Sumit Chakraborty
email: schakraborty2010@hotmail.com

PATIENTCAREFLOW SECURITY INTELLIGENCE VERIFICATION ALGORITHM : COMPLEXITY ANALYSIS

Keywords: patientcareflow, security intelligence verification, algorithm, complexity analysis, workflow automation. 1

This work outlines Patientcareflow Security Intelligence Verification Algorithm (PCF_SIVA) and explores various aspects of patientcareflow such as verification of control flow, resource flow, data flow and verification of security intelligence through deep analytics. It is also essential to verify the system performance of patientcareflow by specifying and analyzing workflow processes, their time management support, process simulations, process bottlenecks, ordering, resources structural and explicit time constraints, execution durations, assignment of deadlines to activities, triggering of process specific exception handling activities when deadlines are missed during process execution. The complexity of patientcareflow mechanism has been analyzed in terms of scope (goal, constraints, collective intelligence), system (machine intelligence, mechanism, technology), structure (control flow, input, output, feedback), security, strategy (data flow, collaborative intelligence, exception, uncertainty), staff-resources (resource flow) and skill-style-support. There are various common types of control flow patterns in the verification of contemporary workflow systems and business process modelling and to identify generic constructs, recurring constructs. modelling formalisms and implementation of healthcare service chain such as sequential construct, parallel construct, structured loop, AND split, AND join, OR split, OR join and cancel patterns. From a data perspective, a series of characteristics may occur repeatedly in different workflow modelling paradigms such as data visibility, data interaction, data transfer and data based routine. It is also crucial to verify the resourceflow of healthcare service chain in terms of resource allocation, resource distribution, resource sharing and transfer based on role, schedule and hierarchy. It is possible to verify security intelligence of patientcareflow at various levels such as access control, workflow design intelligence, system performance, malicious attacks and corruption.

PATIENT CARE FLOW SECURITY INTELLIGENCE VERIFICATION ALGORITHM (PCF_SIVA)

Agents : patients, healthcare team (doctors, surgeons, administration staff, testing staff); Entity: Healthcare service chain, life-science supply chain; Input: data (patients, medicine, tests) Scope: verify collective intelligence (goals: single or multiple objectives, constraints). System : verify collaborative intelligence (real-time monitoring, coordination, integration, exception handling). Structure: verify control flow (sequential, parallel, loop, cancel, task / activity : input, output, mechanism, feedback). Security: verify security intelligence.

patient care flow design intelligence (correctness, fairness, rationality, transparency, accountability, trust, commitment) access control (authentication, authorization, correct identification, privacy, audit, confidentiality, data integrity, nonrepudiation) system performance (reliability, consistency, resiliency, liveness, safety, deadlock freeness, synchronization, time delay, QoS) malicious attacks (DoS, traffic congestion, fault, false data injection, shilling, webflow: hacking, session hijack) corruption (agents, time schedule, malicious business model innovation, healthcare economics) Strategy : verify dataflow (correctness, reliability, consistency, data visibility. data interaction, data transfer, data based routing, data corruption).

Exception management (uncertainty, contingency planning, alternative workflow, collaborative planning, forecasting and replenishment) Staff-resources : verify resources flow and process intelligence (registration, appointment scheduling, consulting, testing, surgical operation, billing) in patientcareflow. Skill-style-support : verify HR intelligence (behavioral disorder : Sybil attack, attitude, rationality, motivation, trust, commitment, ragging, skill: medical, technical, management). Output : Treatment plan, performance scorecard.

COMPLEXITY ANALYSIS

SCOPE : COLLECTIVE INTELLIGENCE

A workflow is a combination of interacting activity elements organized to realize properties, behaviors and capabilities that achieve one or more stated purposes or goals or objectives. The workflow structure is the organization of the activity components, their relations to each other and to the environment and the principles guiding its design and evolution. The organization should follow some principles to justify the structure. It is crucial to innovate a set of intelligent graphical techniques and data visualization tools for modeling anf highlighting patientcareflow such as block diagram, process flow diagram, swimlane diagram, and network diagram. Patientcareflow constitutes a complex combination of resources. It is contained within some form of hierarchy. It may be broken down into subflows and related components, the extent of which depends on complexity and the function(s) being performed. A workflow must have a purpose. It must be functional, able to respond to some identified need and able to achieve its overall objective in a cost effective manner. A workflow must respond to an identified functional need. The patientcareflow is associated with a dynamic closed loop system. It is really challenging to innovate intelligent structure of a complex patientcareflow associated with healthcare service chain. The scope of patientcareflow can be explored in terms of registration, appointment scheduling, consulting, testing, medical diagnosis, prescription, surgical operation, post operation monitoring and follow-up, discharge and feedback. What is WFMS? Workflow management system (WFMS) improves business processes of healthcare service chain by automating tasks, getting the right information to the right place for a specific job function, and integrating information in the enterprise. WFMS and time management are closely related. At build-time, when workflow schemas are defined and developed, workflow modelers need means to represent time related aspects of business processes such as activity durations and time constraints between activities and check their feasibility. At run-time, when workflow processes are instantiated and their executions are started, process managers should be able to adjust time plans by extending deadlines according to time constraints and any unexpected delays. During process execution, pro-active mechanisms are needed for notifying process managers about potential time constraint violations so that they can take the necessary steps to avoid time failures. If a time constraint is violated, the WFMS system should be able to trigger exception handling to regain a consistent state of the workflow instance. Workflow participants need information about urgencies of the tasks assigned to them to manage their personal work lists in accordance with the overall goals. Business process re-engineers need information about the actual time consumption of workflow executions to improve business processes. Controllers and quality managers need information about activity start time and execution duration

