BACKGROUND: Process Mining (PM) has emerged as a transformative tool in healthcare, facilitating the enhancement of process models and predicting potential anomalies. However, the widespread application of PM in healthcare is hindered by the lack of structured event logs and specific data privacy regulations.
METHODS: This paper introduces a pipeline that converts routine healthcare data into PM-compatible event logs, leveraging the newly available permissions under the Health Data Utilization Act to use healthcare data.
METHODS: Our system exploits the Core Data Sets (CDS) provided by Data Integration Centers (DICs). It involves converting routine data into Fast Healthcare Interoperable Resources (FHIR), storing it locally, and subsequently transforming it into standardized PM event logs through FHIR queries applicable on any DIC. This facilitates the extraction of detailed, actionable insights across various healthcare settings without altering existing DIC infrastructures.
CONCLUSIONS: Challenges encountered include handling the variability and quality of data, and overcoming network and computational constraints. Our pipeline demonstrates how PM can be applied even in complex systems like healthcare, by allowing for a standardized yet flexible analysis pipeline which is widely applicable.The successful application emphasize the critical role of tailored event log generation and data querying capabilities in enabling effective PM applications, thus enabling evidence-based improvements in healthcare processes.

UNASSIGNED: Most process mining techniques are primarily automated, meaning that process analysts input information and receive output. As a result, process mining techniques function like black boxes with limited interaction options for analysts, such as simple sliders for filtering infrequent behavior. Recent research tries to break these black boxes by allowing process analysts to provide domain knowledge and guidance to process mining techniques, i.e., hybrid intelligence. Especially, in process discovery-a critical type of process mining-interactive approaches emerged. However, little research has investigated the practical application of such interactive approaches. This paper presents a case study focusing on using incremental and interactive process discovery techniques in the healthcare domain. Though healthcare presents unique challenges, such as high process execution variability and poor data quality, our case study demonstrates that an interactive process mining approach can effectively address these challenges.
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This manuscript introduces a multimedia business process dataset provided by a German research institute. The dataset was systematically collected in a laboratory environment that reflects the workspace of IT staff managing IT Asset Management (ITAM) processes. It encompasses data from 121 process instances across six basic processes, captured using 37 video recordings from two camera perspectives, motion tracking, environmental sensors, an ITAM system trace, and event log data from user interactions. The data is made available in its raw state and processed form. The object-centric event log format (OCEL) provides discrete business process events from system activities. Event data from reality is supplied as raw video files and logs from environmental sensors. The video files were also manually labelled with identifiable business process activities and their associated entities. This multimedia dataset has been designed as a resource for developing, training, and evaluating process mining techniques based on unstructured data. Consequently, the dataset design emphasizes the traceability of activities and entities across the multimedia data sources.

The introduction of the Industrial Internet of Things (IIoT) has led to major changes in the industry. Thanks to machine data, business process management methods and techniques could also be applied to them. However, one data source has so far remained untouched: The network data of the machines. In the business environment, process mining, for example, has already been carried out based on network data, but the IIoT, with its particular protocols such as OPC UA, has yet to be investigated. With the help of design science research and on the shoulders of CRISP-DM, we first develop a framework for process mining in the IIoT in this paper. We then apply the framework to real-world IIoT network traffic data and evaluate the outcome and performance of our approach in detail. We find tremendous potential in network traffic data but also limitations. Among other things, due to the dependence on process experts and the existence of case IDs.

Previous studies have suggested an association between Proton Pump Inhibitors (PPIs) and the progression of chronic kidney disease (CKD). This study aims to assess the association between PPI use and CKD progression by analysing estimated glomerular filtration rate (eGFR) trajectories using a process mining approach. We conducted a retrospective cohort study from 1 January 2006 to 31 December 2011, utilising data from the Stockholm Creatinine Measurements (SCREAM). New users of PPIs and H2 blockers (H2Bs) with CKD (eGFR < 60) were identified using a new-user and active-comparator design. Process mining discovery is a technique that discovers patterns and sequences in events over time, making it suitable for studying longitudinal eGFR trajectories. We used this technique to construct eGFR trajectory models for both PPI and H2B users. Our analysis indicated that PPI users exhibited more complex and rapidly declining eGFR trajectories compared to H2B users, with a 75% increased risk (adjusted hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.49 to 2.06) of transitioning from moderate eGFR stage (G3) to more severe stages (G4 or G5). These findings suggest that PPI use is associated with an increased risk of CKD progression, demonstrating the utility of process mining for longitudinal analysis in epidemiology, leading to an improved understanding of disease progression.

BACKGROUND: The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to \"stepped care,\" in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied.
OBJECTIVE: A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records.
METHODS: Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes.
RESULTS: Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care.
CONCLUSIONS: Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes.

