The Business Process Model and Notation Used for the Representation of Alzheimer’s Disease Patients Care Process
Round 1
Reviewer 1 Report
This paper aims at providing a representation as a business process model of the care process followed by patients affected by Alzheimer.
While I find the topic tackled very interesting and the paper overall well written and undertandable, this contribution suffers from structural and presentation issues, and must be revised before to consider it for publication.
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First of all, the Introduction section fails in explaining the exact target of the paper. On the contrary, it just provides a list of previous works
that can be moved in a separate "Related Work" section. In a research paper, a good introduction must provide the reader with a brief overview
of the topic tackled and an explanation of your thesis/arguments to support it. To sum up, you have to explain set out your rationale, which is
what your research will be based around. In addition, you should also provide a compact version of the relevant background (it is OK that the
real meat of your argument is located in a separate background paragraph) and state hypothesis and the way that you think your work will turn
out in conclusion.
Therefore, it is required that the introduction will be rewritten explaining what said above.
Concerning the related work, you can also give a glance to the following two contributions that will allow to make your state of the art more complete:
Catarci et al.:
Process-Aware Enactment of Clinical Guidelines through Multimodal Interfaces. Computers 8(3): 67 (2019)
Russo & Mecella:
On the evolution of process-oriented approaches for healthcare workflows. IJBPIM 6(3): 224-246 (2013)
Finally, you need to clarify why your work is different from the previous works. Is your research innovative? Are you contributing to extend
the state of the art of process modeling in healthcare?
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Secondly, in the background section you should add a paragraph that explain what are concretely BPM and business processes. Only after that
paragraph, you can start introducing the main flow objects of the BPMN language (you can highly reducing this part in my opinion, it is
too detailed for now, especially at page 4).
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Third, Section "Results" is (in reality) a section that explains how the care process for Alzheimer disease can be modeled in BPMN. I have many
feedback/comments to improve this section:
(1) Clarify the steps required to collect the information required to build the process. Did you perform interviews? surveys? focus groups?
(2) Please design the BPMN model in a proper way. Since BPMN provides an informal semantics, to avoid misunderstandings in the interpretation
of the model, you should adopt the convention that any activity or event can have at maximum one incoming and one outgoing arc. For example,
in Figure 1, rather than connecting the 4 arrows to the end event, connect them to a XOR join that is connected to the end event (like you do
in Figure 3).
(3) It would be also desirable to use proper naming conventions for labelling activities, events and gateways. For example, you can label activities
using imperative verb + noun, events with noun + past-participle verb and XOR splits with a question. Just as an example, in Figure 2, rather than
labelling the start event as "Initial Examination", you can label it as "Initial Examination Required". Moreover, avoid to provide the same label for
the end event in figure 2, you can call it: "Initial Examination Completed".
(4) Often there is no question for evaluating a XOR split in the models. For example, in figures 3 and 5, both the question for evaluating the four
XOR splits and the possible evaluations that should label the outgoing paths are missing.
(5) In the figure describing the main process (figure 1), the subprocesses containing the activities of phase II and phase III are see as exceptional
behaviours. In fact, in BPMN, when you attach an event at the boundary of an activity (in your case, the timer event), you are explicitly stating that
you want to model an exceptional case. Is this true in your case?
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A Discussion section that explains the potential benefits and limitation of your contribution is missing. After all, it is not clear if you just did a modeling exercise with this paper, or if your contribution wants to advance in some way the state of the art. This explaination is completely missing in the paper, and it is crucial to convince the reviewer.
To sum up, my suggestion is to properly rewrite your contribution according to the above feedback, and resubmit it, because the topic tackled has merits.
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MINOR COMMENTS
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- line 12: disintegration -> decomposition
- line 38: The publication -> The work
- line 49: of four medical and medical applications -> of four medical applications
- line 54: The publication -> The work
- line 56: Article -> The work
- line 76: for example:[43–48] -> for example, the works [43-48]
- line 118: not only the ideal "happy ways" -> not only the desired behaviour of a process
- line 119: "friendly" orientation -> "user friedly" orientation
- line 193: Please explain better what MMSE score is and how it is calculated
- line 197: The process of Alzheimer's disease, figure 1, -> The process of Alzheimer's disease, which is shown in figure 1,
- line 213: The "+" symbol is missing in the compound activity "Medical Examination" in Figure 1
- line 214: This sub-process, in figure 3, -> The sub-process shown in figure 3
- line 232: Activities in this process, figure 5, -> Activities in this process, shown figure 5,
- Figure 4: How many times will be repeated the task "Prozac Treatment", which is a loop one?