SYSTEM : COLLABORATIVE INTELLIGENCE

A decision support system (DSS) is an interactive, flexible and adaptable computer based information system specially developed for supporting the solution of a non-structured, semi-structured or structured problem for improved decision making. It uses data, provides easy user interface and can provide decision maker's own insights. In addition, a DSS may use interactive models and may include a knowledge component. The business analysts have done process flow analysis and requirements engineering of the healthcare information systems and have recommended a set of essential deliverables of HIS to the CIO. The output of the basic modules of HIS include registration card, appointment slip and medical prescription for consulting, surgery schedule, quality control certificate, test report, discharge certificate, bill and payment, online feedback form and patient's help guide. The analysts have outlined the inputs to each module, outputs of HIS, process flow logic, protocol and complexities of each deliverable or output. This exercise gives the basic overview of data and computing schema essential for digital transformation. Sequential process flows are suitable for normal cases, parallel process flows are suitable for emergency cases. But, the system should check and complete each task correctly. Let us explore various patientcareflows of healthcare service chain. Let us analyze various issues of security and safety in patient care from the perspective of e-prescription. A secure adaptive filter is effective in adversarial environment. No doubt, e-prescription improves the quality of data structure and data visualization as compared to hand-written prescription. E-prescription indicates patient ID, doctor's ID, contact and digital signature transparently. Both agents may share e-mail ID. But, there are several critical issues regarding flaws in data structure, data consistency, data reliability and system verification. E-prescription is expected to mention the problem, symptoms and medical history of the patient in a structured way. E-prescription is expected to list the name of medicines, dosage, frequency and duration of taking the medicine in terms of a structured table format. It should also mention the list of medical testing transparently. But, there are issues of correctness of data and rationality of decision making. The doctor and / or his assistant may make silly mistakes in selection of medicine, dosage, duration and advice for costly, risky, unnecessary medical testing due to various reasons such as time pressure, casual approach and business intelligence. The patient may not know how to inform his medical problems and medical history correctly. He may not be asked by the doctor and his assistant all the details due to time pressure. Is it possible for a patient to verify and validate the authenticity and correctness of e-prescription data intelligently? The patient may have allergy in a specific element (e.g. Sulphur); he may inform this critical information to the doctor. Still, he is prescribed Sulpher drug. He may contact the customer connect section of life-science or pharmaceutical company for the clarification of his doubt regarding various issues such as composition of medicine and limit of dosage. The patient may not get proper response from the customer connect section in time. Over dosage of a medicine may cause serious side effects. Another option of system verification is web search: the patient may get hints on dosage, side effects and composition of the medicines from various websites. But, if this information does not match with e-prescription data, the patient may be confused in taking proper decision. The final option is self learning; the patient is forced to take decision adaptively based on the experience of side effects. He may assess the risk of a medical test through information search. Is it really possible for an uneducated patient to understand all the critical aspects of complex reasoning process : he may not have knowledge in foreign languages or local language; he may not have skill in web search. The disputes and conflicts of interest may arise in different ways. Can e-prescripton tackle all these issues of security and safety in patient care in terms of correctness, fairness, rationality, trust, commitment, authentication and authorization? The design of intelligent data structure and data schema is expected to eliminate e-prescription errors and ensure correctness in patientcareflow. Another solution is to develop common sense healthcare through education, broadcast communication and Internet. The quality, performance and product life cycle management of biomedical devices and sensors is an important issue in today's healthcare service. The healthcare service provider and consumer should be cautious of these issues while sourcing medical devices through local or global vendors. Quality control is an important function to resist the flow of fake products in grey market of biomedical devices. The patients may face the risk of buying old models of biomedical devices at high price. They may be deprived of features and benefits of new models. It is basically a problem of product life-cyle management. Many devices are imported from foreign countries a long time back; the selling agents may try to clear old stock at high price. The quality control and invoice processing systems should verify the make, date of manufacturing and warranty period carefully.

Registration Card

Appointment Slip for Consulting

Prescription by Consultant

Surgery Schedule

Medical Test Report

Discharge Certificate

Bill and Payment Receipt

Online Feedback Form

Patient's Help Guide

STRUCTURE

There are various common types of control flow patterns in the verification of contemporary workflow systems and business process modelling and to identify generic constructs, recurring constructs. modelling formalisms and implementation of healthcare service chain such as sequential construct, parallel construct, structured loop, AND split, AND join, OR split, OR join and cancel patterns. It is interesting to explore the the application of other several complex patterns in patientcareflow such as synchronizing merge, structured synchronizing merge, multi-choice split and join, acyclic synchronizing merge, general synchronizing merge, discriminator, blocking discriminator, cancelling discriminator, partial or m-out-of-n join, structured partial join, blocking partial join, cancelling partial join, arbitrary cycles. recursion, multiple instance, static partial join for multiple instances, cancelling partial join for multiple instances, dynamic partial join for multiple instances, deferred choice, transient trigger, persistent trigger, interleaved parallel routing, critical section, interleaved routing, cancel region for arbitrary groups of activities in a process to be cancelled during execution. cancel multiple instance activity, complete multiple instance activity, generalised AND join pattern, thread merge and thread split explicit termination.

