A Model-Driven Approach to Create and Maintain an Executable

Transferal Management Platform

Emanuele Laurenzi

Institute for Information & Process Management, University of Applied Sciences, St. Gallen, Switzerland

1 STAGE OF THE RESEARCH

My work falls within the eHealth application domain

and it is embedded into the just started research

project Patient Radar. The project is funded by the

Swiss Commission for Technology and Innovation

(CTI) under the lead of the Institute for Information

and Process Management (IPM-FHS) - University of

Applied Sciences St. Gallen. Two regional hospitals

and a Swiss national technology provider are

involved in the project in which they contribute with

their expertise.

The Patient Radar project wants to facilitate

intersectoral collaboration within the inpatient

sector, also called “transferal management”, i.e.

between acute hospitals and rehabilitation clinics in

Switzerland.

My research aims at supporting and optimizing

such a collaboration by setting up a framework

which adopts a model-driven approach to enable the

creation and maintenance of a transferal

management platform. The model-driven approach

makes the platform highly configurable to

accommodate new clinical pathways and be easily

extendable to include additional functions to meet

future needs. All domain-specific aspects are

described declaratively in application models.

Hence, domain experts will be able to

create/use/manage application models with no

required programming skills. To provide an

executable platform, models are first specified in the

formal semantics description logics and then their

elements are mapped to corresponding elements in

an application framework. In this way, we will

ensure that executable code can be derived from all

application models. Additionally, the transferal

management platform includes reference models

from which domain experts can easily create and

adapt application models.

Research questions are established and along my

work, these will be refined more and more.

2 OUTLINE OF OBJECTIVES

Developing a transferal management platform

includes the challenge of combining the clinical

pathways of several hospitals and several

rehabilitation clinics into one coherent treatment

process. The project intends to address this

challenge by creating a transferal management

platform that will serve as a hub for post-acute care,

which enables and supports the interaction between

acute hospitals and rehabilitation clinics as well as

further actors such as nursing facilities, family

doctors and health insurances for granting cost

reimbursement. While a patient is still in the acute

hospital, information such as concerning the

patient’s health status, required rehabilitation

treatment, planned transfer date need to be available

on the platform so that rehabilitation clinics can

apply for those patients and plan ahead their

resources and determine early on therapies which are

specifically adapted to the expected patient. In

particular, the transferal management platform

should

 know about clinical pathway (i.e. the patient

treatment process) of acute hospitals and partly

of the rehabilitation clinics;

 monitor the progress of a patient along the

clinical pathway according to predefined

medical indicators;

 give the rehabilitation clinics access to the

progress of the patients as well as further

rehabilitation-specific parameters such as age,

weight, and diagnosis; all other personal data

are anonymized until the patient is transferred.

The transferal management platform will have to

support wide variety of clinical pathways for all

kinds of acute hospitals and rehabilitation clinics.

Therefore, the platform must be highly configurable

to accommodate new pathways, and it must permit

that a given pathway slightly differs between

hospitals. Moreover, the platform should be easily

extendable to include additional functions to meet

future needs. As a consequence, we decided to adopt

Laurenzi E..

A Model-Driven Approach to Create and Maintain an Executable Transferal Management Platform.

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

a model-driven approach where all domain-

specific aspects are described declaratively in an

application model. The elements in the application

model will be mapped to corresponding elements in

an application framework to obtain the executable

transferal management platform.

In order to guide and support building and

maintaining the application model we introduce

reference models that provide blueprints for

common application scenarios, such as typical

pathways with the necessary patient data, generic

models of the associated administration processes as

well as role models for typical users of the platform

with their rights.

While the use of reference models helps create

specific application models it is very difficult to

constrain the adaptations to a reference model so

that only models are created that can be mapped to

the underlying application framework, i.e. can be

made executable. Since our primary purpose is to

obtain executable platforms from the application

models losing executability must be avoided.

We therefore decided to ground the reference

model in a domain-specific language (DSL)

(Jouault F. und Bézivin 2006) (Mernik et al. 2005)

(Ranabahu et al. 2012) (van Deursen et al. 2000)

instead of a general-purpose modelling language

such as UML or BPMN. The reference models and

all application models are created using

representation constructs from the DSL. Since the

definitions of the mapping from model elements to

elements of the application framework are tied to the

DSL contructs any model expressed in the DSL can

be mapped to the framework and thus be made

executable.

3 RESEARCH PROBLEM

As outlined in the previous two sub-sections we

adopt a model-driven approach where the domain-

specific aspects of the transferal management

platform are specified by an application model from

which code fragments for the actual transferal

management platform are generated.