BACKGROUND: Understanding patient pathways from discovery of breast symptoms to treatment start can aid in identifying ways to improve access to timely cancer care. This study aimed to describe the patient pathways experienced by uninsured women from detection to treatment initiation for breast cancer in Mexico City and estimate the potential impact of earlier treatment on patient survival.
METHODS: We used process mining, a data analytics technique, to create maps of the patient pathways. We then compared the waiting times and pathways between patients who initially consulted a private service versus those who sought care at a public health service. Finally, we conducted scenario modelling to estimate the impact of early diagnosis and treatment on patient survival.
RESULTS: Our study revealed a common pathway followed by breast cancer patients treated at the two largest public cancer centres in Mexico City. However, patients who initially sought care in private clinics experienced shorter mean wait times for their first medical consultation (66 vs 88 days), and diagnostic confirmation of cancer (57 vs 71 days) compared to those who initially utilized public clinics. Our scenario modelling indicated that improving early diagnosis to achieve at least 60% of patients starting treatment at early stages could increase mean patient survival by up to two years.
CONCLUSIONS: Our study highlights the potential of process mining to inform healthcare policy for improvement of breast cancer care in Mexico. Also, our findings indicate that reducing diagnostic and treatment intervals for breast cancer patients could result in substantially better patient outcomes.
UNASSIGNED: This study revealed significant differences in time intervals along the pathways of women with breast cancer according to the type of health service first consulted by the patients: whether public primary care clinics or private doctors. Policies directed to reduce these inequities in access to timely cancer care are desperately needed to reduce socioeconomic disparities in breast cancer survival.

BACKGROUND: To discover pharmacotherapy prescription patterns and their statistical associations with outcomes through a clinical pathway inference framework applied to real-world data.
METHODS: We apply machine learning steps in our framework using a 2006 to 2020 cohort of veterans with major depressive disorder (MDD). Outpatient antidepressant pharmacy fills, dispensed inpatient antidepressant medications, emergency department visits, self-harm, and all-cause mortality data were extracted from the Department of Veterans Affairs Corporate Data Warehouse.
RESULTS: Our MDD cohort consisted of 252,179 individuals. During the study period there were 98,417 emergency department visits, 1,016 cases of self-harm, and 1,507 deaths from all causes. The top ten prescription patterns accounted for 69.3% of the data for individuals starting antidepressants at the fluoxetine equivalent of 20-39 mg. Additionally, we found associations between outcomes and dosage change.
CONCLUSIONS: For 252,179 Veterans who served in Iraq and Afghanistan with subsequent MDD noted in their electronic medical records, we documented and described the major pharmacotherapy prescription patterns implemented by Veterans Health Administration providers. Ten patterns accounted for almost 70% of the data. Associations between antidepressant usage and outcomes in observational data may be confounded. The low numbers of adverse events, especially those associated with all-cause mortality, make our calculations imprecise. Furthermore, our outcomes are also indications for both disease and treatment. Despite these limitations, we demonstrate the usefulness of our framework in providing operational insight into clinical practice, and our results underscore the need for increased monitoring during critical points of treatment.

The article discusses the need for a lightweight software architecture evaluation framework that can address practitioners\' concerns. Specifically, the proposed framework uses process mining and Petri nets to analyze security and performance in software development\'s early and late stages. Moreover, the framework has been implemented in six case studies, and the results show that it is a feasible and effective solution that can detect security and performance issues in complex and heterogeneous architecture with less time and effort. Furthermore, the article provides a detailed explanation of the framework\'s features, factors, and evaluation criteria. Additionally, this article discusses the challenges associated with traditional software architecture documentation methods using Unified Modeling Language diagrams and the limitations of code alone for creating comprehensive Software Architecture models. Various methods have been developed to extract implicit Software Architecture from code artifacts, but they tend to produce code-oriented diagrams instead of Software Architecture diagrams. Therefore, to bridge the model-code gap, the article proposes a framework that considers existing Software Architecture in the source code as architectural components and focuses on Software Architecture behaviors for analyzing performance and security. The proposed framework also suggests comparing Software Architecture extracted by different Process Mining algorithms to achieve consensus on architecture descriptions, using visualizations to understand differences and similarities. Finally, the article suggests that analyzing the previous version of a system\'s Software Architecture can lead to improvements and deviations from planned Software Architecture can be detected using traceability approaches to aid software architects in detecting inconsistencies.

OBJECTIVE: Follow-up guidelines barely diverge from a one-size-fits-all approach, even though the risk of recurrence differs per patient. However, the personalization of breast cancer care improves outcomes for patients. This study explores the variation in follow-up pathways in the Netherlands using real-world data to determine guideline adherence and the gap between daily practice and risk-based surveillance, to demonstrate the benefits of personalized risk-based surveillance compared with usual care.
METHODS: Patients with stage I-III invasive breast cancer who received surgical treatment in a general hospital between 2005 and 2020 were selected from the Netherlands Cancer Registry and included all imaging activities during follow-up from hospital-based electronic health records. Process analysis techniques were used to map patients and activities to investigate the real-world utilisation of resources and identify the opportunities for improvement. The INFLUENCE 2.0 nomogram was used for risk prediction of recurrence.
RESULTS: In the period between 2005 and 2020, 3478 patients were included with a mean follow-up of 4.9 years. In the first 12 months following treatment, patients visited the hospital between 1 and 5 times (mean 1.3, IQR 1-1) and received between 1 and 9 imaging activities (mean 1.7, IQR 1-2). Mammogram was the prevailing imaging modality, accounting for 70% of imaging activities. Patients with a low predicted risk of recurrence visited the hospital more often.
CONCLUSIONS: Deviations from the guideline were not in line with the risk of recurrence and revealed a large gap, indicating that it is hard for clinicians to accurately estimate this risk and therefore objective risk predictions could bridge this gap.