You can add a text annotation to provide more details about the expected number of repetitions.
- Figure 4: There is an arrow that starts from another arrow and reaches the end event!? Please fix it!
- line 249: remove "and exciting"
Author Response
RESPONSE LETTER
Dear Editor, Dear Reviewer,
Thank you for your letter and constructive comments concerning our manuscript. We have studied your comments carefully and made major corrections, which we hope to meet with your approval. We highlighted any text changes in the attached document.
If the text will be accepted for publication, it will be sent to the English Edit.
Please kindly help us to see the following contents :
Response to Reviewer 1 Comments
Point 1 :
„it is required that the introduction will be rewritten“
Response:
Thank you very much for your comments and suggestions. The Introduction has been rewritten according to your recomendation and extended according to the modifications of the whole article.
Point 2 :
„Concerning the related work, you can also give a glance to the following two contributions that will allow to make your state of the art more complete…“
Response:
Thank you very much for your comments and suggestions. These publications have been studied, this approach has been incorporated into the changes in the text section.
Point 3 :
„you need to clarify why your work is different from the previous works. Is your research innovative? Are you contributing to extend the state of the art of process modeling in healthcare? „
Response:
Our research group has been working on Alzheimer's models for several years, during which we cooperate with the University Hospital Hradec Králové, nursing facilities, and health insurance companies. The first results of our research were the use of system dynamics for estimating the population of Alzheimer's disease and predicting the development of these patients. These estimates were a crucial indicator in planning the capacity of care centers and proposed state and private funding. Subsequently, our group began to deal with the financing of care and treatment from an overall perspective. There are cost values for some activities and some items in the healing and nursing process, but there is no overall view or simulation environment. Our group, therefore, developed a simulation model using BPMN process models and linked them to Activity Based Costing, in a simulation model. However, this model has shown how little scientific journals are devoted to the description and models of treatment and care for Alzheimer's patients. The low number of publications found led us to the goal of this article: to describe the fundamental procedural aspects of Alzheimer's disease patients caring, using the Business process model and Notation (BPMN), and show the possibilities of using this notation in the description of treatment and care.
Point 3 :
„in the background section you should add a paragraph that explain what are concretely BPM and business processes“
Response
We have added short text on BPM and business processes.
Point 4 :
„Clarify the steps required to collect the information required to build the process. Did you perform interviews? surveys? focus groups?“
Response
The text now contains information about cooperation with the Faculty Hospital in Hradec Králové and the care facility, where we have created the process of treatment and patient care through interviews.
Point 5 :
Please design the BPMN model in a proper way.
Response
Thank you for your comment. The models were primarily built for the simulation plugin and, as you correctly said, are not entirely correct concerning the notation standards. Therefore, the partial graphs have now been redrawn according to the notation standards.
Point 6 :
A Discussion section that explains the potential benefits and limitation of your contribution is missing.
Response
We added section Discussion.
Point 7 :
Minor comments.
Response
All proposed changes have been incorporated into the new version of the text.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The topic is interesting and definitely worth investigating.
The introduction part is well written, it offers the reader the general understanding of the aspects treated in this paper.
One of the most important part of an article is the discussion part and in this paper there is not such a section. I consider that this is an important part that need to be corrected and added to this paper otherwise is just a presentation of the results obtained from the questionnaire. The difference id made on how this data are analyzed and used.
In general the paper has a good base but it need a little more attention and it is necessary to have a part of interpreting the results to bring some added value to the research field.
Good luck in your future research.
Author Response
RESPONSE LETTER
Dear Editor, Dear Reviewer,
Thank you for your letter and constructive comments concerning our manuscript. We have studied your comments carefully and made major corrections, which we hope to meet with your approval. We highlighted any text changes in the attached document.
If the text will be accepted for publication, it will be sent to the English Edit.
Please kindly help us to see the following contents :
Response to Reviewer 2 Comments
Point 1 :
A Discussion section that explains the potential benefits and limitation of your contribution is missing.
