Petri Net Based Reliable Work Flow Framework for Nephrology Unit in Hospital Environment

International Journal on Recent and Innovation Trends in Computing and Communication ISSN: 2321-8169
Volume: 5 Issue: 7 858 – 864
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Petri Net Based Reliable Work Flow Framework for Nephrology Unit in Hospital
Environment
P.T.V. Bhuvaneswari1
1
Department of Electronics Engineering, MIT Campus
Anna University, Chennai, India
ptvbmit@annauniv.edu
M. Amaliya Princy2
2
Verizon Data Services India Pvt. Ltd
Chennai, India
princysugu@gmail.com
Abstract— The 21st century has witnessed a revolution in Biology and Medicine that has radically changed the way health, diagnosis, prognosis,
etc., of a disease is monitored nowadays. Accordingly, hospital redesign, workforce planning and scheduling, patient flow, performance
management, disease monitoring, and health care technology assessment need to be modeled efficiently. Mathematical modeling and computer
simulation techniques have been shown to be increasingly valuable in providing useful information to aid planning and management. Petri Net
(PN) is considered as a powerful model since it combines well-defined mathematical theory with a graphical representation which reflects the
dynamic behavior of systems of interest. Due to dynamic characteristics, it is found to be more suitable for modeling Hospital Management
System (HMS). In this paper, a Petri net model-based reliable workflow framework for Nephrology unit in hospital environment is proposed to
track the movement of patients in the unit. The key objective of the proposed reliable workflow framework is to provide a well-organized health
care unit to reduce the waiting time of the resource/ patient. The performance of the proposed Petri net model-based reliable workflow
framework is simulated and validated through reachability graph using HPSim tool. The proposed Petri net workflow framework for the
Nephrology unit can be used to deliver highly efficient and reliable healthcare services.
Keywords- Hospital redesign, Petri net, Nephrology, Reliable, Workflow and Waiting time.
__________________________________________________*****_________________________________________________
I. INTRODUCTION
The growth of automation, which is largely linked to
advancements in microelectronics, has led to significant
improvement in reliable and cost-effective productions [1].
Hospital automation is a subarea of automation, which aims to
automate processes in the hospital environment. The
efficiency and productivity of the process can be increased by
using industrial automation concepts. However, selection of
these concepts depends on the characteristics and restrictions
of the medical environment. For example, data acquisition
must ensure privacy in preserving medical ethics and patient
integrity [2].
Hospital Information System (HIS) contains three
different modules, namely Patient record, Resource record and
Infrastructure record. A Database containing electronic
medical records of the patient is available in the Patient record.
Another two Databases contain information about the
employees of the hospital and various infrastructure facilities
available in the hospital. Reliability is the fundamental
requirement of HIS. That is, whenever the system fails, an
alternative mechanism needs to be devised to protect the
privacy and integrity of the information present in HIS. Thus,
in order to ensure reliability, the workflow of the system needs
to be monitored [3]. The study presented in this paper
emphasizes workflow management of healthcare services with
special reference to Nephrology unit. Modeling is the process
of producing a simple model that represents the construction
and working of the system of interest. The purpose of a model
is to enable the analyst to predict the effect of changes to the
system. It may be a close approximation to the real system and
incorporate most of its salient features. It should be simple to
provide ease of understanding.
A good model is a judicious trade-off between realism
and simplicity. Validation of model is an important issue in
modeling [1], [3]. Validation technique includes simulation of
the model under known input conditions and comparison of
the model output with system output. Several Mathematical
models have been proposed in the literature [4], [5].
Petri Net (PN) is a mathematical model introduced in
1962 by Dr. Carl Adam Petri [1]. It is a powerful modeling
formalism in computer science, system engineering and many
other disciplines [5], [6], [7], [8], [9], [10], [11], [12]. It
combines a well-defined mathematical theory with a graphical
representation to analyze the dynamic behavior of system of
interest. The theoretical aspect of Petri net allows precise
modeling and analysis of system behavior, while the graphical
representation enables visualization of the modeled system
state changes. This combination is the main reason for the
great success of Petri net [1].
The main purpose of a workflow management in
Hospitals is to efficiently synchronize and coordinate various
processes undergone by the patient. It becomes vital to use an
established framework for modeling and analyzing workflow
processes [3], [5]. In this paper, a workflow framework based
on Petri net model is proposed to improve the reliability of
health care services related to Nephrology unit.
