study shows the usability and effectiveness of the system. T 2019 8 67 [corp]20  
through EHR systems have become necessary aspects of healthcare environments, which can not be avoided entirely. While the realization of a technological solution that supports doctors in the enactment of care procedures through mobile devices requiring a limited physical/cognitive effort for their usage, and that ensures the continuity of information flow through EHR systems, would be desirable, to date, most of the existing solutions focus exclusively on one aspect of the foregoing requirements or a partial combination of them [11]. On the one hand, the Human-Computer Interaction (HCI) community has investigated how the use of _multimodal interfaces_ has the potential to reduce the cognitive efforts on users that manage complex activities such as the clinical ones. For example, in [12], the authors state that \"_multimodal interface users spontaneously respond to dynamic changes in their own cognitive load by shifting to multimodal communication as load increases with task difficulty and communicative complexity_\". Furthermore, recent research by [PERSON] et al. [13] has shown that multimodal approaches to healthcare deliver the most effective results, compared to a single modality on its own. On the other hand, the Business Process Management (BPM) community has studied how to organize clinical activities in well-structured _healthcare processes_ and automate their execution through the use of dedicated Process Aware Information Systems (PAISs). PAISs are able to interpret such processes and to deliver to doctors and medical staff (e.g., nurses, general practitioners) relevant information, documents and clinical tasks to be enacted, by invoking (when needed) external tools and applications [14]. Nonetheless, current BPM solutions, which are driven by predefined rules lists, have proven to be suitable to manage just the lower-level administrative processes, such as appointment making, but have made little progress into the core care procedures [15]. Based on the foregoing, in this paper, we present the main findings of the Italian project TESTMED (TESTMED was a 24-month Italian project, and stands for \"_meTodi e tEcniche per la geSTione dei processi nella MEdicina D'urgenza_\", in English: \"_methods and techniques for process management in emergency healthcare_\"), whose purpose was to design and develop a clinical PAIS, referred to as TESTMED system, which investigated touch and vocal interfaces as a potential solution to reduce the cognitive load of doctors interacting with (clinical) mobile devices during the patient's visit, and a process-aware approach for the automation of a specific class of care procedures, called _clinical guidelines_ (CGs).