Eindhoven University of Technology MASTER Process mining in intensive care unit data Lybeshari, E. Award date: 2012 Link to publication Disclaimer This document contains a student thesis (bachelor's or master's), as authored by a student at Eindhoven University of Technology. Student theses are made available in the TU/e repository upon obtaining the required degree. The grade received is not published on the document as presented in the repository. The required complexity or quality of research of student theses may vary by program, and the required minimum study period may vary in duration. 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Mans (Ronny) TU/e, M&CS Eindhoven, August 2012 2 Acknowledgements It is a pleasure to thank the people who made this thesis possible. This work would not have been possible without the great support from my supervisor Irene Vanderfeesten under whose guidance, I chose this topic. She has been abundantly helpful and has assisted me in numerous ways. I specially thank her for the frequent valuable feedback and for believing in me from the first day of this project. I would like to say a big thanks to Ronny Mans who assisted me during the whole process of this thesis project. His advices and feedback were very important for the research done in this thesis. I am grateful to professor Uzay Kaymak. Thank you for helping me in the most crucial phase of this thesis, for your feedback and for being part of assessment committee. I would like to thank also André Fialho who even though was not officially involved in this thesis project was always available to answer my questions. The next thanks are for Leo Celi (doctor at BIDMC hospital), Erik Korsten (doctor at Catharina hospital) Walther van Mook (doctor at Academic hospital of Maastricht) and Dennis Bergmans (doctor at Academic hospital of Maastricht) who supported me in the early phases of this thesis. My final words go to my family. I want to thank my family, whose love and guidance is with me in whatever I pursue. Thank you mom and dad for your unconditioned support during all my period of studying. Thank you Lenci for being extremely patient with me and my strange attitude during this thesis project. The most special thank you is for my little baby boy, Princ who made this thesis project an unforgettable journey. I feel lucky having you all in my life. Edlira Lybeshari Eindhoven, August 2012 3 4 Abstract Intensive care units (ICUs) of hospitals provide health care services to critically ill patients. The number of such patients is continuously increasing and the services provided to them by ICUs take a significant part of hospitals’ budgets. So, improving the quality of ICU services is important but also challenging. In this thesis, we use process mining to investigate ICU healthcare services by mining the data of clinical processes (such as treatment, diagnosis and monitoring processes) related to these services. More specifically, we focus on applying process mining for checking whether medical guidelines are followed correctly by ICU staff, by contributing so in the improvement of ICU clinical processes and as a result having a better health care in ICUs. So, to reach our goal we have followed a research approach moving from specific observations to broader generalizations, by first selecting a specific ICU database and some ICU clinical processes and then trying to mine their data from the selected source of data. This attempt can be successful (in cases when we have some mining results) or it can fail due to the lack of the required process data (in cases when we cannot do process mining). In this last case, we suggest solutions on how to store process data and how to collect them so that they are suitable for process mining. The results of applying our approach in the selected ICU database (MIMICII database) and for the selected ICU processes (‘Daily checklist’ and ‘ST‐elevation treatment’ processes) showed that the data of these processes stored in the MIMICII database were not suitable for process mining. Consequently, we have not obtained mining results but we have designed a process oriented database schema for MIMICII and further generalized it to an abstract process oriented database schema that can be suitable for different healthcare clinical databases (including here, also ICU databases). These schemas make it clear what is the basic information needed for process mining and how it should be stored in a database. In addition, we have also provided procedural solutions on how to collect these process data. Finally, in this thesis we realized that even when a healthcare database is large and varied in data, it is not sure that it contains the right data needed for process mining. Keywords: intensive care, ICU, process mining, database 5 Table of Contents Acknowledgements ....................................................................................................................................... 3 Abstract ......................................................................................................................................................... 5 Table of Contents .......................................................................................................................................... 6 Tables of Figures ........................................................................................................................................... 9 Tables of Tables........................................................................................................................................... 10 1 Introduction ........................................................................................................................................ 11 1.1 Context ........................................................................................................................................ 11 1.2 Motivation ................................................................................................................................... 12 1.2.1 Why process mining? .......................................................................................................... 12 1.2.2 Why process mining in healthcare and ICU? ...................................................................... 12 1.3 Research question ....................................................................................................................... 13 1.4 Outline......................................................................................................................................... 14 2 Background ......................................................................................................................................... 16 2.1 Description of intensive care units ............................................................................................. 16 2.2 Processes and Process mining .................................................................................................... 16 2.2.1 What is a business process? ................................................................................................ 17 2.2.2 Process mining basics .......................................................................................................... 17 2.2.3 What data do we need to do process mining? ................................................................... 19 2.2.4 Process mining tools ........................................................................................................... 21 2.3 Related work ............................................................................................................................... 21 2.3.1 Applications of process mining in healthcare ..................................................................... 21 2.3.2 Mining ICU data .................................................................................................................. 23 2.4 Structured Query Language (SQL) ............................................................................................... 24 3 Methodology ....................................................................................................................................... 26 3.1 Select an ICU database ................................................................................................................ 26 3.2 Select ICU process (es). ............................................................................................................... 27 3.3 Look for process(es) data. ........................................................................................................... 28 3.4