Incidence of Chronic Kidney Disease (CKD) is increasing
worldwide at an annual growth rate of 8% [13]. Recent Survey
states that the prevalence of CKD is higher in developing
countries than in the developed countries. The most common
causes of CKD in India are chronic glomerulo nephritis and

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systemic hypertension, and diabetic nephropathy. The key
objective of the proposed workflow management framework is
to automate and optimize the clinical procedures undergone by
patient posing CKD in a hospital environment.
The rest of the paper is organized as follows: In section 2,
the state-of-the-art in PN modeling workflows in Hospital
Management System is discussed. In section 3, the proposed
Petri net based reliable workflow framework is described. The
simulation and the validation of the proposed framework are
discussed in section 4. Finally, the conclusions and further
extensions of the proposed work are presented in section 5.
II. REVIEW OF LITERATURE
Several works reported in the literature [14], [15], [16],
[17], [18], [19], [20], [21] highlighting the usage of Petri net
model for Hospital Management System are available. A few
works related to the proposed methodology are presented in
this section. Houshang Darabi and William L. Galanter [14]
have suggested a method to create comprehensive formal
models using Petri net to monitor the workflow of various
healthcare delivery facilities available in major hospitals. The
Presented model has integrated all relevant aspects of
hospital operations including the status and availability of
various classes of hospital personnel, the history and status of
all patients currently in the hospital, and the availability of a
broad range of healthcare resources available in the hospital.
P.E. Miyagi et al [12] have devised a systematic methodology
for modeling and simulation of control strategies in
Intelligent Buildings systems through a Petri net approach.
The effectiveness of time continuous Petri net model has
allowed the definition of suitable optimization problems in
order to optimize the devised methodology, by applying to an
elevator system and HVAC system.
M.Dotoli et al [15] have presented Timed Petri net based
management framework to monitor the workflow of drug
distribution system and mobility of patients in the
Pulmonology department of the general hospital of Bari, Italy.
M.Dotoli et al [16] have described a concise timed continuous
Petri net framework to model the flow of patients in a hospital,
starting from their arrival to the emergency medical service, to
the assignment of a bed in the appropriate department until
their discharge.
Dong-Sheng Zhai et al., [18] have presented a Multi-
Agent based architecture for a distributed environment
scanning system. A scheduling model to optimize the average
waiting time of tasks and agent has been built using
Hierarchical Timed Colored Petri net (HTCP-net) model.
In this paper, a Petri net based reliable workflow
management frame-work is proposed for Nephrology units in
a hospital environment. Initially, the various causes and
treatment procedures adopted in hospital for Kidney related
problems are described. The aim of the proposed work is to
monitor managerial activities like patient management,
hospital staff task assignment and utilization of clinical
equipment in the Nephrology unit. The proposed framework is
adaptive due to the dynamic characteristics of Petri net model.
III. PROPOSED PETRI NET BASED RELIABLE WORKFLOW
FRAMEWORK
Millions of people around the world suffer from Kidney
diseases, and these patients will eventually need renal
replacement therapy. Whenever the kidney is damaged for
more than 3 months or Glomerular Filtration Rate (GFR) is 60
mL/min/1.73 m2, it results in Chronic Kidney Disease (CKD).
Kidney damage is defined as structural or functional
abnormalities of the Kidney. Most of the time, the severity of
CKD may lead to Chronic Renal Failure (CRF) [13]. Chronic
Renal Failure occurs when GFR gets decreased to 15
mL/min/1.73 m2. When the stage of Uremia is reached, the
treatment to be executed is renal replacement therapy which
reduces the risk of mortality and morbidity.
The proposed Petri net based reliable workflow
management framework is a generic framework which
addresses all stages of kidney disease. The key objective is to
optimize the waiting time of the patient in various levels of the
treatment. Further, it also enables proper management of
hospital resources ensuring reliability.
A. System Description Of The Proposed Work Flow
Framework
Basic workflow model of the proposed Petri net based
reliable framework is shown in Fig 1. Arrival of patients to the
hospital occurs at random instants of time. The proposed
framework serves various categories of patients like new
patients, regular patients, patients undergoing only clinical
procedures, and critical patients.