Response
We added section Discussion.
Point 2 :
… the paper need a little more attention…
Response
Thank you very much for your comments and suggestions. The Introduction has been rewritten and extended according to the modifications of the whole article. The text now contains information about cooperation with the Faculty Hospital in Hradec Králové and the care facility, where we have created the process of treatment and patient care through interviews. Our research group has been working on Alzheimer's models for several years, during which we cooperate with the University Hospital Hradec Králové, nursing facilities, and health insurance companies. The first results of our research were the use of system dynamics for estimating the population of Alzheimer's disease and predicting the development of these patients. These estimates were a crucial indicator in planning the capacity of care centers and proposed state and private funding. Subsequently, our group began to deal with the financing of care and treatment from an overall perspective. There are cost values for some activities and some items in the healing and nursing process, but there is no overall view or simulation environment. Our group, therefore, developed a simulation model using BPMN process models and linked them to Activity Based Costing, in a simulation model. However, this model has shown how little scientific journals are devoted to the description and models of treatment and care for Alzheimer's patients. The low number of publications found led us to the goal of this article: to describe the fundamental procedural aspects of Alzheimer's disease patients caring, using the Business process model and Notation (BPMN), and show the possibilities of using this notation in the description of treatment and care.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
The revised version of the paper has been improved if compared to the original manuscript. However, in my opinion, still some effort is required to
the authors to improve the contribution to a level that is adequate for a scientific journal.
The Introduction section, even if improved, is still failing in providing a concrete research target of the paper. To provide a BPMN model that represents
the care procedure to be followed by patients affected by Alzheimer can be seen just as a "modeling exercise" if the authors do not explicitly state which
is the advantage of having such a representation. It would be useful for medicians? It would be interesting to implement it through a process-aware
information system? It would enable to discover hidden relationships in the care procedure? In a nutshell, please clearly state the **research** target
of the paper.
It is OK that the authors state that "The model was used for simulation analysis using the activity-based costing method...", but in the paper there
is no trace of the results obtained using this method. Such results can potentially represent the research innovation of the paper. Therefore, if
you have them, please discuss them in the paper. On the contrary, do not promise in the introduction something that it is not really discussed in the paper.
Secondly, please provide the introduction with a table of content making clear the content of any section. Something like: "The rest of the paper is organized
as follows. Section 2 presents the related works ...."
Thirdly, make the related work section as a separate section of the paper (not a subsection of the introduction), better if it is placed before the
conclusion section.
Finally, please che nge the name of the section "Results". More than results, in that section is ti shown the modeling activity of the AD care procedure.
To sum up, the authors followed the right direction to improve the quality of their paper, but I think that a final effor is required to make the
contribution ready to be accepted.
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Minor comments
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lines 45-46 [WRONG] Our group, therefore, developed a simulation model using the Business Process Model and Notation (BPMN) process models
[OK] Our group, therefore, developed a simulation model using the Business Process Model and Notation (BPMN)
lines 47-48: However, this model has shown that few scientific journals are devoted to the description and models of treatment and care
for Alzheimer’s patients. --> This sentence is unclear. Please rewrite it.
Author Response
RESPONSE LETTER
Dear Editor, Dear Reviewer,
Thank you for your letter and constructive comments concerning our manuscript. We have studied your comments carefully and made minor corrections. We highlighted any text changes in the attached document.
Response to Reviewer 1 Comments
Point 1 :
... please clearly state the **research** target of the paper.
Response:
Thank you very much for your comments and suggestions. A paragraph summarizing the research target and specifying the current and future use of the process model is now part of the Introduction section.
Point 2 :
„.. provide the introduction with a table of content…“
Response:
Thank you very much for your comments and suggestions. The paragraph describing the article content by sections is now part of the Introduction section.
Point 3 :
„make the related work section as a separate section of the paper (not a subsection of the introduction), better if it is placed before the conclusion section „
Response:
Thank you very much for your comments and suggestions. The Related work subsection is now a section and is placed before the Conclusion section.
Point 4 :
„please change the name of the section "Results".
Response
Thank you very much for your comments and suggestions. The section is renamed.
Point 5 :
„ Minor comments“
Response
lines 45-46 are corrected.
lines 47-48 are reformulated.
