Population-Based Cancer Screening analysis in Northern Portugal Using Process Mining

BACKGROUND: This study focuses on the Colorectal Cancer Screening Program in Northern Portugal, aiming to evaluate the disruption effects on its performance and efficiency.

METHODS: We conducted an observational analyses of 271 637 administrative records from 2020 to 2022. Administrative timestamps were converted into a step-by-step dataset of screening activities (an "event log") and analysed using process mining and comparative performance analysis across time periods and ACeS (primary care administrative clusters).

RESULTS: Consultation‑to‑colonoscopy time lengthened by 53 %, rising from a median 58 days (IQR 29-92) in early 2020 to 89 days (IQR 53-127) in 2021, before improving to 73 days in 2022. Conversely, referral‑to‑consultation time fell from 110 days to 26 days (-76 %), reflecting targeted backlog clearance. Screening volumes declined in 2020 but recovered above baseline levels by 2022. Performance differences across primary care administrative clusters were significant (p < 0.001), with some units outperforming regional median transition times. Early adoption of automated electronic referrals and flexible consultation scheduling may have contributed to improved programme performance during the recovery period following pandemic-related disruptions. Substantial heterogeneity across units was observed for key transitions, indicating uneven disruption and recovery patterns across administrative units.

CONCLUSION: Process Mining techniques revealed critical vulnerabilities in the screening program during the initial stages of the period in analysis (matching the pandemic). These findings support targeted monitoring and prioritisation of operational improvements to reduce avoidable delays and strengthen continuity of population-based screening.

POLICY SUMMARY: Policies aimed at strengthening healthcare service continuity and operational capacity benefit from analytical methods like process mining. Key recommendations include standardizing workflows, enhancing coordination between primary care and hospital services, and investing in digital monitoring systems to mitigate disruptions and ensure continuity in cancer screening programs during periods of system stress.