The Implementation of a Business Process Model and Notation for Modeling Patient Health Care Trajectories: Systematic Review.

Background: Health care systems are increasingly confronted with the challenge of managing complex clinical processes. One proposed solution is a patient-centered management intervention called a care pathway that needs process mapping to support process improvement. Although the adoption and use of Business Process Modeling Notation (BPMN) for modeling patient health care trajectories has increased, evidence of the benefits of implementing it in health care organization management systems remains unclear. Objective: This review sought to examine effectiveness by mapping implementation factors linking intended purpose to expected or demonstrated outcomes. Methods: A systematic review of the use of BPMN for modeling patient health care trajectories was conducted across 8 databases. We followed the Cochrane Methods Group and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We selected empirical, experimental, and conceptual articles in French and English that analyzed and evaluated the implementation of BPMN for modeling patient health care trajectories in the health care field. Quality appraisal was performed using the Mixed Methods Appraisal Tool. Data were charted using a customized form and analyzed thematically with qualitative and semiquantitative syntheses. Results: After screening, 61 studies were included. BPMN offers significant benefits in health care. Its use allows health care professionals to gain an understanding of patient health care trajectories, making it easier to identify inefficiencies and areas for improvement. The definition of processes ensures that workflows remain consistent across different settings, thereby reducing variation and improving the quality of care. Several studies have demonstrated BPMN's effectiveness in process optimization, highlighting its ability to streamline workflows, reduce redundancies, and enhance operational efficiency. Moreover, when integrated with decision-support tools, BPMN enhances clinical decision-making by enabling better adherence to guidelines and best practices. Another advantage is BPMN's interoperability with existing health care IT standards. However, managerial considerations reveal trade-offs between BPMN's benefits and limitations, especially in highly complex health care settings. Several challenges persist, including issues related to scalability, integration with advanced decision-making frameworks, and the complexity of modeling dynamic health care environments. While BPMN is widely adopted, alternative methodologies offer complementary or competing advantages. Several opportunities exist to enhance BPMN's applicability in health care, such as creating domain-specific BPMN extensions or integrating artificial intelligence and machine learning. However, limitations in the methodological quality of the studies selected and the concentration of the research mainly in European countries limit the generalizability of our results. Conclusions: This review highlights BPMN's potential as a valuable tool for modeling patient health care trajectories. Its ability to standardize and optimize processes makes it promising for improving clinical and operational efficiency. However, trade-offs between benefits and limits of BPMN characterize its implementation in patient health care trajectories, creating opportunities for the development and integration of new tools.