{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T23:44:37Z","timestamp":1781307877753,"version":"3.54.1"},"reference-count":66,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T00:00:00Z","timestamp":1594598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Education, University and Research (MIUR)","award":["CUP H92H18000210006 and H92H18000200006"],"award-info":[{"award-number":["CUP H92H18000210006 and H92H18000200006"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Information"],"abstract":"<jats:p>Integrated clinical pathways (ICPs) are task-oriented care plans detailing the essential steps of the therapeutic pathway referring to a specific clinical problem with a patient\u2019s expected clinical course. ICPs represent an effective tool for resource management in the public and private health domains. To be automatically executed, the ICP process has to be described by means of complex general purpose description language (GPDL) formalisms. However, GPDLs make the process model difficult to grasp by a human. On the other hand, the adoption of a reduced set of graphical constructs prevents a fully automated process execution due to the lack of information required by a machine. Unfortunately, it is difficult to find a balance between modelling language expressiveness and the automated execution of the modelled processes. In this paper, we present a meta-model based on a GPDL to organize the ICP process knowledge. This meta-model allows the management of ICP information in a way that is independent from the graphic representation of the adopted modelling standard. We also propose a general framework and a methodology that aim to guarantee a high degree of automation in process execution. In particular, the corresponding execution engine is implemented as a chatbot (integrated with social media), which plays a two-fold role: during the actual execution of the entire ICP, it acts as a virtual assistant and gathers the patient\u2019s health data. Tests performed on a real ICP showed that, thanks to the proposed solution, the chatbot engine is able to engage in a dialogue with the patient. We provide discussion about how the system could be extended and how it could be seen as an alternative to Artificial Intelligence (AI) and Natural Language Processing (NLP)-based approaches.<\/jats:p>","DOI":"10.3390\/info11070362","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T04:46:01Z","timestamp":1594701961000},"page":"362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Design and Execution of Integrated Clinical Pathway: A Simplified Meta-Model and Associated Methodology"],"prefix":"10.3390","volume":"11","author":[{"given":"Carmelo","family":"Ardito","sequence":"first","affiliation":[{"name":"Dipartimento di Ingegneria Elettrica e dell\u2019Informazione (DEI), Politecnico di Bari, Via Edoardo Orabona, 4, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5719-7447","authenticated-orcid":false,"given":"Danilo","family":"Caivano","sequence":"additional","affiliation":[{"name":"Dipartimento di Informatica, University of Bari Aldo Moro, Via Edoardo Orabona, 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2840-7235","authenticated-orcid":false,"given":"Lucio","family":"Colizzi","sequence":"additional","affiliation":[{"name":"Dipartimento di Informatica, University of Bari Aldo Moro, Via Edoardo Orabona, 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4120-5876","authenticated-orcid":false,"given":"Giovanni","family":"Dimauro","sequence":"additional","affiliation":[{"name":"Dipartimento di Informatica, University of Bari Aldo Moro, Via Edoardo Orabona, 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana","family":"Verardi","sequence":"additional","affiliation":[{"name":"Dipartimento di Informatica, University of Bari Aldo Moro, Via Edoardo Orabona, 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,13]]},"reference":[{"key":"ref_1","first-page":"111","article-title":"Care pathways for the organization of patients\u2019 care","volume":"28","author":"Panella","year":"2012","journal-title":"Bull. Econ. Organ. Inform. Healthc."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dimauro, G., Caivano, D., Bevilacqua, V., Girardi, F., and Napoletano, V. (2016, January 15\u201318). VoxTester, software for digital evaluation of speech changes in Parkinson disease. Proceedings of the 2016 IEEE International Symposium on Medical Measurements and Applications (MeMeA), Benevento, Italy.","DOI":"10.1109\/MeMeA.2016.7533761"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Dimauro, G., Girardi, F., Gelardi, M., Bevilacqua, V., and Caivano, D. (2018). Rhino-Cyt: A System for Supporting the Rhinologist in the Analysis of Nasal Cytology. Intelligent Computing Theories and Application, Springer.","DOI":"10.1007\/978-3-319-95933-7_71"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ijmedinf.2018.11.010","article-title":"Nasal cytology with deep learning techniques","volume":"122","author":"Dimauro","year":"2019","journal-title":"Int. J. Med Inform."