This study analyzes COVID-19 care pathways using the COVID Data for Shared Learning dataset. We build a transparent, reproducible pipeline that transforms heterogeneous clinical tables into a process-mining-ready event log and applies discovery, declarative conformance checking, and outcome analysis. The reconstructed pathways highlight the monitoring backbone of inpatient care, variability at the Emergency department-admission interface, and outcome differences driven by age and exposure to intensive care units. These insights support triage standardization, capacity planning, and step-down coordination from intensive care units to lower-acuity wards, showing how process mining can inform evidence-based hospital governance.
This paper presents a reproducible and process-aware pipeline for predictive monitoring of clinical pathways. The approach integrates data lifting, temporal reconstruction, event log construction, prefix-based representations, and predictive modeling to support continuous reasoning on partially observed patient trajectories, overcoming the limitations of traditional retrospective process mining. The framework is evaluated on COVID-19 clinical pathways using ICU admission as the prediction target, considering 4,479 patient cases and 46,804 prefixes. Predictive models are trained and evaluated using a case-level split, with 896 patients in the test set. Logistic Regression achieves the best performance (AUC 0.906, F1-score 0.835). A detailed prefix-based analysis shows that predictive performance improves progressively as new clinical events become available, with AUC increasing from 0.642 at early stages to 0.942 at later stages of the pathway. The results highlight two key findings: predictive signals emerge progressively along clinical pathways, and process-aware representations enable effective early risk estimation from evolving patient trajectories. Overall, the findings suggest that predictive monitoring in healthcare is best conceived as a continuous, dynamically aware process, in which risk estimates are progressively refined as the patient journey evolves.
Pasquale Ardimento, Mario Luca Bernardi, Marta Cimitile +1
Clinical pathways are disseminated as visual flowcharts where spatial topology, arrow direction, colour coding, and font weight encode critical triage logic that remains inaccessible to computational systems. We present PathWISE, a five-phase pipeline combining four LLM-based agents with a deterministic depth-first search auditor and a Java compiler critic, transforming these non-computable artefacts into validated, executable HL7 Clinical Quality Language (CQL) libraries deployable as FHIR CDS Hooks services. Purpose-built agents extract flowchart structure into a typed directed graph, perform deterministic path enumeration, conduct a structured semantic audit of every node's computability, generate terminology-constrained CQL definitions verified by the official Java CQL-to-ELM compiler, and produce routing logic covering 100% of enumerated patient journeys. Demonstrated across five UK NHS cancer pathways (colorectal, lung, skin, upper GI, and breast), PathWISE audits up to 183 nodes (182 under the Hybrid configuration), identifies 544 structured governance findings across four issue categories, achieves 100% syntactic compilation success, with UNCOMPUTABLE nodes receiving false placeholders that preserve compilability while surfacing governance gaps for clinical review, and produces zero hallucinated terminology codes for dictionary-covered concepts. Critically, PathWISE confines non-deterministic LLM inference to knowledge extraction while deterministic graph mathematics and a standard compiler underpin every verification step.
One hospital runs bloods and imaging at the same time. Another runs them one after the other, in either order, equally often. Knowing which actually happened, and how it is recorded in data, is critical for all operational managers. In process mining, the standard approach is to construct an event log, and attempt to discover concurrent and sequential processes in a data-driven way. We show this standard approach, built on the stochastic language of an event log, reports only the assumptions of its discovery algorithm, because every such log is explained equally well by a model with no concurrency at all. Further, before any data is acquired, we characterise when data can and cannot distinguish concurrent behaviour. Where it cannot, the distinction is recoverable from evidence the stochastic language discards, such as the times at which activities start and end, or object-centric records that fix an order within an execution. The remedy is therefore a choice of what is recorded, rather than a larger sample. This impacts decision making, as planning resource for truly concurrent services is very different from sequential services.