HIV Case Surveillance Informatics Business Process Modeling

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1 HIV Case Surveillance Informatics Business Process Modeling TECHNICAL NOTE Corresponding Author EJ Manders US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS 7 March 2014 This document does not necessarily represent the opinion of the US Centers for Disease Control and Prevention *

2 Information needs in HIV interventions Business process modeling for HIV case surveillance In any complex activity that involves multiple organizations, people roles, documents, and the importance of a sequence of events, we need an accurate description of these activities in order to have a shared unambiguous understanding of all aspects of the activity. The concept of business process modeling (BPM) is mature method to develop clear, comprehensive descriptions of activities of arbitrary complexity. A business process model diagram represents an activity or set of activities in a graphical manner, so that all relations are represented in a clear and precise way. A business process model diagram can be considered a structured way to create a flow diagram, where the graphical rules to create the diagram help any reader understand what the modeler intended to represent. The diagram uses visual shapes to indicate the specific meaning of business process concepts. The graphical representation including shapes, and the rules to connect the shapes is known as the Business process Modeling Notation (BPMN). The evolution of BPMN is governed by an international standards organization. Tutorial introductions to BPM are readily available on the Internet, and we do not specifically include a tutorial in this guide. A good starting point for learning more is the website dedicated to BPMN, hosted by the Object Management Group ( BPMN can be adopted from basic principles, to advanced modeling. Fortunately, an incremental refinement of the models is always possible and it is not necessary to start using all features from the beginning. Software tools are available to help the user create these diagrams. Microsoft Visio, a component of the Microsoft office suite of tools support business process modeling. The Intalio Business process modeling tool is a dedicated tool suite for business process modeling, and the diagram creation component of the tool is available free of charge ( While a creating a business process model diagram with these applications may require a short learning curve, the increased clarity of the resulting diagrams is a clear benefit. Business process modeling is also an integrated element of enterprise architecture modeling. If an enterprise architecture initiative exists in your setting, developing a business process model for key activities that define critical information flows may be an investment worth making. Figure 1 shows the graphical shapes as supported by the Visio tool. 2 P a g e

3 Information needs in HIV interventions Figure 1: Overview of the BPMN shapes available in the MS Visio tool An excellent example of BPMN use with a public health focus can be found in work from the Public Health Informatics Institute has produced a report on collaborative requirements development for local health departments that emphasizes the use of business process modeling as a method to improve the descriptions of how public health processes should be represented. ( Public Health Informatics Institute - Collaborative Requirements Development Methodology 2012) For the limited application of HIV case surveillance we suggest the use of BPMN specifically to govern the change management required to introduce electronic information systems into an existing business process that is based on a paper CRF flow. Figure 2, shows a basic HIV case surveillance BPM diagram To illustrate the utility of BPMN of HIV case surveillance, we have provided several examples. These examples illustrate how BPMN can help in describe the real processes in the surveillance chain of activities from facility to central level analysis. For a precise interpretation of some of the graphics used, please reference a tutorial introduction to BPMN. Many variations of these models are possible and they do not necessarily correspond with actual operations in a particular surveillance settings. 3 P a g e

4 This example is a paper based surveillance system, in a reporting hierarchy from facility to local health department to central health department. Data entry into a computerized information system happens only at the central level. However, the local level does have a data manager who performs initial DQA on the paper based CRF, and a local coordinator who carries out local analysis, essentially case counting. Information needs in HIV interventions 4 P a g e

5 This example begins with paper based CRF at the facility, but entry into surveillance information system occurs at the local level, The paper CRF path remains in existence. There is an explicit synchronization step between each local data base and the central level database. Information needs in HIV interventions 5 P a g e

6 This example shows a paper based CRF only at the health facility and data entry into a computerized information system occurs directly at the facility. The paper CRF is no longer physically sent to the local health department, but archived at the facility level. The computerized information system is accessible over a network but local officers do not have access to data from outside their area. Hence, in this example, case matching is required both at the local and the central level. Information needs in HIV interventions. 6 P a g e

7 This example shows an electronic CRF being populated from an electronic patient record, directly to a central level. Data management at the central level handles a DQA program as well as centralized case de-duplication. In this example we have removed the local health department surveillance resources because the information system allows more efficient processes. Presumably the local health department would be able to access the centralized surveillance information system Information needs in HIV interventions. 7 P a g e

8 Information needs in HIV interventions References Public Health Informatics Institute - Collaborative Requirements Development Methodology Accessed October P a g e