Figure 1. Basic workflow model of the proposed PN based Workflow
Framework
The proposed framework consists of four sections, namely
consultation, surgical ward/CCU, clinical and dialysis. Initially
the arrival of patient is registered in the database available in
the reception of the hospital. From the information created in
the database, the category of the patient as mentioned above is
determined. If the patient is new, then a new record is created
with reports received from the doctor after consultation. On
the other hand, for a regular patient, based on the history of

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disease, retrieved from the database system, appropriate
diagnosis is carried out.
Patients with Chronic Kidney Disease (CKD) visiting the
hospital for clinical tests are directed to the respective
clinical procedure with the help of a care taker after
confirming billing.
Finally, if the patient is in the critical stage, he/she either
directed to surgical unit or Critical Care Unit (CCU) for
necessary treatment. As far as the clinical procedure is
concerned, the patient is made to wait in the queue, if the
particular section is not readily available.
Normal clinical test conducted to examine GFR of the
kidney are Blood Pressure (BP) test, Blood Creatinine test.
Urine culture is studied based on the result of the urinalysis
test. Scanning of kidney is performed to determine the
percentage kidney damage. Based on the reports generated
from the above mentioned medical examinations, the severity
of the disease is diagnosed. The patient can be either advised
to undergo dialysis or medication or kidney transplantation.
To undergo any type of surgery, the patient has to consult
the surgeon and make payment of necessary fees. When a
patient completes the clinical treatment procedures, he/she has
to purchase medicines prescribed from the Pharmacy. In any
case, after completion of each treatment process, a report is
drawn and is collected at the Database section with the
confirmation from the billing section. The Database section
updates the record of the patient and informs them of future
appointments. After completing all the due procedures for the
visit and updating the Database, the patient leaves the hospital.
B. System Modeling using Petri net
Petri net (PN) is a particular kind of bipartite directed
graphs populated by three types of objects, namely places,
transitions, and directed arcs. In its simplest form, a Petri net
can be represented by a transition together with an input place
and an output place. This elementary net may be used to
represent various aspects of the modeled systems.
The proposed framework is modeled using Petri nets.
Each activity involved in the framework is represented by a
place with an input transition showing the beginning of the
activity and an output transition indicating the end of the
activity. In order to study the dynamic behavior of the
modeled system in terms of its states and state changes, each
place potentially holds either none or a positive number of
tokens. Tokens are a primitive concept for Petri nets in
addition to places and transitions. The presence or absence of
token (patient) in a place (Dialysis unit) indicates whether a
condition associated with the place is true (patient is
undergoing Dialysis procedure) or false (patient is not
available in the Dialysis unit).
C. Workflow Definitions
Definition 1: A Petri net N = (P, T, F, W) is given by a
finite set of places P = {p1 p2 pn}, a finite set of transitions T =
{t1 t2 tk} disjoint from P, a flow relation F (P * T) (T * P)
and weight function W: FN, where N denotes the set of non-
negative integers.
Definition 2: Let X = P T. For an element x X the set
•x = {v / (v, x) F} is the set of input elements of x and x• =
{u / (x, u) ∈ F} is the set of output elements of x.
Definition 3: A marking in a Petri net is an assignment of
tokens to the places of a Petri net. Tokens reside in the places
of a Petri net. The number and position of tokens may change
during the execution of a Petri net. The tokens are used to
define the execution of a Petri net.
Definition 4: A marking of a Petri net is a function m:
PN. The global state of a Petri net is represented by a
marking m Nn
. m(p), denotes the number of tokens of the
place p in the marking m Nn
. m0 is used to denote the initial
marking of a Petri net.
In a graphical representation of a Petri net, circles are used
to denote places; rectangular boxes/ lines are used to denote
transitions; directed arcs are used to connect places to
transitions and to connect transitions to places; small black
dots are used as tokens to represent a marking.
Definition 5: The dynamic behavior of Petri net is
represented by ring of transitions. A transition t T of a Petri
net N has a concession or can fire or is enabled at the marking
m, if m(p) ≥ W(p, t) for all p •t. This is denoted by m [t >. If
t is enabled at the marking m, it fires and leads to a new
marking m' Nn
, where this ring relation is denoted by m[t >
m'
Definition 6: Let β denote a finite sequence of transitions.