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"113488","DOI":"10.1109\/ACCESS.2019.2932274","article-title":"Detecting clinical signs of anaemia from digital images of the palpebral conjunctiva","volume":"7","author":"Dimauro","year":"2019","journal-title":"IEEE Access"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Dimauro, G., de Ruvo, S., di Terlizzi, F., Ruggieri, A., Volpe, V., Colizzi, L., and Girardi, F. (2020). Estimate of Anemia with New Non-Invasive Systems\u2014A Moment of Reflection. Electronics, 9.","DOI":"10.3390\/electronics9050780"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Dimauro, G., Caivano, D., Girardi, F., and Ciccone, M.M. (2014, January 17). The Patient Centered Electronic Multimedia Health Fascicle-EMHF. Proceedings of the 2014 IEEE Workshop on Biometric Measurements and Systems for Security and Medical Applications (BIOMS) Proceedings, Rome, Italy.","DOI":"10.1109\/BIOMS.2014.6951537"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Dimauro, G., Girardi, F., Caivano, D., and Colizzi, L.N. (2018). Personal Health E-Record\u2014Toward an enabling Ambient Assisted Living Technology for communication and information sharing between patients and care providers. Italian Forum of Ambient Assisted Living, Springer.","DOI":"10.1007\/978-3-030-05921-7_39"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1744-1609.2009.00127.x","article-title":"Systematic review of the effectiveness of integrated care pathways: What works, for whom, in which circumstances?","volume":"7","author":"Allen","year":"2009","journal-title":"Int. J. Evid. Based Healthc."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Aspland, E., Gartner, D., and Harper, P. (2019). Clinical pathway modelling: A literature review. Health Syst., 1\u201323.","DOI":"10.1080\/20476965.2019.1652547"},{"key":"ref_11","unstructured":"Philadelphia, C.H.O. (2020, May 01). ED Clinical Pathway for the Evaluation\/Treatment of the Patient with Migraine Headache. Available online: https:\/\/www.chop.edu\/clinical-pathway\/migraine-headache-emergent-care-clinical-pathway."},{"key":"ref_12","unstructured":"Burwitz, M., Schlieter, H., and Esswein, W. (March, January 27). Modeling Clinical Pathways-Design and Application of a Domain-Specific Modeling Language. Proceedings of the 11th International Conference on Wirtschaftsinformatik (WI2013), Leipzig, Germany."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Stroppi, L.J.R., Chiotti, O., and Villarreal, P.D. (2011). Extending BPMN 2.0: Method and tool support. Business Process Model and Notation, Springer.","DOI":"10.1007\/978-3-642-25160-3_5"},{"key":"ref_14","first-page":"221","article-title":"Languages of process modeling","volume":"4","author":"Pawlewski","year":"2014","journal-title":"Res. Logist. Prod."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wang, W., Ding, H., Dong, J., and Ren, C. (2006, January 21\u201323). A Comparison of Business Process Modeling Methods. Proceedings of the 2006 IEEE International Conference on Service Operations and Logistics, and Informatics, Shanghai, China.","DOI":"10.1109\/SOLI.2006.328910"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9027","DOI":"10.1109\/ACCESS.2018.2791666","article-title":"Event-Driven Process Chain for Modeling and Verification of Business Requirements\u2013A Systematic Literature Review","volume":"6","author":"Amjad","year":"2018","journal-title":"IEEE Access"},{"key":"ref_17","unstructured":"M\u00fcller, R., and Rogge-Solti, A. (2011, January 21\u201322). BPMN for healthcare processes. Proceedings of the 3rd Central-European Workshop on Services and their Composition, Karlsruhe, Germany."},{"key":"ref_18","unstructured":"The Object Management Group (2011). Business Process Model and Notation (BPMN) Version 2.0, Object Management Group. OMG Specification."},{"key":"ref_19","unstructured":"The Object Management Group (2019, June 14). Business Process Model and Notation. Available online: https:\/\/www.omg.org\/spec\/BPMN\/2.0\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.infsof.2016.05.004","article-title":"A metamodel to integrate business processes time perspective in BPMN 2.0","volume":"77","author":"Arevalo","year":"2016","journal-title":"Inf. Softw. Technol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Braun, R., Schlieter, H., Burwitz, M., and Esswein, W. (2014, January 2\u20135). BPMN4CP: Design and implementation of a BPMN extension for clinical pathways. Proceedings of the IEEE International Conference on Bioinformatics and Biomedicine (BIBM \u201814), Belfast, UK.","DOI":"10.1109\/BIBM.2014.6999261"},{"key":"ref_22","unstructured":"Braun, R., Schlieter, H., Burwitz, M., and Esswein, W. (2015, January 4\u20136). Extending a Business Process Modeling Language for Domain-Specific Adaptation in Healthcare. Proceedings of the 12th International Conference on Wirtschaftsinformatik, Osnabr\u00fcck, Germany."