ProjectFlow: a configurable workflow management application for point of care research

Abstract

Objective: To best meet our point-of-care research (POC-R) needs, we developed ProjectFlow, a configurable, clinical research workflow management application. In this article, we describe ProjectFlow and how it is used to manage study processes for the Diuretic Comparison Project (DCP) and the Research Precision Oncology Program (RePOP).

Materials and methods: The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. ProjectFlow is a flexible web-based workflow management tool specifically created to facilitate conduct of our clinical research initiatives within the VHA. The application was developed using the Grails web framework and allows researchers to create custom workflows using Business Process Model and Notation.

Results: As of January 2021, ProjectFlow has facilitated management of study recruitment, enrollment, randomization, and drug orders for over 10 000 patients for the DCP clinical trial. It has also helped us evaluate over 3800 patients for recruitment and enroll over 370 of them into RePOP for use in data sharing partnerships and predictive analytics aimed at optimizing cancer treatment in the VHA.

Discussion: The POC-R study design embeds research processes within day-to-day clinical care and leverages longitudinal electronic health record (EHR) data for study recruitment, monitoring, and outcome reporting. Software that allows flexibility in study workflow creation and integrates with enterprise EHR systems is critical to the success of POC-R.

Conclusions: We developed a flexible web-based informatics solution called ProjectFlow that supports custom research workflow configuration and has ability to integrate data from existing VHA EHR systems.

Keywords: clinical trial; data sharing; diuretic; embedded pragmatic; learning healthcare; precision oncology; randomization; veterans.

Figure 1.

Workflow creation and integration with VHA EHR systems. (A) Example of simple BPMN 2.0 workflow: User defined clinical elements proceed through user designed study workflows. The figure depicts a workflow for updating a patient’s status. More specifically, once the “Update Patient Status” task is completed, synchronous web-service communication transmits the updated information to the database. If an error occurs in transmission, this will be registered via the “IT log” pathway. (B) Data flow utilized by the ProjectFlow web-based application: (B1) Clinicians utilize the computerized patient record system (CPRS) user interface to access and enter patient data into VistA. The DCP study utilizes “View Alerts” embedded within CPRS to facilitate trial recruitment, randomization, and prescription ordering. (B2) VistA data are transferred nightly to the VA Corporate Data Warehouse (CDW) where it resides for secondary operational and research use. (B3) Scheduled, nightly, extract transform load processes extract relevant EHR data from CDW into the study database (Study DB) which is utilized by (B4) ProjectFlow as needed for patient recruitment, randomization, prescription tracking and monitoring. Authorized study staff may access the ProjectFlow system and CPRS via their VHA workstation.

Figure 2.

Integration with clinical interfaces, CPRS view alerts. (A) DCP utilizes CPRS “View Alert” screens to obtain provider consent to contact a patient (top panel) and (B) obtain provider consent to randomize consented patients (bottom panel). Providers may “Discontinue” or “Sign” these requests (red arrows). As the view alerts are embedded in CPRS the provider response also becomes part of the patient record. ProjectFlow queries and tracks these provider responses as they appear within the CDW.

Figure 3.

ProjectFlow dashboard showing “Patient” clinical element views for the “Nurse” user/role. (A) Clinical elements appear at the top of the dashboard (red oval). In this example, a “Nurse” has already selected the element “Patient.” (A1) The “All” tab lists tasks (complete, incomplete or on hold) assigned to any user/role. The “Assigned To Me” tab displays only tasks the Nurse role may execute. The Nurse has the ability to “release” the task after which it would appear in the “Patient Tasks” tab which lists all unassigned patient tasks. (A2) The “Filter by Tasks” dropdown shows which tasks require action by the Nurse as well as the number of patients for which that task must be performed. (A3) Data associated with a given patient or task may be queried using the search fields. (A4) In order to complete a task, the Nurse clicks the arrow “>” to open the “Complete Task” view. (B1) The Complete Task view displays relevant patient data. (B2) For this particular task the Nurse must decide whether or not to cancel the patients existing prescription order. (B3) After data entry, the task is completed by hitting the “Next” button. (B4) To view the workflow in its entirety and see which stage of the workflow a patient is currently in; the Nurse may select “View Workflow.” (B5) The “History” panel lists completed workflow steps for the patient as well as which users completed them and when.

Figure 4.

RePOP and DCP tasks managed and tracked by ProjectFlow. (A) RePOP workflows primarily support recruitment and enrollment (consenting) of patients. (B) DCP workflows not only support recruitment and enrollment but also study randomization and monitoring of prescription orders. Detailed descriptions of the workflows are provided in the main text.