SECURITY

Let us analyze the fourth element of deep analytics -security. What do you mean by technology-security? A system may face various types of threats from both external and internal environments but it should be vigilant and protected through a set of security policies. An emerging technology demands the support of an adaptive security architecture so that the associated system can continuously assess and mitigate risks intelligently. Adaptive security is a critical feature of a technology that monitors the network or grid associated with a system in real time to detect any anomalies, vulnerabilities or malicious traffic congestion and. If a threat is detected, the technology should be able to mitigate the risks through a set of preventive, detective, retrospective and predictive capabilities and measures. Adaptive security analyzes the behaviors and events of a system to protect against and adapt to specific threats before the occurrence of known or unknown types of malicious attacks. Let us explain the objectives of adaptive security architecture in depth. New threats are getting originated as an outcome of technology innovation and may cause new forms of disruptions with severe impact. Today, it is essential to deploy adaptive security architecture for the emerging technologies. The systems demand continuous monitoring and remediation; traditional 'prevent and detect' and incident response mindsets may be not sufficient to prevent a set of malicious attacks. It is required to assess as-is system administration strategies, investment and competencies; identify the gaps and deficiencies and adopt a continuous, contextual and coordinated approach. In the context of WFMS, verification is the act of proving or disproving the correctness of algorithms underlying a system with respect to certain formal specification or property using formal methods. Formal verification proves the correctness of the patientcareflow through systematically exhaustive exploration of the model. Verification is one aspect of testing the fitness WFMS for purpose. Validation is the complementary aspect; are we trying to make the right thing? is the workflow specified to the actual needs the patient and healthcare team? Verification: have we made what we were trying to make? does the WFMS confIrm to the specifications? The verification process checks static/structural (e.g. source code) and dynamic/behavioral aspects (specific test cases). For WFMS, one can inspect the source code (static) and run against specific test cases (dynamic). Validation usually can be done only dynamically,

Theorem 1 : At level L1, it is crucial to verify the efficiency of access control mechanism for patientcareflow management system in terms of authentication, authorization, correct identification, privacy, audit, confidentiality, non-repudiation and data integrity.

Let us consider the security of WFMS in terms of access control. At level L1, it is required to verify the efficiency of access control mechanism in terms of authentication, authorization, correct identification, privacy, audit, confidentiality, non-repudiation and data integrity. For any secure service, the system should ask the identity and authentication of one or more agents involved in a transaction. The agents of the same trust zone may skip authentication but it is essential for all sensitive communication across different trust boundaries. After the identification and authentication, WFMS should address the issue of authorization. The system should be configured in such a way that an unauthorized agent cannot perform any task out of scope. The system should ask the credentials of the requester; validate the credentials and authorize the agents to perform a specific task as per agreed protocol. Each agent should be assigned an explicit set of access rights according to role. Privacy is another important issue; an agent can view only the information according to authorized access rights. A protocol preserves privacy if no agent learns anything more than its output; the only information that should be disclosed about other agent's inputs is what can be derived from the output itself. The agents must commit the confidentiality of data exchange associated with private communication. Cryptography ensures privacy and secrecy of information through encryption methods. Data integrity ensures that data is protected from unauthorized modifications or false data injection attack. The system should provide public verifiability so that anyone can verify the integrity of the data. Redundancy of data is a critical issue which is resulted through replication across the writers. Data integrity is the overall completeness, accuracy, consistency and (validity) of data over its lifecycle. Compromised data is of a real threat to enterprise security as it indicates that data is intact and unchanged; it guarantees and secures the searchability and traceability of data to its original source, data performance stability and data protection. Data should have a set of qualities to maintain data integrity : attributable, legible, contemporaneous, original and accurate. It is possible to ensure data integrity through risk based validation, system audit and quality control. Physical integrity is the protection of data's wholeness and accuracy as it is stored and retrieved. The threats of data integrity are human error and storage erosion. Data integrity is essential for healthcare service chain and life-science supply chain. : data should be complete, accurate, consistent and up-to-date making decisions about patient care. Physical integrity deals with challenges such as correctly storage and fetching the data itself against the threats of system faults, design flaws, material fatigue, corrosion, power outages and natural disasters and other environmental hazards such as fire. Logical integrity is concerned with the correctness or rationality of data given a particular context. This includes referential integrity (foreign key), entity integrity (primary key), domain integrity and user defined integrity in a relational database. Data makes sense given its environment against the threats of software bugs, design flaws and human errors. Logical integrity is ensured through check constraints, foreign key constraints, program assertions, run-time sanity checks and data retention policy. Non-repudiation refers to a situation where a statement's author cannot successfully dispute its authorship or the validity of an associated contract. It is applicable in a legal setting when the authenticity of a signature is being challenged. It involves associating actions or changes with a unique individual. In digital security, non-repudiation means a service that provides proof of the integrity and origin of data and also authenticity with high confidence. Confidentiality involves a set of rules or a promise usually executed through agreements that limits access or places restrictions on certain types of information. It ensures privacy and respecting someone's wishes; a group of agents shouldn't share critical and strategic data about someone with others unless it is absolutely necessary.

Therem 2 ; At level L2, it is essential to verify the design intelligence of the patientcareflow in terms of fairness, robustness, correctness, transparency, accountability, trust and commitment.