Without the framework given by both, the

reference model and application model, the

transferal management platform would just consist

of an ordinary model that can be modified in any

possible way, including desired ways as well as

undesired ones. In particular, our framework should

 enable domain experts to adapt and extend the

platform to future needs without the help of

computer specialists; this is done by adapting

the platform through modelling instead of

programming;

 ensure that changes to the model do not destroy

the code generation property.

The following three sub-sections describe our

proposed approach. The research questions are

defined subsequently.

3.1 Basic Approach

We embed our approach into a meta modelling

framework (Karagiannis und Kühn) (Laarman und

Kurtev 2010) where the application models reside on

level 1 and the DSL is defined as a meta model on

level 2, thus providing the modelling language in

which the level 1 models are represented (cf. Figure

1).

The reference models also reside on level 1 and

serve as blueprints for the application models. An

application model is derived by modifying and

adapting a reference model but not by instantiating

it. That is why reference models and application

models are on the same level. Level 3 provides the

language constructs needed to define the DSL.

By using the two-tier approach shown in Figure

1 we aim for two kinds of extensibility:

 On level 1 new application models are created

and existing ones adapted to suit new needs,

e.g. to accommodate completely new or

slightly adapted clinical pathways. This is the

task of a domain expert who is guided by the

reference models and uses the domain-specific

constructs provided by the DSL. We especially

aim at enabling domain experts for this task

who do not have to be modelling experts by

providing a user interface which translates

modelling into an interactive visual paradigm.

 New requirements that cannot be met by

adapting an existing model on level 1 are taken

care of on level 2 by extending the DSL to

provide the additional expressiveness needed

on level 1. This is the task of a modelling

expert.

Executability of the models on level 1 will be

provided by mappings from the DSL constructs to

corresponding elements in the application

framework. Via this approach we will ensure that all

models on level 1 can in fact be properly mapped to

the application framework. An alternative approach

without a DSL would have used a general purpose

language, such as UML, and extended or refined its

semantics by adding constraints that restrict the

range of possible changes to the model (Lodderstedt

et al. 2002)

IC3K2014-DoctoralConsortium

Figure 1: Our approach in a meta modelling framework.

Such an approach, however, has the disadvantage

that it increases the complexity of the modellers’

task because they have then to know all these

constraints and take them into account, or they are

hindered by the system to make certain

modifications to a model when they would violate a

constraint. Our approach using a DSL promises to be

much easier for the modellers.

3.2 The Approach in Detail

A first idea for designing the DSL might be to use a

traditional process modelling language as its basis

since a description of the clinical pathways are at the

center of the transferal management platform. In our

case, however, we do not need to describe the

pathways in detail but only certain aspects of them,

mainly from a healing progress point of view and

not from a medical treatment perspective. The DSL

must allow to represent what the main healing and

rehabilitation phases are and which conditions must

be met (called gateways) to get to the next phase.

For this we do not need a full-fledged process

modelling language. Instead, our DSL only includes

some basic process modelling elements, thus

reducing model complexity, increasing modelling

productivity (Ulrich F. 2010) and enabling a simpler

mapping to executable elements in an application

framework.

The backbone of our DSL is the domain-specific

terminology which includes the object types relevant

for our domain as meta classes. Currently we have

the following meta classes: “ClinicalPathway” for

the patient treatment process, which consists of

activities. An activity leads to gateways that stand

for certain conditions being tested. Gateways with

fulfilled conditions enable further activities (cf.

Figure 2). Activities are associated with patients and

can be specialized into various subclasses such as

treatment activities and administrative activities.

Figure 2: Part of the domain-specific language.

All the classes used in an application model are

instances of a meta class in the DSL. We have

already created an application model for knee

replacement surgery. It contains a sequence of

activities with gateways between two activities.

Most important are the gateways since they are the

indicators how soon a patient can be released to a

rehabilitation clinic. Each activity has two duration

attributes: “typical duration” says how long the

activity usually lasts, “actual duration” says how

long the activity has already lasted. From these

attributes the transferal management platform can

derive the expected transferal date. Each gateway

has an attribute which says if the condition the

gateway stands for has been fulfilled, not been

fulfilled or not yet been tested.

Besides their duration the activities themselves

are often not of interest and are then represented by

the class “SomePostSurgeryTreatment”. In cases of

complications a second surgery or even a stay in an

intensive care unit might become necessary. When

covering such cases in the model it might be

necessary to represent these treatment activities

explicitly so that a rehabilitation clinic can see the

reason why a patient will be released later than

originally expected.