The ring relation is recursively extended to finite sequence of
transitions by m[ βt > m' m[ β > m'' and m'' [t > m' for all m
Nn
and t T.
Definition 7: The marking m' is said to be reachable from
the marking m if 𝛽 such that m0[ 𝛽 > m'. The set of all
markings reachable from the initial marking m0 of a Petri net
N is denoted by R(N, m0) or R(N).
PN used for modeling real systems are sometimes referred
to as Condition/Events system. Places identify the conditions
of the parts of the system (working, idle, queuing, and failed),
and transitions describe the passage from one condition to
another (end of a task, failure, repair). An event occurs (a
transition results) when all the conditions are satisfied (input
places are marked) and concession given to the event.
Occurrence of the event modifies in whole or in part the status
of the conditions (marking). The number of tokens in a place
can be used to identify the number of resources lying in the
condition denoted by that place.
TABLE I. DESCRIPTION OF PLACES IN THE PROPOSED
FRAMEWORK
PLACE NAME DESCRIPTION
p1 Reception Arrival of patient in the
hospital
p2 Database section Creation and maintenance of
patient records
p3 Cash counter Collection of fees for the

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treatment
p4 Waiting hall Queuing of Patients for
treatment
p5 Laboratory Execution of clinical tests like
BP, GFR and Urine analysis
p6 Doctor’s office Physical examination of
patients and treatment
recommended
p7 Surgeon’s consulting
room
Consultation with Surgeon for
operation
p8 Operation theatre Perform operation like Fistula
vein for Dialysis or kidney
transplant for critical patients
p9 Nurse station Nurses present in the Dialysis
unit to carry out dialysis for
patients
p10 Dialysis unit
Patient undergoing dialysis
p11 Pharmacy Availability of medicines
prescribed by the Doctor
p12 Care taker Nurse or family member
accompanying the Patient
These places are the main components involved in the
work flow of the Nephrology unit in the hospital. Table 2
shows the description of the transitions in the proposed Petri
net based reliable workflow framework. These transitions are
the main clinical procedures involved in the kidney disease
treatment observed in a typical Nephrology unit of a hospital.
TABLE II. DESCRIPTION OF TRANSITIONS IN THE PROPOSED
FRAMEWORK
TRANSI
-TION
NAME DESCRIPTION
t1 Registration /
Authentication
New patients-registration Old
patients-authentication using
RFID
t2 Billing Registration, consultation,
dialysis or operation fees
t3 Queued up for
treatment
Patients waiting in queue
t4 Visit laboratory to
conduct clinical test
Patient visiting laboratory to
take test or collect report
t5 Queued up for next
procedure
Patient waiting for report
collection or for doctor
consultation
t6 Consultation Examination of report by
doctor and recommendation of
treatment
t7 Execution of
treatment
Execution of treatment as
recommended by doctor
t8 Consultation with
surgeon
Obtain opinion from surgeon to
check the patient condition
t9 Requesting patient to
make payment for
operation charges
Check whether the patient
has paid the charges to undergo
surgery
t10 Report collection
from Doctor
Patients with insufficient funds
postponing surgery are
prescribed with relevant
medications and diet
t11 Surgery Patient confirmed of payment
undergoes surgery and taken
toward
t12 Discharge from
hospital
Well recovered patient collects
reports and medicines as
prescribed
t13 Testing of Blood
Pressure
Patient with normal Blood
Pressure undergo dialysis
t14 Abnormal Blood
Pressure
Medications given to patient to
attain normal Blood Pressure
t15 Dialysis Patient undergoes dialysis
(hemodialysis or peritoneal)
t16 Report collection Collect the treatment reports
and medicines as prescribed
t17 Update database After collecting the reports and
medicines, patient must update
his/her profile information in
the DB
Figure 2. Proposed Petri net for Nephrology unit
IV. RESULTS AND DISCUSSIONS
The proposed PN model for Nephrology unit in a hospital
environment is simulated and validated using HPSim
version1.1 software tool. HPSim tool is user-friendly and
easily understandable as it possesses a Graphical editor.
Simulation and analysis can be carried out at a faster rate.
Further, it is compatible with any version of Microsoft
Windows Operating Systems (95, 98, NT, 2000, XP, Vista or
higher).