At level L2, it is required to verify the design intelligence of the patientcareflow in terms of fairness, robustness, correctness, transparency, accountability, trust and commitment. A protocol ensures correctness if the sending agent broadcasts correct data and each recipient receives the same correct data in time without any change and modification done by any malicious agent. Fairness is associated with the commitment, honesty and rational reasoning on payment function, trust and quality of service. Fairness ensures that something will or will not occur infinitely often under certain conditions. The recipients expect fairness in private communication according to their demand plan, objectives and constraints. The sending agent expects fairness from the recipients in terms of true feedback and commitment on confidentiality of data. As per traditional definition of fairness, either all parties learn the output or none. The system must ensure the accountability and responsibility of the agents in access control, data integrity and non-repudiation. In fact, accountability is also associated with collective intelligence. Transparency is associated with communication protocols, revelation principle and automated system verification procedures. For example, a mechanism should clearly state its goal to define a policy. There exist an inherent tension between transparency and privacy. A fully transparent system allows anyone to view any data without any provision of privacy. On the other side, a fully private system provides no transparency. Privacy can be achieved using cryptographic techniques at increased cost of computation and communication. Is it possible to trade-off privacy vs. transparency? Is it possible to provide public verifiability of its overall state without disclosing information about the state of each entity? Public Verifiability allows anyone to verify the correctness of the state of the system. Correctness of patientcareflow is asserted when it is said that the algorithm is correct with respect to a specification. Functional correctness refers to the input-output behavior of the algorithm; for each input it produces the expected output. There is a difference between total and partial correctness. The correctness of an algorithm depends on convergence, stopping criteria and termination. Fairness measures metrics to quantify the fair distribution of resources. It is applicable to social justice, environmental justice and HR policy and distributive justice for allocation, distribution and sharing of resources, Fairness ensures absence of bias, hype and controversies in system design and operating mechanism of the patientcareflow. Fair division, fair price, fair share of system resources and fair measure are commonly adopted in WFMS. The next parameter is transparency of patientcareflow. An action is transparent if it takes place without any visible effect. Transparency is usually considered to be a good characteristic of a system because it shields the user from the system's complexity. There are various forms of transparency in technology innovation, adoption and diffusion: full, partial and transparency within a networked organization. It is the quality or state of being transparent. The policy of information disclosure or revelation and privacy of WFMS should be transparent to the stakeholders. The scope of the patientcareflow should be transparent to the designers. In ethics and governance, accountability is answerability, blameworthiness, liability and applicable to the domains of public and private corporate sector and individual contexts. In leadership roles, accountability is the acknowledgment and assumption of responsibility for actions, products, decisions and policies including the administration, governance and implementation within the scope of the role or employment position and encompassing the obligation to report, explain and be answerable for resulting consequences. In governance, accountability has expanded beyond being called to account for one's actions. Accountability cannot exist without proper accounting practices and good records management. The success of patientcareflow depends on the principles of accountability, transparency, participation, evaluation and feedback. Accountability eliminates the time and effort spent on distracting activities and other unproductive behavior. Rationality is the quality or state of being rational based on or agreeable to reason. Rationality implies the conformity of one's beliefs with one's reasons to believe and of one's actions with one's reasons for action. Bounded rationality is the idea that, when individuals make decisions rationality is limited by: the tractability of the decision problem; the cognitive limitations of the mind; and, the time available to make the decision. Ttrust is a three party relationship in which the first party, the trustor or settlor, transfers or settles a property upon the second party (the trustee) for the benefit of the third party (the beneficiary. The basic elements of trust are consistency, compassion, communication and competency. Each of these factors is necessary in a trusting relationship but insufficient in isolation; these factors together develop trust. A commitment scheme allows an agent to commit to a chosen value (or chosen statement) while keeping it hidden to others, with the ability to reveal the committed value later. Commitment schemes are designed so that a party cannot change the value or statement after they have committed to it: that is, commitment schemes are binding.

Theorem 3 : At level L3 it is essential to verify the system performance associated with patientcareflow in terms of time management efficiency, reliability, consistency, resiliency, liveness, deadlock freeness, reachability, synchronization and safety.

It is required to verify the system performance at level L3 in terms of stability, robustness, reliability, consistency, resiliency, liveness, deadlock freeness, reachability, synchronization and safety. The performance of a system and quality of service is expected to be consistent and reliable. Reachability ensures that some particular state or situation can be reached. Safety indicates that under certain conditions, an event never occurs. Safety is a critical requirement of any system whether it may be mechanical, electrical, electronics, information technology, civil, chemical, metallurgical or instrumentation engineering. Liveness ensures that under certain conditions an event will ultimately occur. Deadlock freeness indicates that a system can never be in a state in which no progress is possible; this indicates the correctness of a real-time dynamic system. Another important issue is robustness of a system. The delivery of the output should be guaranteed and the adversary should not be able to threaten a denial of service attack against a protocol. Application consistency is the state in which all related files and data are synchronized representing the true status of the application. Stability is an important issue of patientcareflow control. A system is stable, if its output is under control; otherwise it is unstable. A stable system produces a bounded output for a given bounded input. what happens with the system after a long period of time.? What is the equilibrium points? Stability means that the trajectories do not change too much under small perturbations. There are other issues such as steady state stability, dynamic stability and stability limit. Resiliency is an important property of patientcarefow; it indicates how fast a system returns to normal operating conditions following a disruption or faults. Organizational resilience considers the ability of an organization to adapt and survive in the face of threats, including the prevention or mitigation of unsafe, hazardous or compromising conditions that threaten its very existence. It may beconsidered as quality of service. Computing considers dependability and performance in the face of unanticipated changes . Cyber security assesses the abilities of the hacker to undermine desired control system behavior also create a significant challenge to control system resilience. Base Metrics for resilient control systems include physical disturbances (time latency affecting stability, data integrity affecting stability), cyber disturbances (time latency, data confidentiality, integrity and availability), cognitive disturbances (time latency in response) and data digression from desired response. Generally liveness property indicates that something good will eventually occur contrasting safety property meaning something bad does not occur. If a safety property is violated there is always a finite execution that shows the violation, but a liveness property cannot be violated in a finite execution of a distributed system as the good event might still occur at some later time. Eventual consistency, linear time properties, freedom from deadlock and freedom from starvation address liveness property. Reachability is a fundamental problem in workflow management system. Given a system with a set of allowed rules, it decides whether a certain state of a system is reachable from a given initial state of the system. Synchronization is the coordination of events to operate a system in unison such as hardware and software synchronization. In case of process synchronization multiple processes are to join up or handshake at a certain point, in order to reach an agreement or commit to a certain sequence of action. Data synchronization keeps multiple copies of a dataset in coherence with one another to maintain data integrity. Process synchronization primitives are commonly used to implement data synchronization. Synchronization deals with mutual exclusion, deadlock, starvation, priority inversion and busy waiting, which occurs when a process frequently polls to determine if it has access to a critical section.

