Names are arbitrary labels. So why do we assign so much meaning to names? In certain context, certain names can create confusion. In others, a name can disambiguate the intended meaning being communicated. In the context of business decisions, the names given to various business concepts play a crucial role in providing meaningful and unambiguous business decisions. This becomes even more important in the context of life critical business decisions such as those made in a healthcare clinical context. Medical information systems need to be able to communicate complex and detailed medical data securely and efficiently. This is obviously a difficult task and requires a profound analysis of the structure and the concepts of medical terminologies. In this presentation we will explore the use of disambiguated business terms to express decision requirements and decision logic in DMN.

1. What’s in a name?
Business Vocabularies, Business Rules and DMN
Denis Gagne
CEO & CTO
dgagne@Trisotech.com
Acknowledgement
s:
Dr. John Svirbely
CMIO Trisotech

2. Abstract
Names are arbitrary labels. So why do we assign so much meaning to names? In
certain context, certain names can create confusion. In others, a name can
disambiguate the intended meaning being communicated. In the context of
business decisions, the names given to various business concepts play a crucial role
in providing meaningful and unambiguous business decisions. This becomes even
more important in the context of life critical business decisions such as those made
in a healthcare clinical context. Medical information systems need to be able to
communicate complex and detailed medical data securely and efficiently. This is
obviously a difficult task and requires a profound analysis of the structure and the
concepts of medical terminologies.
In this presentation we will explore the use of disambiguated business terms to
express decision requirements and decision logic in DMN.

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Introduction

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Business Vocabularies, Business Rules and DMN
I will attempt to take you on a journey to
try to make DMN Models truly
semantically interchangeable.
o It is a though journey, as you will have to leave all your
assumptions and presumptions beside.
WHAT’S IN A NAME?
https://www.omg.org/spec/DMN
DMN: Decision Model and Notation
 Open standard published by OMG.
 A common meta-model and notation for describing and modeling repeatable
Business Decisions.
 Enables various groups to effectively collaborate in defining a Decision Model.
 Provides a standard notation for Decision Requirements and Decision Tables.
 Provides execution semantics via the FEEL expression language.
 Current Version: DMN 1.3.

5. Often used to imply that the names of things do not affect what they really are.

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What does this mean?
Based on DMN we know:
• it depicts decisions (Square boxes)
and Inputs (Ovals), and
• the information requirement relations
between them
INTRODUCTION
The DMN Notation/Spec
provides structural and
relational semantics

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The DMN Notation/Spec
provides structural and
relational semantics
What does this mean?
Does adding labels help?
Now we know:
• Both decision “a” and decision “b”
only need decision “c” as an input
• Decision “c” needs “aa”, “bb”, “cc”,
decision “d” and “ff” as inputs
• Decision “d” needs both “dd” and “cc”
as inputs
INTRODUCTION

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What does this mean?
Does adding logic help?
Now we know:
• The logic (rules) that dictates how the
decision is achieved
INTRODUCTION
The DMN Notation/Spec
provides logical semantics

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What does this mean?
Does adding meaningful labels help?
Now we know (can guess):
• It is a model related to healthcare but
without domain knowledge it is still
obscure to most
INTRODUCTION
The DMN Notation/Spec does not
provide interpretation (domain
semantics)

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The DMN Notation/Spec does not
provide interpretation (domain
semantics)
What does this mean?
Does adding logic using meaningful labels help?
Now we know:
• The logic (rules) that dictates how the
decision is made
INTRODUCTION

11. noun
 the quality of being open to more than one interpretation;
inexactness.
As in
o "we can detect ambiguity in this DMN model"
Source: Oxford Languages
🐘am·bi·gu·i·ty

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Are Labels enough?
INTRODUCTION
Some problems:
• Within a domain
• Different terms with the
same meaning
• Between domains
• Same term with different
meaning
The list can be long…

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Controlled Vocabularies
Business Vocabularies

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• DMN Models should use defined Terms
• Using terms defined in a Controlled Vocabulary increases DMN
model quality:
oNaming across models is consistent
oDefinition of terms is known

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What if we introduceTerm Definitions?
CONTROLLED VOCABULARIES

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What does this mean?
Does adding definitions help?
Now we know:
• What “CURB65” is
CONTROLLEDVOCABULARIES

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Is adding Controlled Vocabulariesenough?
Vocabularies need to be meaningful:
o Meaningful context
o Relational understanding
o Critical features
CONTROLLED VOCABULARIES

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Healthcare Coding
Ontology-based terminologies

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What does this mean?
Does adding definitions help?
Now we know:
• The definition of “confusion”
HEALTHCARECODING

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Ontologies in medicinehave a long history
They are mostly used to:
o Unambiguously capture clinical data in a standardised and granular manner
With the goal of
o improving data quality and patient safety, and facilitating (semantic) interoperability between
systems
They normally provide terms, synonyms and codes along with relational information
Well known coding systems includes:
o LOINC codes describe tests, measurements, and observations.
o RxNorm codes describe prescriptions and medications. They include dosage information and common Brands.
o SNOMED Clinical terms (SNOMED-CT) describe clinical findings, symptoms, diagnoses, procedures, body structures,
organisms and other etiologies, substances, pharmaceuticals, devices and specimens.
• and many others
HEALTHCARE CODING