The Petri net model for the proposed framework is
designed by drag-and-drop of places, transitions and directed
arcs from the editor bar located on the right corner of the
editor window. The properties of all the three elements are
defined in the project explorer window located on the left
corner of the editor window. The properties defined for places
are: name, size, initial tokens, current tokens, capacity and
tokens count. Similarly attributes defined for transition are:
initial delay, range delay, current delay and tokens red. The
constructed PN model consisting of 12 places and 17
transitions are shown in Fig 3. Initial state of the proposed PN
model contains two tokens. The token in p1 represents the
arrival of the patient suffering from Nephrology problem. The
token in p12 represents the care taker assisting the patient
undergoing clinical treatment.

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The Petri net model for the proposed framework is
designed by drag-and-drop of places, transitions and directed
arcs from the editor bar located on the right corner of the
editor window. The properties of all the three elements are
defined in the project explorer window located on the left
corner of the editor window. The properties defined for places
are: name, size, initial tokens, current tokens, capacity and
tokens count.
Similarly attributes defined for transition are: initial delay,
range delay, current delay and tokens red. The constructed PN
model consisting of 12 places and 17 transitions are shown in
Fig 3. Initial state of the proposed PN model contains two
tokens. The token in p1 represents the arrival of the patient
suffering from Nephrology problem. The token in p12
represents the care taker assisting the patient undergoing
clinical treatment.
Figure 3. Initial state of PN model
Transition is enabled using the step button present in the
tool. The intermediate stages of the model can be viewed using
status window as illustrated in Fig 4. Movement of different
class of patients and corresponding treatment undergone are
traced and analyzed/studied by our patient work flow model.
Final stage of the model is attained when both the tokens
(patient and care taker) reach the place p2 (Database section)
indicating the completion of the treatment procedure as shown
in Fig 5.
Figure 4. Intermediate stage of PN model
Figure 5. Final state of PN model
The proposed framework is validated using Reachability
graph as shown in Fig 6. It is seen that the initial marking
contains two tokens, one in p1 and the other in p12. In the final
marking both tokens reach the place p2 validating the
correctness of the model.

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Figure 6. Validation of PN model through Reachability graph
V. CASE STUDY
The proposed work flow framework supports four
different categories of patients, namely new patient, regular
patient, patient undergoing only clinical procedure, and critical
patient. The work flow of the model is analyzed for all these
cases. The set of sequence of transitions obtained from the
Reachability graph R(N) for different cases is presented in
Table 3.
TABLE III. SEQUENCE OF TRANSITIONS OBTAINED FROM
REACHABILITY GRAPH
S.NO CATEGORY OF
PATIENT
SEQUENCE OF
TRANSITION
1 New patient t1 t2 t3 t6 t7 t3 t4 t5 t6 t8 t9 t3 t11
t12 t17
2 Regular patient t1 t2 t3 t13 t15 t16 t17
3 Patient undergoing only
clinical procedure
t1 t2 t3 t4 t5 t6 t10 t17
4 Critical patient t1 t2 t3 t6 t8 t9 t11 t12 t17
VI. CONCLUSION AND FUTURE WORK
In this paper, a PN based reliable work flow framework for
Nephrology unit in hospital environment is designed. The
objective of the framework is to provide a well-organized
health care unit to reduce the waiting time of the resource/
patient. The framework is modeled using simple Petri net
model. The proposed model is simulated in HPSim version 1.1
tools and analyzed through Reachability graph for safe
termination. It is observed that the constructed Petri net is live
and no deadlocks are encountered. Conflict transitions are only
transitions that model regular continuation and final
termination, such as (t4, t6, t11, t13), (t7, t8, t10). These conflicts
describe mutually exclusive actions. From the simulation
results, it is inferred that the constructed Petri net is error-free.
Hence, our proposed Petri net model is analyzed and verified
using the Reachability graph which is found to be finite and
reachable. Further, the proposed workflow framework can be
extended for other units like Cardiology department,
Orthopaedics, etc to support a multi-specialty environment.
ACKNOWLEDGMENT
We whole heartedly thank Dr. K. Thirusangu,
Department of Mathematics, SIVET College, Chennai for the
guidance provided in performing the work flow analysis using
the developed Petri Net model.
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