Reference models are on the same level in the

meta-model hierarchy as application models (cf.

Figure 1) so that their classes are instances of meta

classes of the DSL as well. The difference to an

application model is that a reference model is more

abstract and thus can serve as a blueprint for many

application models. We have also created an

example of a reference model for knee surgery,

which is more abstract than the application model

(above described) and only includes the absolute

necessary activities and gateways. There might also

be a reference model for surgery, which would be

even more generic. In fact, many different reference

models might be created over time, some of them

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AModel-DrivenApproachtoCreateandMaintainanExecutableTransferalManagementPlatform

specializing or generalizing already existing ones.

Thus, for example, even an application model might

be regarded as a reference model, which would then

still have to be refined to reflect the specific

procedures of different hospitals. Summarising, if a

model is an application model or a reference model

depends on its degree of generality and on the

purpose it needs to fulfil and is thus much a matter

of viewpoint.

3.3 Mapping Application Models to an

Application Framework

The application models are not just created to

describe an application domain but primarily to be

translated into some specific behaviour in the Patient

Radar transferal management platform. To achieve

this, application models will be mapped to

corresponding elements of the application

framework that is the basis for the transferal

management platform (cf. the similar approach in

(Reimer et al. 2008)). In our project we use the

application framework Vivates by the Swiss Post

(http://www.vivates.ch/). The mapping rules will be

defined in the DSL where they are attached to each

meta class.

For example, certain classes such as

“SurgeryPatient” will be mapped to corresponding

object types in Vivates. The objects belonging to

these object types reside in the runtime environment

of the application framework and are conceptually

instances of the corresponding classes in the

application model.

Other classes, such as “Gateway” will be mapped

to states in Vivates. A sequence of gateways

(through intermediate activities) will be mapped to

rules which reflect that order by specifying which

gateways have to be reached before another gateway

can be reached. In the case of parallel gateways a

rule is generated that requires both gateways to be

fulfilled in order to enable the subsequent activity.

The duration attributes of each activity class will

be used in a web service of Vivates to compute the

expected time until transferal to the rehabilitation

clinics is possible and makes this value available on

the transferal management platform.

3.4 Research Questions

The development of reference/application models by

adopting the model-driven approach pose the

following research questions:

 How can DSL constructs be mapped to

corresponding elements of the application

framework to enable and preserve executability

in the platform?

 How much variability can the application

model and/or the reference model allow

without losing its executability property for the

platform?

 How can an application model and/or a

reference model take advantage from a

domain-specific modelling language?

 How do reference models and application

models differentiate each other to enhance the

domain expert understanding of managing the

work space platform environment?

 How can the employment of a description logic

with formal semantics and reasoning

capabilities enhance the definition of a DSL in

a meta modelling approach?

 How and in which level of our proposed meta

modelling framework (cf. Figure 1) does the

integration of the description logics take place

in order to assure the dynamic behaviour of the

transferal management platform?

These questions are intended to be answered

within our application domain. In this way, insights

gained in the application domain will be valuable

and will be a contribution to a general understanding

of how to make use of application models, reference

models, DSLs, description logics and model-driven

development.

4 STATE OF THE ART

There are various approaches that combine a DSL

with a model-driven approach. For example, (Nunes

und Schwabe 2006) describes their HyperDe system

as an environment to support the rapid prototyping

of Web applications by combining model-driven

development with the use of DSLs. This

combination allows the developer to create code by

manipulating models that specify the application.

HyperDe environment supports designing Web

application through a meta model instantiation.

Furthermore, HyperDe extends the Ruby on Rails

framework into a DSL, allowing direct manipulation

within Ruby scripts of both the model and the meta

model.

Similarly, (Cadavid et al. 2009) introduces a

DSL into a model-driven software development

process to reduce the complexity of Web

applications development. The work describes the

elements used in the process of transforming a UML

domain model into a deployable Web application. In

this way they demonstrate that models can be

IC3K2014-DoctoralConsortium

transformed and executed for the automatic

generation of applications.

Different to existing approaches we not only

employ a DSL but also include reference models in

our approach to provide modelling guidance. Thus

the reference models will make it easier for domain

experts to create and adapt application models

because they do not have to start from scratch but

only need to adapt already existing meaningful

model fragments from the reference models.

Among the several meta modelling frameworks

available today (Kern et al. 2011), we adopt the one

provided by ADOxx. ADOxx features a three-step

modelling hierarchy with a rich meta-meta model

(Kern 2008), i.e. the ADOxx hierarchy (Karagiannis

und Visic 2011). This hierarchical approach suits

our approach of first defining a DSL and then a

reference model which is created using the DSL.