How is it possible to verify efficiency in managing time of patintcareflow system? It is essential to audit various parameters of patientcareflow model in terms of time constraints satisfiability, handling missed deadlines, schedule based execution, time monitoring, deadline checking, and handling of time errors at run-time. Pro-active time calculation is essential to detect time constraint violations and raise alerts in case of potential future time violations. It is essential to verify the patientcareflow model in terms of activities (nodes in workflow graph), agents, dependencies ( edges in

Deadlock is a state in operating system and concurrent engineering in which each member of a group waits for another member including itself to take action such as sending a message or releasing a lock. If a process is unable to change its state indefinitely as the resources requested by it are being used by another waiting process, then the system is in a deadlock. A deadlock situation on a resource can arise if and only if all of the conditions hold simultaneously in a system. In case of mutual exclusion, at least one resource must be held in a non-shareable mode. Otherwise, the processes would not be prevented from using the resource when necessary. Only one process can use the resource at any given instant of time. Another condition is hold and wait ; a process is currently holding at least one resource and requesting additional resources which are being held by other processes. In case of no preemption: a resource can be released only voluntarily by the process holding it. Circular wait is a specific condition where: each process must be waiting for a resource which is being held by another process, which in turn is waiting for the first process to release the resource. There is a set of waiting processes, P = {P1, P2, …, PN}, such that P1 is waiting for a resource held by P2, P2 is waiting for a resource held by P3 and so on until PN is waiting for a resource held by P1.

Deadlock handling is a complex issue. When a deadlock occurs, different systems respond to them in different non-standard manners. Ignoring deadlock assumes that a deadlock will never occur. It is applicable when the time intervals between occurrences of deadlocks are large and the data loss incurred each time is tolerable. Ignoring deadlocks can be safely done if deadlocks are formally proven to never occur. Deadlocks are allowed to occur; then the state of the system is examined to detect that a deadlock has occurred and subsequently it is corrected. An algorithm is employed to track resource allocation and process states, it rolls back and restarts one or more of the processes in order to remove the detected deadlock. After a deadlock is detected, it can be corrected by using process termination and resource preemptin; resources allocated to various processes may be successively preempted and allocated to other processes until the deadlock is broken. Controllability is an important property of a control system such as stabilization of unstable systems by feedback, or optimal control. Controllability and observability are dual aspects of the same problem. There are various types such as state, output and behavioral controllability of a system. Safety is the state of being safe, the condition of being protected from harm or other non-desirable outcomes against various types of hazards such as infection; it is the control of recognized hazards in order to achieve an acceptable level of risk. Workplace health and safety procedures are important for the well-being of both employees i.e. healthcare team and employers since human loss is immeasurable and intolerable. Safety is a state of being protected from potential harm or something that has been designed to protect and prevent harm. General Safety is a multi-disciplinary approach to developing and ensuring compliance with regulatory agencies, safe working practices, and maintaining the health and well-being of those employed in a particular occupation or workplace. There is close association between robustness, agility, adaptive capacity, adaptive insufficiency and resiliency. Agility is the derivative of the disturbance curve; the ability of the system to resist degradation on the downward slope, but also to recover on the upward. Adaptive capacity is the ability of the system to adapt or transform from impact and maintain minimum normalcy. Adaptive insufficiency is the inability of the system to adapt or transform from impact, indicating an unacceptable performance loss due to the disturbance. Brittleness indicates the area under the disturbance curve as intersected by the resilience threshold. This indicates the impact from the loss of operational normalcy. Robustness is a positive or negative number associated with the area between the disturbance curve and the resilience threshold indicating either the capacity or insufficiency respectively. Next, it is essential to develop effective ways to move towards adaptive security architecture. The patientcareflow mechanism should surfaces anomalies and adjusts individualized security controls proactively in near real-time to protect the critical data of a system. Adaptive Security with dynamic data protection is expected to offer several benefits over traditional security platforms depending on the size of the system and complexity of networking schema : real time monitoring of events, users and network traffic; autonomous and dynamic resolutions; prioritization and filtering of security breaches; reduction of attack surface and impact or damage of a threat and reduction of resolution time. The emerging technology is expected to adapt to the needs of a system irrespective of the size of network, nature of operation or exposure of threats. It can assess the requirements of security with greater accuracy through a set of intelligent policies and procedures and can ensure better understanding of strength, weakness, opportunities and threats of the patientcareflow. A resource is an entity that is capable of doing work. A resource is usually assigned a set of of work items, each of which is an integral unit of work that the resource should undertake. A resource is classified as either human or non-human (e.g. machine, tool, equipment). A human resource is typically a member of an organisation. An organisation is a formal grouping of resources that undertake work items as per goals and usually hase a specific position in the organization. A resources may have a number of associated privileges. The resources may be the members of one or more organisational units; they may be the members of one or more organisational teams. Organisational groups are used to define groupings of resources with some common characteristic. Each resource is generally associated with a specific branch which defines a grouping of resources within the organisation at a specific physical location. Resources may also have a level which indicates their position within the organisational hierarchy. They may also belong to a division which defines a large scale grouping of resources within an organisation either along regional geographic or business purpose lines. In terms of the organisational hierarchy, each resource may have a number of specific relationships with other resources in terms of direct report or top bottom approach. A resource may also have a delegate for reassignment of work on a temporary or permanent basis. A resource may have one or more associated roles. Roles serve as a grouping mechanism for human resources with similar job roles or responsibility levels. Individual resources are allocated based on their capabilities or attributes such as qualifications, experiences and skills. Non-human resources may be durable or consumable in nature. The capacity of a durable resource is unaffected by the amount of work a consumable resource is one that is consumed either partially or wholly in the act of completing a work item. A consumable resource has usually a rate of consumption or capacity indicating how much work they can actually undertake before being depleted and requiring further replenishment. Each resource may have a schedule and history. A schedule is a list of work items that a resource is committed to undertake at a specified future time where as a history or work log is a list of work items that a resource has completed successfully or otherwise at some time in the past.

