Automatic Generation of Executable BPMN Models from Medical Guidelines

Automated generation of executable Business Process Model and Notation (BPMN) models from natural-language specifications is increasingly enabled by large language models. However, ambiguous or underspecified text can yield structurally valid models with different simulated behavior. Our goal is not to prove that one generated BPMN model is semantically correct, but to detect when a natural-language specification fails to support a stable executable interpretation under repeated generation and simulation. We present a diagnosis-driven framework that detects behavioral inconsistency from the empirical distribution of key performance indicators (KPIs), localizes divergence to gateway logic using model-based diagnosis, maps that logic back to verbatim narrative segments, and repairs the source text through evidence-based refinement. Experiments on diabetic nephropathy health-guidance policies show that the method reduces variability in regenerated model behavior. The result is a closed-loop approach for validating and repairing executable process specifications in the absence of ground-truth BPMN models.

The creation of Business Process Model and Notation (BPMN) models is a complex and time-consuming task requiring both domain knowledge and proficiency in modeling conventions. Recent advances in large language models (LLMs) have significantly expanded the possibilities for generating BPMN models directly from natural language, building upon earlier text-to-process methods with enhanced capabilities in handling complex descriptions. However, there is a lack of systematic evaluations of LLM-generated process models. Current efforts either use LLM-as-a-judge approaches or do not consider established dimensions of model quality. To this end, we introduce BEF4LLM, a novel LLM evaluation framework comprising four perspectives: syntactic quality, pragmatic quality, semantic quality, and validity. Using BEF4LLM, we conduct a comprehensive analysis of open-source LLMs and benchmark their performance against human modeling experts. Results indicate that LLMs excel in syntactic and pragmatic quality, while humans outperform LLMs in semantic aspects; however, the differences in scores are relatively modest, highlighting LLMs' competitive potential despite challenges in validity and semantic quality. The insights highlight current strengths and limitations of using LLMs for BPMN modeling and guide future model development and fine-tuning. Addressing these areas is essential for advancing the practical deployment of LLMs in business process modeling.

Introduction: NICE guidelines provide evidence-based recommendations for clinical care but remain largely in unstructured natural language. Existing approaches to converting them into computable representations often focus on individual diseases, require substantial manual encoding, and do not scale. Large language models (LLMs) may enable much of this translation to be automated. Methods: We present an end-to-end approach that converts textual clinical guidelines into executable models capable of generating explainable, patient-specific recommendations. A stepwise LLM-based transformation with in-context examples produces human-inspectable intermediate artifacts. We apply the approach to NICE pancreatic and lung cancer guidelines, use expert review to assess rule alignment, and evaluate the executable pancreatic cancer model on 20 patient vignettes. Results: Expert review showed strong alignment between the source guidelines and generated executable models. Most discrepancies were partial omissions rather than incorrect logic, while hallucinated or fundamentally incorrect rules were rare. On the patient vignettes, the executable model achieved an F1 score of 82.5%. Conclusion: LLMs can transform natural-language NICE guidelines into interpretable, executable models that preserve guideline structure, support transparent inspection and modification, and generate patient-specific recommendations. These findings demonstrate the feasibility of scalable automated generation of computable clinical guidelines.