Additionally, in contrast to most other

approaches, which are e.g. based on UML, we will

employ a description logic for defining the DSL.

We will utilize the model-theoretic semantics of the

description logic to obtain a sound semantic

foundation of the DSL. This will allow for

terminological inferences and integrity control. The

semantics will specify in which ways the language

constructs can be combined and will enable the

modelling tools to support the users in creating

consistent and meaningful models, e.g. by

prohibiting inconsistent combination of constructs

(see e.g. (Staab et al. 2010)).

The application models are not just created to

describe an application domain but primarily to be

translated into some specific behaviour in the Patient

Radar transferal management platform. To achieve

this, application models are mapped to

corresponding elements of the application

framework that is the basis for the transferal

management platform (cf. the similar approach in

(Reimer et al. 2008). In our project we use the

application framework Vivates by the Swiss Post

(http://www.vivates.ch/). The mapping rules are

defined in the DSL where they are attached to each

meta class.

5 METHODOLOGY

Since my research work is about developing a novel

kind of artefact, the design science research

methodology has been adopted to successfully carry

out this dissertation. The design science research

allows building a sound knowledge base through

cycles of artefacts construction and subsequent

evaluation. In particular, my work will be based on

the general design cycle (GDC) (cf. Figure 3)

elaborated by (Vaishnavi and Kuechler 2007) whom

applied it into design science research.

Figure 3: Reasoning in the general design (GDC) adapted

from (Vaishnavi and Kuechler 2007).

The cycle depicted in Figure 3 shows that the

design begins with Awareness of Problem. In it, the

problem is identified and defined. More specifically,

a case study will be created and approved among the

participant of the Patient Radar project. The research

strategy “case study” thus provides a concrete

contribution to better understand the application

domain, i.e.

 Which terminology needs to be developed

within the application domain

 To which general degree a reference model and

an application model need to be designed,

 Which elements of an application model need

to be mapped to corresponding elements of the

give application framework.

Techniques to be used in creating the case study

are literature review, expert interviews involved in

the Patient Radar project such as Physician, Nurses,

eHealth professionals.

Next, in the Suggestion phase, a problem

solution is abductively developed and a tentative

design is given. Collected data in the Awareness of

Problem together with further literature review will

help elaborate the conceptual model related to the

domain-specific terminology, reference model and

application models. Additionally, the mapping rules

in the DSL where they are attached to each meta

class will be defined.

Then in the Development phase, the design is

further refined and an actual artefact is produced

through many iterations.

I will implement the conceptual model by using

the ADOxx Modelling Toolkit Platform. Hence,

AModel-DrivenApproachtoCreateandMaintainanExecutableTransferalManagementPlatform

guidelines and best practices implemented in

ADOxx will be taken into consideration. Moreover,

further literature will be sought aimed at

implementing the mapping rule which then allow to

establish and maintain executability of the transferal

management platform.

Subsequently, we reach the Evaluation phase.

Here the artefact is evaluated by using the well-

known Technology Acceptance Model (TAM)

which provides a valid and reliable measure to

predict acceptance or adoption of new technologies

by end users (Davis et al. 1989; Davis 1989).

Additionally, TAM is a commonly used model to

measure technology acceptance (King and He 2006).

Finally, the Conclusion phase, in which insights

gained from the work are reported and future

research will be addressed.

6 EXPECTED OUTCOME

The work aims at adopting a model-driven approach

to create and maintain a transferal management

platform for supporting the collaboration between

acute hospitals and rehabilitation clinics to optimize

transferal management. Thus, the expected outcome

is a framework which allows the development of the

transferal management platform being highly

configurable, e.g. to accommodate new clinical

pathways, and to permit a given pathway to

(slightly) differ between hospitals. Moreover, the

platform should be easily extendable to include

additional functions to meet future needs.

All domain-specific aspects will be described

declaratively in a reference or application model.

The elements in the application model will be

mapped to corresponding elements in an application

framework to obtain the executable platform. The

mapping will be enabled by mapping rules that are

defined on the constructs of a domain-specific

language (DSL). In this way, it can be assured that

executable code derived from all

reference/application models expressed with the

DSL. The mappings from DSL constructs to

application framework elements will be specified

using the description logic semantics to enable the

modelling tools supporting the users in creating

consistent and meaningful models.

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AModel-DrivenApproachtoCreateandMaintainanExecutableTransferalManagementPlatform