Theorem 4 : At level L4, it is crucial to assess the risks of various types of malicious attacks by adversaries on patientcareflow such as

STRATEGY

STAFF-RESOURCES

SKILL-STYLE-SUPPORT

Today, the critical need of healthcare service providers striving to become more competitive is the ability to control the flow of information and work throughout the organization in a timely manner. Consequently, time related restrictions (e.g. bounded execution duration, absolute deadline) are associated with process activities. Arbitrary time constraints and unexpected delays may lead to time violations. Typically, time violations increases the cost of business processes as they require some type of exception handling. Therefore, the comprehensive treatment of time and time constraints is crucial in designing and managing business processes. The process managers need tools to help them anticipate time problems, pro-actively avoid time constraints violations, and make decisions about the relative process priorities and timing constraints when significant or unexpected delays occur. Workflow management systems (WFMSs) improve business processes by automating tasks, getting the right information to the right place for a specific job function and integrating information in the enterprise. Although currently available commercial workflow products offer sophisticated modeling tools for specifying and analyzing workflow processes, their time management functionality is rudimentary. Existing time management functionality supports process simulations to identify potential bottlenecks, analyze activity execution durations, assignment of deadlines to activities, and triggering of escalations of process specific exception handling activities when deadlines are not met. However, the consistency of these deadlines and the side effects of missing deadlines are neglected. WFMS is expected to provide the necessary information about a process, its time restrictions and its actual time requirements to process modelers and managers At build-time, when workflow schemas are defined and developed, workflow modelers need means to represent time related aspects of business processes such as activity durations, time constraints between activities and check their feasibility.

CONCLUSION

The effectiveness of time management depends on the workflow kind, how detailed its description is and whether there are external causes for time relevant events. For highly structured workflows, time requirements can be calculated with a high degree of accuracy. For administrative workflows, which span different organizations, depend on external events or may change their schema during execution; For dynamic and ad-hoc workflows, time calculations are imprecise. Time planning, management and controlling has to be done to perform the performance of patientcareflow. Typically, time planning relies on estimates based on experience. Time management during the execution of a process becomes even more important in such environments, where time monitoring is essential for adjusting plans to avoid deadline violations. Therefore, any knowledge about time issues should be modeled and used during patientcareflow execution. Even though currently available workflow management systems offer sophisticated modeling tools for specifying and analyzing workflow processes, their time management support is still rudimentary. The patientcareflow mechanism is expected to addresses process simulations to identify process bottlenecks, analyze execution durations, assignment of deadlines to activities and triggering of process specific exception-handling activities or escalations when deadlines are missed during process execution. It is important to address the crucial role of time management in patientcareflow : how time constraints can be modeled during process definition, validated during modeling and instantiation times and finally, monitored and managed during execution time. Is workflow automation the solution for the future to streamline patientcareflow in healthcare service chain and life-science supply chain?

  receipt to T; T gives test reports to C. Output : Test report [ Report id, report date, request no., location, Referred by, package, specimen, date and time of collection, result date, Test : type, test parameters, results, unit, biological reference interval, method of testing, remarks / opinion / conclusion from test results, verified by, authorized by]

  Agents : Discharge associate (D), Healthcare service consumer (C); Input : Registration card; Patient's flow chart; Patientcareflow : C produces registration card to D. D generates discharge certificate and gives to C. Output : Discharge certificate [ Registration no., name of patient, age, gender, location, user, date and time; discharge summary : medical problem, reason for admission, date of surgery, operative procedure; details of hospital stay : event during hospitalization, medication administered during hospitalization, investigation, condition at discharge, date of discharge; Advice on discharge : serial no., medicine, form, dose, frequency, duration, quantity, from, to, remarks; special instruction, next appointment : consultant, location, time]

  registration card, patient's flow chart and discharge certificate to B. 2. B generates medical bill or invoice. 3. C checks the correctness of computation and pays through cash or credit card or demand draft. 4. B generates receipt and gives to C. Output : Discharge bill [ Patient details : registration no., name of patient, age, gender; Billing: bill no., service tax registration no., admission date, discharge date, location, user, date and time, serial no., service description, tariff, total bill amount, advance paid, patient's due or refund; digital signature or stamp; consolidated bill break up details : anesthesia charges, bed / stay / ambulatory service charges, drug, non-medical items, OT store items, others, surgery charges, theatre charges]

  system accepts data and generates feedback number. Output : Feedback acceptance confirmation with feedback number Critical success factors: open feedback; rational, logical and analytical thinking; understanding of the patient on performance metrics and questions.

  registration card to H. H provides patient help guide, general instruction chart and medical problem information sheet to C. Output : Patient help guide [Location of facilities, contact phone number, email, rules, service offerings, list of consultants, tariff or service charges, patient's rights and responsibilities]; Patient information guide [ Medical problem, biological information, causes of problems, symptoms, treatment procedure, general patient queries, post treatment problems]

  How is it possible to verify the security intelligence of patientcareflow? It is rational to call threat analytics  verify what is corrupted or compromised (agents, computing schema, communication schema, data schema, application schema)? detect type of threat; exercise time series analysis: what occurred? what is occuring? what will occur? assess probability of occurrence and impact; gain insights : how and why did it occur? do causeeffect analysis on performance, sensitivity, trends, exception and alerts; recommend : what is the next best action? predict : what is the best or worst that can happen? It is essential to verify security intelligence of patientcareflow collectively through rational threat analytics at five levels : L1, L2, L3, L4 and L5. It is essential to assess risks associated with the workflow and mitigate the risks by adopting a set of countermeasures. The basic building blocks of the security element are an adversary model and an intelligent threat analytics. An adversary is a malicious agent who attacks a system or a protocol; the basic objectives are to cause disruption and malfunctioning of the patientcareflow. The security element should be analyzed in terms of the assumptions, goals and capabilities of the adversary. It is also crucial to analyze the adversary model in terms of environment, location, network, resources, access privileges, equipments, devices, actions, results, risks, reasons and motivations of attacks and probable targets (i.e. why the adversary attacks and to obtain what data).