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What does this mean?
Does adding medical codes help?
Now we know:
• The SNOMED code to disambiguate
our term “confusion”
• We can search for that code in
various information systems
HEALTHCARECODING
https://www.trisotech.com/fhir/#trisotech-and-fhir

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Coding in Healthcare
Clinical Coders, Clinical Coding Officer, Diagnostic Coder, or Medical Coder:
o a health information professional whose main duties are to analyze and transform healthcare
diagnosis, procedures, medical services, and equipment into universal medical alphanumeric
codes using classification systems.
But what about abstractions, granularity and generalization
o while a code may disambiguate a term, it can cause a loss of resolution, the entire spectrum
and complexity of a disease is reduced to a single code.
Enters Value Sets:
o sets of codes drawn from one or more code systems, intended for use in a particular context.
Values Sets broaden the meaning and potential code matching in various information systems.
HEALTHCARE CODING

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What does this mean?
Does adding Value Sets help?
Now we know:
• A set codes from various coding
systems that we associate with our
term “confusion”
• We have broadened our meaning of
“confusion”
HEALTHCARECODING
https://www.trisotech.com/fhir/#trisotech-and-fhir

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Concept Models
Depicted in Concept Maps

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What if we introduceConcept Models?
CONCEPT MODELS
o A Concept Model is a set of
concepts and the relations
amongst them
o Terms represent Concepts
o Noun Concepts are associated
via Verb Concepts.
o Depicted as boxes and arrows in
a diagram called Concept Map

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What does this mean?
Does adding concept models help?
Now we know:
• CURB65 is based on series of
observations, where each may
indicate potential organ failure
which can lead to death
CONCEPTMODELS

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What does this mean?
Does combining Concept Models with Definitions help?
Now we know:
• The definition in a relational
context
CONCEPTMODELS

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Is adding Concept Models enough?
oWhat are the rules that govern the
interpretation?
oWhat are the criterion to operationalize
this knowledge?
CONCEPT MODELS

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Business Rules

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What if we introduceBusiness Rules?
BUSINESSRULES
o Definitional and Behavioral rules
o Capturing Necessity (Alethic) and Obligation (Deontic)

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What does this mean?
Does combining Business Ruleswith Definitions help?
Now we know:
• how to interpret a CURB65
Score decision and how to
adequately react
BUSINESSRULES

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Is adding Business Rules enough?
oWhat are the sources and authority
behind that knowledge
BUSINESSRULES

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Knowledge Sources and Authority
Bringing it all together

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What if we introduceKnowledge Sourcesand Authority ?
KNOWLEDGE SOURCES AND AUTHORITY

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What does this mean?
Does adding Business Rulesas Knowledge Sourcesand
Authorityhelp?
Now we know:
• how to interpret a CURB65
score and how to adequately
react
KNOWLEDGESOURCESANDAUTHORITY

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What does this mean?
Does adding References as Knowledge Sourcesand
Authorityhelp?
Now we know:
• the evidence under which
authority this knowledge was
crafted
KNOWLEDGESOURCESANDAUTHORITY

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BPM+
Generalizing

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BPM+
Workflow
Automation
Decision
Automation
Open Standards
DMN
(DECISION MODEL AND NOTATION)
Decisions that may influence behavior
BPMN
(BUSINESS PROCESS MODEL AND NOTATION)
Behavior is prescribed from a triggering event
CMMN
(CASE MANAGEMENT MODEL AND NOTATION)
Behavior is reactive to events in a context (the case)
Technology enabled
orchestration of activities, able
to react to business events.
Both may have humans in the loop or not.
(Referred to as Knowledge Workers.)
Technology enabled decisions,
returning answers given some
provided inputs.
SETTING SOME CONTEXT

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Generalizingto BPM+
o Adding Knowledge
Sources and Authority
Associations to BPMN and
CMMN
BPM+

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Conclusion
Creating Semantically Interchangeable Knowledge Packages

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Creating InterchangeableKnowledgePackages
For DMN models to become truly semantically interchangeable:
 Labels on models are not enough, we need to add Controlled Vocabularies.
 Controlled Vocabularies are not enough, we need to add Concept Models.
o Healthcare requires coding (coded Ontology-based terminologies).
 Concept Models are not enough, we need to add Business Rules.
 Business Rules are not enough, we need to add Knowledge Sources and Authority.
CONCLUSION

42. dis·am·big·u·ate
verb
• remove uncertainty of meaning from (an ambiguous sentence, phrase, or other
linguistic unit).
• "word senses can be disambiguated by examining the context"
Source: Oxford Languages
For a set of BPM+ Models to become truly
semantically interchangeable Knowledge
Packages, we need to add in SBVR to the mixt.
SBVR: Semantics Of Business Vocabulary And Business Rules
https://www.omg.org/spec/SBVR

43. THANKS!
Any questions?
dgagne@Trisotech.com
Hope this presentation made you FEEL good!
What’s in a name?