A BPMN-based Framework to Manage ERAS-inspired Pathway for Patients Undergoing Pancreatic Surgery.

It has been proved that patients on the way to pancreatic surgery could benefit from a set of activities to improve their psycho-physical status. The Enhanced Recovery After Surgery (ERAS) program is a proven set of evidence-based activities to support the perioperative pathway of patients. On the other hand, the Business Process Model and Notation (BPMN) is able to describe complex process semantics in an intuitive notation that constitutes a common language between different stakeholders. Finally, web-based applications could help clinicians to monitor, support, and manage patients in the perioperative stage, enabling communications with surgeons, psychologists, nutritionists, and physiatrists.In this paper, we propose a framework to model an ERAS-inspired prehabilitation program as BPMN processes, which includes activities in four macro areas: surgery, nutrition, physical activity, and psychology. We also propose Fit to Fight, a process-driven web application (built from scratch) that executes and manages the processes in conjunction with a BPMN process engine. Activities are scheduled during a 30 days time-frame, and the underlying processes implement a fine set of temporal constraints to ensure it. The prehabilitation program considered is the one currently adopted by the Unit of Pancreatic Surgery at the Verona University Hospital, which is part of the Verona Pancreas Institute, the first interdisciplinary center of excellence for diagnosing and treating pancreatic diseases in Italy. Thanks to this close collaboration, we adopted the agile methodology where the prehabilitation program modeling and the web application development were made with the clinicians’ continuous involvement. Finally, we developed an elaborated yet user-friendly and responsive interface to present the activities to patients.