  WF graph), execution of patientcareflow (e.g. sequential execution, repeated execution, parallel execution [ unconditional, conditional, alternative], time information (earliest possible execution time, latest possible execution time, best case, worst case, optional activities not executed and fastest alternative always selected, all optional activities executed and any alternative selected), time points, minimum, maximum and average duration, deadlines (maximum allowable execution time for activities and processes, structural and explicit time constraints, upper and lower bound constraints and fixed date object. Reliability is the overall consistency of a measure. A measure is a high reliabe if it produces similar results under consistent conditions. It is the characteristic of a set of test scores that relates to the amount of random error from the measurement process that might be embedded in the scores. Scores that are highly reliable are precise, reproducible and consistent from one testing occasion to another. If the testing process is repeated with a group of test takers, essentially the same results should be obtained. Various kinds of reliability coefficients between 0.00 (much error) and 1.00 (no error) indicate the amount of error in the scores. There are several general classes of reliability estimates such as inter-rater reliability , test-retest reliability, inter-method reliability and internal consistency reliability. Reliability does not imply validity. Test scores reflect the influence of two factors: factors that contribute to consistency and inconsistencyErrors of measurement may have random and systematic error. It represents the discrepancies between scores obtained on tests and the corresponding true scores. Reliability engineering is a sub-discipline of systems engineering that emphasizes the ability of patientcareflow to function without failure. Reliability indicates the ability of healthcare service chain to function under stated conditions for a specified period of time. Reliability function is the probability of success at time t, denoted as R(t). This probability is estimated from detailed (physics of failure) analysis, previous data sets or through reliability testing and reliabilitymodelling. Availability, testability, maintainability and maintenanc e are closely associated with reliability. Reliability plays the key role in the cost-effectiveness of systems. Reliability is defined as the probability that a device will perform its intended function during a specified period of time under stated conditions. WFMS reliability is a special aspect of reliability engineering. System reliability includes all parts of the system like hardware, software, supporting infrastructure external interfaces, operators and procedures. Reliability for safety and availability are often closely related. Reliability is tied to a probability of not encountering a failure. A failure can cause loss of safety, loss of availability or both. It is undesirable to lose safety or availability in a critical system. Reliability is closely associated with fault tolerance, availability and quality. Quality often focuses on defects during the execution of patientcareflow. Reliability looks at the failure intensity over a specific time period. Reliability describes the ability of a system or component to function under stated conditions for a specified period of time. The next critical issues is consistency that does not entail a contradiction. The patientcareflow should be consistent consistent as per logic and rules. It is a desired property of hypothesis tests. Consistency requires that the outcome of the procedure with unlimited data should identify the underlying truth. Consistency is desired in in patientcareflow; any transaction must change affected data only in allowed ways. Data consistency ensures that any data of patientcareflow must be valid as per all defined rules, constraints, cascades and triggers. Transaction consistency ensures that the results of a data transaction are visible to all nodes simultaneously.

  Denial of Service (DoS), false data injection attack, sybil attack, shilling attack, coremelt attack (or traffic congestion), rushing and jellyfish attacks. Another threat is associated with webflow : internet link failure, hacking and session hijack. Theorem 5 : At level L5, it is required to assess the risks of various types of corruptions on patientcareflow such as agents, system administrator, communication protocol and payment function.Corruption is a form of dishonesty or criminal offense undertaken by a person or organization entrusted with a position of authority, to acquire illicit benefit or abuse power for one's private gain. Corruption may include bribery and embezzlement, illegal and unethical practices, power play and politics. Corruption and crime are endemic sociological occurrences which appear with regular frequency on a global scale in varying degree and proportion. It is essential to allocates domestic resources for the control and regulation of corruption and crime through anti-corruption measures. Systemic corruption is corruption which is primarily due to the weaknesses of an organization or process. It can be contrasted with individual officials or agents who act corruptly within the system. Factors which encourage systemic corruption include conflicting incentives, discretionary powers, monopolistic powers, lack of transparency; low pay and a culture of impunity. In criminology, corporate crime refers to crimes committed either by a corporation or by individuals acting on behalf of a that occur during writing, reading, storage, transmission, or processing which introduce unintended changes to the original data. Computer, transmission and storage systems use a number of measures to provide end-to-end data integrity, or lack of errors. When data corruption occurs, a file containing that data produces unexpected results when accessed by the system or related application. Results of corruption may range from a minor loss of data to a system crash.Theorem 6: The basic building blocks of adaptive security schema for patientcareflow are supervisory control data acquisition system and real-time fault diagnostics.Prevention and detection are traditional approaches to the security of a system. In today's world of expanding threats and risks, real-time system monitoring is essential to predict new threats and automate routine responses and practices. The system should not only rely on traditional prevent-and-detect perimeter defense strategies and rule based security but should adopt SCADA & RTFD. Advanced analytics is the basic building block of next generation security protection which should be to manage an enormous volume, velocity and variety of data through AI and machine learning techniques. Intelligent analytics are expected to detect anomalous patterns by comparing with the normal profile and the activities of the users, peer groups and other entities such as devices, applications and smart networks and trigger alarms by sensing single or multiple attacks on the system. The security element must overcome the barriers among security, application development and operations teams and be integrated deeply into system architecture.

  Workflow systems are expected to support complex and recurring business processes in healthcare service chain. The basic objectives of workflow data patterns are to capture various ways in which data is represented and utilized in workflows. From a data perspective, a series of characteristics may occur repeatedly in different workflow modelling paradigms. Data visibility relates to the extent and manner in which data elements can be viewed by various components of a workflow process. Data interaction focuses on the manner in which data is communicated between active elements within a workflow. Data transfer considers the means by which actual transfer of data elements occurs between workflow components and describe various mechanisms by which data elements can be passed across the interface of a workflow component. Data based routing characterise the manner in which data elements can influence the operation of control flow and resource flow. The common data elements in workflow systems are integer, float, string, Boolean, date, time, document, reference, enumeration, composition, array and set.