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Braun, R., Schlieter, H., Burwitz, M., and Esswein, W. (2016, January 10). BPMN4CP Revised\u2014Extending BPMN for Multi-perspective Modeling of Clinical Pathways. Proceedings of the 2016 49th Hawaii International Conference on System Sciences (HICSS), Koloa, HI, USA.","DOI":"10.1109\/HICSS.2016.407"},{"key":"ref_24","unstructured":"(1998). IEEE Std-Standard for Functional Modeling Language-1320.1, IEEE."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4","DOI":"10.15587\/2312-8372.2018.128455","article-title":"Development of medical diagnostic decision support systems and their economic efficiency","volume":"2","author":"Kravchenko","year":"2018","journal-title":"Echnology Audit Prod. Reserves"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Weske, M. (2019). Business Process Modelling Foundation. Business Process Management, Springer.","DOI":"10.1007\/978-3-662-59432-2"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Jeston, J. (2014). Business Process Management, Routledge.","DOI":"10.4324\/9780203081327"},{"key":"ref_28","unstructured":"Reis, L., Maier, C., Mattke, J., and Weitzel, T. (2020, January 15\u201317). Chatbots in Healthcare: Status Quo, Application Scenarios for Physicians and Patients and Future Directions. Proceedings of the 28th European Conference on Information Systems (ECIS), Online AIS Conference, Marrakech, Morocco."},{"key":"ref_29","first-page":"225","article-title":"A Literature Review On Chatbots In Healthcare Domain","volume":"8","author":"Bhirud","year":"2019","journal-title":"Int. J. Sci. Technol. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zamanirad, S., Benatallah, B., Rodriguez, C., Yaghoubzadehfard, M., Bouguelia, S., and Brabra, H. (2020). State Machine Based Human-Bot Conversation Model and Services. International Conference on Advanced Information Systems Engineering, Springer.","DOI":"10.1007\/978-3-030-49435-3_13"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rooein, D., Bianchini, D., Leotta, F., Mecella, M., Paolini, P., and Pernici, B. (2020). Chatting About Processes in Digital Factories: A Model-Based Approach. Enterprise, Business-Process and Information Systems Modeling, Springer.","DOI":"10.1007\/978-3-030-49418-6_5"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"L\u00f3pez, A., S\u00e0nchez-Ferreres, J., Carmona, J., and Padr\u00f3, L. (2019). From process models to chatbots. International Conference on Advanced Information Systems Engineering, Springer.","DOI":"10.1007\/978-3-030-21290-2_24"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ayanouz, S., Abdelhakim, B.A., and Benhmed, M. (2020, January 19\u201321). A Smart Chatbot Architecture based NLP and Machine Learning for Health Care Assistance. Proceedings of the 3rd International Conference on Networking, Information Systems & Security, Modena, Italy.","DOI":"10.1145\/3386723.3387897"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Pereira, J., and D\u00edaz, O. (2018, January 9\u201313). A quality analysis of Facebook Messenger\u2019s most popular. Proceedings of the Symposium on Applied Computing, Pau, France.","DOI":"10.1145\/3167132.3167362"},{"key":"ref_35","unstructured":"(2020, June 01). Available online: https:\/\/www.safeinbreastfeeding.com\/safedrugbot-chatbot-medical-assistant\/."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1093\/pubmed\/fdq044","article-title":"Estimating the future healthcare costs of an aging population in the UK: Expansion of morbidity and the need for preventative care","volume":"33","author":"Caley","year":"2011","journal-title":"J. Public Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1109\/MPUL.2017.2678098","article-title":"Cognitive computing and the future of health care cognitive computing and the future of healthcare: The cognitive power of IBM Watson has the potential to transform global personalized medicine","volume":"8","author":"Ahmed","year":"2017","journal-title":"Ieee Pulse"},{"key":"ref_38","unstructured":"(2020, June 01). Available online: http:\/\/www.superizzy.ai\/."},{"key":"ref_39","unstructured":"(2020, June 01). Available online: https:\/\/getforksy.com\/."},{"key":"ref_40","unstructured":"(2020, June 01). Available online: https:\/\/www.babylonhealth.com\/."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"m266","DOI":"10.1136\/bmj.m266","article-title":"Babylon Health holds talks with \u201csignificant\u201d number of NHS trusts","volume":"368","author":"Iacobucci","year":"2020","journal-title":"BMJ"},{"key":"ref_42","unstructured":"Chittamuru, D., Ramondt, S., Kravitz, R., and Ramirez, S. (2019). Who uses an online intelligent medical information system and what do they do with that information? Results from a pilot study of users of Buoy Health. APHA\u2019s 2019 Annual Meeting and Expo, American Public Health Association."},{"key":"ref_43","unstructured":"(2020, June 01). Available online: https:\/\/www.buoyhealth.com\/."},{"key":"ref_44","unstructured":"(2020, June 01). Available online: https:\/\/www.facebook.com\/CancerChatbot\/."},{"key":"ref_45","unstructured":"(2020, June 01). Available online: http:\/\/www.sensely.com\/."