Using Event logs and Rapid Ethnographic Data to Mine Clinical Pathways

Background: Process mining (PM) using event log files is gaining popularity in healthcare to investigate clinical pathways. But it has many unique challenges. Clinical Pathways (CPs) are often complex and unstructured which results in spaghetti-like models. Moreover, the log files collected from the electronic health record (EHR) often contain noisy and incomplete data. Objective: Based on the traditional process mining technique of using event logs generated by an EHR, observational video data from rapid ethnography (RE) were combined to model, interpret, simplify and validate the perioperative (PeriOp) CPs. Method: The data collection and analysis pipeline consisted of the following steps: (1) Obtain RE data, (2) Obtain EHR event logs, (3) Generate CP from RE data, (4) Identify EHR interfaces and functionalities, (5) Analyze EHR functionalities to identify missing events, (6) Clean and preprocess event logs to remove noise, (7) Use PM to compute CP time metrics, (8) Further remove noise by removing outliers, (9) Mine CP from event logs and (10) Compare CPs resulting from RE and PM. Results: Four provider interviews and 1,917,059 event logs and 877 minutes of video ethnography recording EHRs interaction were collected. When mapping event logs to EHR functionalities, the intraoperative (IntraOp) event logs were more complete (45%) when compared with preoperative (35%) and postoperative (21.5%) event logs. After removing the noise (496 outliers) and calculating the duration of the PeriOp CP, the median was 189 minutes and the standard deviation was 291 minutes. Finally, RE data were analyzed to help identify most clinically relevant event logs and simplify spaghetti-like CPs resulting from PM. Conclusion: The study demonstrated the use of RE to help overcome challenges of automatic discovery of CPs. It also demonstrated that RE data could be used to identify relevant clinical tasks and incomplete data, remove noise (outliers), simplify CPs and validate mined CPs.