  At run-time, when workflow processes are instantiated and their executions are started, process managers should be able to adjust time plans like extending deadlines based on time constraints and unexpected delays. During process execution, pro-active mechanisms are needed for notifying process managers about potential time constraint violations so that they can take the necessary steps to avoid time failures; If a time constraint is violated, WFMS should be able to trigger exception handling to regain a consistent state of the workflow instance. Workflow participants need information about urgencies of the tasks assigned to them to manage their personal work lists in accordance with the overall goals. Business process re-engineering needs information about the actual time consumption of workflow executions to improve business processes. Finally, controllers and quality managers need information about activity start time and execution durations through workflow history or workflow logging and monitoring interfaces. Pro-active time calculations are crucial to detect time constraint violations and raise alerts in case of potential future time violations. The critical tasks are time monitoring, deadline checking, and handling of time errors at run-time.

Agents: Registration associate (R), Healthcare service consumer (C); Input : Name of patient, address, contact phone number, e-mail id, medical problems : symptoms, medicine consumed (if any), case history, drug allergy; Patientcareflow : 1. The patient or the attendant of the patient fills registration form. R checks voter ID card/ passport / ration card / aadhar card/ PAN card for correct identification of the patient. 2. R enters the patient data into the system and generates registration card with registration number and healthcareflow chart and allocate resources. Output: Registration card [registration no., date of issue, patient's name, age, gender, bar code, consulting hours, address, logo]; patient's flow chart [registration no., patient's name, serial no., date, process, signature]

Agents : Appointment scheduler (A), Healthcare service consumer (C); Input: Name of patient, Address, Contact phone number, E-mail id, Medical problem; Patientcareflow : 1. C submits registration card and medical documents to A. 2. A enters the patient's data into the system; searches for empty slot as per availability of consultant; fixes time and date through negotiation with patient, reserves slot and generates appointment slip based on availability of consultant and First-In-First-Out (FIFO) queuing rule. 3. A manages exception rationally based on the critical and complex nature of a case and emergency. 4. Collaborative planning, forecasting and exception management Output : Appointment slip [registration no., patient's name, age, gender, appointment no. and date, date of appointment, consultant, healthcare service: specialist and treatment, consulting charges, location, remarks, issued by]

Agents : Healthcare consultant or Doctor (P), Healthcare service consumer (C); Input : Registration card; Patient's flow chart; Patientcareflow

: 1. C produces registration card to P. 2. P checks case history and test reports of C; verifies health conditions of C; calls case based reasoning system. 3. D

generates prescription from HIS and gives to C. Output : Prescription [ Registration no., name of patient, age, gender, location, consultant's name, date and time; Diagnosis : medical problem, case history, measurements : weight, blood pressure, body temperature, pulse rate; medicine prescribed : serial no., medicine name, form, dose, frequency, duration, quantity, from, to, remarks; special instructions: testing, surgical operations, next appointment : consultant, location, time ]

Agents: Scheduling associate of surgery scheduling center (S), Healthcare service consumer (C); Input: Registration card, patient's flow chart, consultant's prescription; Patientcareflow : 1. C submits registration card and medical documents to S. 2. S enters the patient's registration no. into HIS; searches for empty slot as per availability of operation theater and surgeons. 3. S negotiates with C on technical and commercial issues of various options: technical specification of medical device to be implanted, make, features, surgical operation procedure and tariff; 4. S fixes time and date of surgical operation through negotiation with patient, reserves slot and generates surgery schedule based on availability of surgeons and First-In-First-Out (FIFO) queuing rule. S manages exception rationally based on the critical and complex nature of a case and emergency. Output : Surgery schedule [ Report id, user id, date and time; registration no. of patient, patient's name, age, gender, surgery advised, organ, name of surgeon, list of pre-operative medical tests and charges, advance to be deposited for surgical operation, admission date, surgery scheduled date and time, reporting location / unit, anticipated duration of stay, pre-operative treatment : drugs, instructions of use, remarks : emergency contact]; 3.2.5 Quality Control Certificate Agents: Healthcare service consumer or patient (C), healthcare service provider (P), Quality control associate (Q), vendor or supplier (V); Input : Registration ID of patient, Purchase order no. of medical device or drug; Patientcareflow : 1. C gets admitted to the hospital; the surgeon or doctor consults with C. 2. P issues RFQ (request for quotation) to the vendors. 3. The vendors submit bids or quotations. 4. C and doctor jointly select the best bid subject to financial and quality constraints and C signs device consent form. 5. P issues purchase order to V. 6. V supplies the medical devices or drugs with invoice. P makes goods receipt note (GRN) in the system with reference to purchase order. 7. Q inspects the model, technical specification, manufacturing date, import history, valid warranty period, test certificate, manual, programming performance and invoice in presence of the patient or his attendant and accepts or rejects the device. The basic objective is to procure the best and latest model. 8. If there is a three way match between purchase order, GRN and invoice; C gives payment to V by cheque or credit card. The vendor issues receipt of cheque. 9. The device gets installed; the performance is monitored for a specific duration. If there is any problem in device's performance; V is recalled and the device get rejected and replaced through issuing rejection memo. The packets of the devices or equipments should be collected by C for future reference. 10. V gives final receipt to C and a copy to P. Output : QC test certificate [Purchase order reference, Device : make, serial no., date of manufacturing, warranty period; quantity, delivery date, GRN no., invoice no. and date]

Resource characterization (5M : man, machine, material, method, money) in patientcare flow Resource creation (role, schedule, history, hierarchy) Resource storage Resource distribution Resource allocation Resource transfer Resource mobilization Resource sharing Resource application or utilization (capacity utilization) Resource planning (demand, inventory, supply, capacity) Resource collaboration (CPFR, sourcing) Resource execution (delivery, storage, packing, shipping) Resource classification (ABC, XYZ, HML)