},{"key":"ref_46","unstructured":"(2020, June 01). Available online: https:\/\/gyant.com\/."},{"key":"ref_47","unstructured":"(2020, June 01). Available online: https:\/\/woebot.io."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.2196\/mental.7785","article-title":"Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): A randomized controlled trial","volume":"4","author":"Fitzpatrick","year":"2017","journal-title":"Jmir Ment. Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e2598","DOI":"10.1136\/bmj.e2598","article-title":"The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: Randomised controlled non-inferiority trial","volume":"344","author":"Merry","year":"2012","journal-title":"BMJ"},{"key":"ref_50","unstructured":"(2020, June 01). Available online: https:\/\/www.healthtap.com."},{"key":"ref_51","unstructured":"Your.MD (2020, June 01). Available online: https:\/\/www.your.md."},{"key":"ref_52","unstructured":"Ada (2020, June 01). Available online: https:\/\/ada.com."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Zagorecki, A., Orzechowski, P., and Ho\u0142ownia, K. (2013). Online diagnostic system based on Bayesian networks. Conference on Artificial Intelligence in Medicine in Europe, Springer.","DOI":"10.1007\/978-3-642-38326-7_22"},{"key":"ref_54","unstructured":"bots4health (2020, June 01). Available online: https:\/\/cristinasantamarina.com\/work\/bots4health\/."},{"key":"ref_55","first-page":"196","article-title":"eMedication Meets eHealth with the Electronic Medication Management Assistant (eMMA)","volume":"236","author":"Tschanz","year":"2017","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Thalheim, B. (2011). The enhanced entity-relationship model. Handbook of Conceptual Modeling, Springer.","DOI":"10.1007\/978-3-642-15865-0_6"},{"key":"ref_57","unstructured":"(2020, May 14). Active Knowledge Modeling: Simplifying BPMN 2.0. Available online: https:\/\/activeknowledgemodeling.com\/2010\/03\/23\/simplifying-bpmn-2-0\/."},{"key":"ref_58","unstructured":"Mills, K. (2003). Computer-Supported Cooperative Work, Marcel Dekker."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1093\/jamia\/ocy072","article-title":"Conversational agents in healthcare: A systematic review","volume":"25","author":"Laranjo","year":"2018","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_60","unstructured":"Linn, L., and Koo, M. (2016). Blockchain for health data and its potential use in health it and health care related research, ONC\/NIST Use of Blockchain for Healthcare and Research Workshop."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Girardi, F., de Gennaro, G., Colizzi, L., and Convertini, N. (2020). Improving the Healthcare Effectiveness: The Possible Role of EHR, IoMT and Blockchain. Electronics, 9.","DOI":"10.3390\/electronics9060884"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Fielding, R.T., Taylor, R.N., Erenkrantz, J.R., Gorlick, M.M., Whitehead, J., Khare, R., and Oreizy, P. (2017, January 4\u20138). Reflections on the REST architectural style and\u201d principled design of the modern web architecture. Proceedings of the 2017 11th Joint Meeting on Foundations of Software Engineering, Paderborn, Germany.","DOI":"10.1145\/3106237.3121282"},{"key":"ref_63","unstructured":"Emilia-Romagna, R. (2019, June 15). Organizzazione Dell\u2019assistenza Integrata al Paziente con Cefalea: Percorso Cefalea-Approvazione Linee Guida per le Aziende Sanitarie Della Regione Emilia-Romagna. Available online: https:\/\/bur.regione.emilia-romagna.it\/bur\/area-bollettini\/bollettini-pubblicati\/2013\/n.-372-del-12.12.2013.2013-12-11.0512037846\/organizzazione-dellassistenza-integrata-al-paziente-con-cefalea-percorso-cefalea-approvazione-linee-guida-per-le-aziende-sanit."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Ferragina, P., and Scaiella, U. (2010, January 26\u201330). Tagme: On-the-fly annotation of short text fragments (by wikipedia entities). Proceedings of the 19th ACM international conference on Information and knowledge management, Toronto, ON, Canada.","DOI":"10.1145\/1871437.1871689"},{"key":"ref_65","unstructured":"TAGme API (2019, September 01). Available online: https:\/\/sobigdata.d4science.org\/web\/tagme\/tagme-help."},{"key":"ref_66","unstructured":"ISO (2011). IEC25010: 2011 systems and software engineering\u2014Systems and software quality requirements and evaluation (square)\u2013system and software quality models. Int. Organ. Stand., 34, 2910."}],"container-title":["Information"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2078-2489\/11\/7\/362\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:50:40Z","timestamp":1760176240000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2078-2489\/11\/7\/362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,13]]},"references-count":66,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["info11070362"],"URL":"https:\/\/doi.org\/10.3390\/info11070362","relation":{},"ISSN":["2078-2489"],"issn-type":[{"value":"2078-2489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,13]]}}}