# Process-Aware Enactment of Clinical Guidelines through Multimodal Interfaces
## 2 Background  
### Healthcare Processes  
In the context of a hospital, the work of the doctors and the medical staff includes the enactment of several organizational and clinical tasks, which are organized in a care pathway customized for the patient to be visited. In addition, various organizational units are involved in the care pathway of a patient. For example, for a patient treated in the department of cardiology, general blood tests at the laboratory and a thoracic RX at the radiology department are required. This means that doctors from different departments must visit the patient, write medical reports and share the clinical results, i.e., all clinical tasks must be performed in certain orders and cooperation between different organizational units is required to properly achieve such tasks [11]. Based on the foregoing, it is possible to identify several _healthcare processes_ having growing complexity and duration. For example, there are short organizational procedures like patient acceptance or long-running treatment processes like physiotherapy. According to [23], healthcare processes can be classified into two abstract groups: _elective care_ and _non-elective care_. * _Elective care_ refers to clinical treatments that can be postponed for days or weeks [24]. According to [25], elective care can be classified into three subclasses: _(i) standard processes_, which are care pathways where the ordering of activities and their timing is predefined; _(ii) routine processes_, which are care pathways providing potential alternative treatments to be followed for reaching an overall clinical target; and _(iii) non-routine processes_, where the next step of the care pathway depends on how the patient reacts to a dedicated treatment [26]. * _Non-elective care_ refers to _emergency care_, which has to be enacted immediately, and _urgent care_, which can be procrastinated for a short time. To additionally understand the complexity of a healthcare process, it is possible to classify it in six macro steps [27], organized according to the degree of structuring and predictability they exhibit [28]. Figure 1 shows such a classification. The six macro steps include:  
1. _patient registration_, which consists of creating a medical case file;
2. _patient assessment_, where an initial diagnosis for the patient is performed;
3. _treatment plan definition_, which refers to the realization of (dedicated) individual care plan;
4. _treatment delivery_, which consists of enacting the clinical actions provided by the care plan;
5. _treatment review_, which consists of a continuous monitoring of the impact and efficacy of enacted treatments, in order to provide feedback for the previous steps;
6. _patient discharge_, consisting of the closure of the case file. Administrative steps such as _patient registration_ and _patient discharge_, as well as organizational activities such as lab tests and patient transfer, are typically structured and repetitive. Any potential exceptional behaviour is limited and can be anticipated at the outset. For this reason, they are good candidates for being enacted by traditional approaches for process management [11]. On the contrary, all the other diagnostic and therapeutic steps of the healthcare process can be seen as _knowledge-intensive activities_, since they depend on medical knowledge and evidence, on patient-specific and case data, and on doctors' experience and expertise. Moreover, many complicating circumstances--often not easily predictable in advance--may arise during their enactment. For this reason, they typically lead to loosely structured or unstructured processes [29]. To sum up, the overall healthcare process, even in its oversimplified view of Figure 1, reflects the combination of predictable and unpredictable elements, making their complete automation through traditional Process-aware Information Systems (PAISs) extremely complex, which tend to restrict the range of actions of doctors and medical staff too much [28].