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GiraffDiabetes Project: Cassie Breen, Ekaterina ColeRequirements Project AssignmentDr. Isabelle BichindaritzBHI 504 Systems Design, Integrity, Safety & Security5 March 2016

User Stories

The following table demonstrates the User Stories, and other attributes, like Interviewee, Objects/ “Artifacts”, Business Rules, split by user in terms of their view. To see the overall list, including Interview Notes, please refer to Section 7 (Supplementary Materials).

Name of the User Role

Interviewee User Stories Objects/ “Artifacts” Business Rules

“Diabetic Patients”

Virginia Cole, 83-year old resident of Holy Trinity Nursing and Rehabilitation Center in Worcester, MA, who was relocated there from Assisted Living Condo Apartments, due to her acute condition.

1) As a patient, I want to see my vital sign levels within the normal range, and I want to be able to measure some of them myself, so that I can ensure my condition is not worsening.Priority: must (high)Overall Priority Rank: 1Estimate: 8

Devices/ Objects: Giraff Mobile Robotic

Telepresence System; Empatica E4

wristband; System of Sensors. Medications, medical

tools, insulin vials and syringes.

Software/ Program Interfaces:

Giraff-based Embedded Windows XP system;

Empatica wristband embedded system;

Additional tools that

1) A Patient is expected to comply with all regulations and procedures for using the Giraff Home Care System: ensure that the MRT and Empatica systems are charged, turned on and utilized in a proper manner to ensure continuity of care.

2) Normal blood pressure for a patient is less than 120/80 mm Hg (less than 120 systolic AND less than 80 diastolic) for an adult age 20 or over.

3) Normal resting heart rate ranges from 60 to 100

2)As a patient, I want to make sure that there’s both a medical professional and family member I can be easily reached out by at any moment, to see if I don’t feel well or in case of emergency, so that they can take timely measures.Priority: must (high) Overall Priority Rank: 1Estimate: 8

3) As a patient, I want to be supervised and reminded when to take my medications,

administer insulin injections, and do some of my prophylactic activities, so that I don’t forget to accomplish these tasks.Priority: must (high)Overall Priority Rank: 1Estimate: 8

would allow reporting and monitoring patient’s metrics (to be designed).

Additional: Training Giraff

System Manuals;

beats per minute for adults.

4) Patients are expected to contact medical provider/ aide or other taker immediately in case of emergency.

4) As a patient, I want to receive feedback on my medical metrics and day-to-day activities, if something is abnormal or outside of the accepted range, so that I can be aware of my condition and ask for further recommendations if needed.Priority: should (medium)Overall Priority Rank: 2Estimate: 6

5) As a patient, who lives alone and far away from my children and family, I want to be able to talk to them more often, and experience their presence, even in a teleconversation/ video format, so that I don’t feel lonely, depressed and can socialize and address any urgent issues.Priority: should (medium)Estimate: 4Overall Priority Rank: 3

“Other caretakers”

Melissa Frechette, RN, caretaker at Samaritan Summit Village and home health aide for her grandparents.

1)As a caretaker, I want to ensure my family member’s/ patient’s diabetes health monitoring metrics are being constantly taken, assessed, are sent as a report to me, and are under control, so that I can act quickly in case of


Giraff-based Pilot 4.0 system;

Additional reporting

6) Patients’ caretakers/ family members are expected to install the Client-side software of Giraff Home Health System (Pilot, and

emergency or consult a provider.Priority: must (high)Overall Priority Rank: 1Estimate: 8

tools that would allow reporting, viewing and monitoring patient’s metrics (to be designed).

Additional: Training Giraff System Manuals;

Reporting Tools) and utilize them on constant basis, to follow the patients’ condition dynamics.

7) Patients’ caretakers will have access to only those patient’s Home Health System metrics who they are taking care of.

2)As a caretaker, I want to ensure that my family member/ patient can easily and effortlessly call/ contact me or healthcare provider in case if they don’t feel well, since it may not be obvious to us, so that we can arrive at the patient’s home as soon as possible and provide the needed treatment.Priority: must (high)Overall Priority Rank: 1Estimate: 2

3)As a caretaker, I want to know how my family member is doing at any moment of time, so that I know that they are pursuing the needed daily activities, taking medications, and remember administering insulin injections, as prescribed.Priority: must (high)Overall Priority Rank: 1Estimate: 8

4)As a caretaker, I want to be able to make video calls and explore my family member’s place at any moment, so that I can make sure my family member can socialize and is not feeling forgotten or lonely, and that I can see if everything is in order in their place and they are not missing anything.

Priority: should (medium)Estimate: 4Overall Priority Rank: 3

5)As a caretaker, I would like to ensure that my family member receives notifications about important home environment related issues: smoke and carbon monoxide detectors activation, daily meals, etc., so that they stay safe and organized in their home.Priority: should (medium)Estimate: 4Overall Priority Rank: 3

“System Administrator/ Instructor”

Ekaterina Cole, graduate student working on the current project.

1) As a system administrator, I want the system to be customizable for setup, in accordance with a plan/ layout of a person’s home, so that I can install the MRTP-based Home Health System.Priority: must (high)Overall Priority Rank: 1Estimate: 4



wristband; System of Sensors.



Giraff-based Sentry Administration system;



8) System Administrator/ Instructor is to have access to Home Health Management system patient’s profile settings, but not to its medical records.

9) System Administrator/ Instructor is to create associating settings for a particular patient/ patients with a particular provide/ providers, in a safe manner.

2) As a system administrator, I want the system to be customizable for setup, in accordance with a specifics of a patient’s lifestyle and the provider’s basic medical guidelines, so that I can adjust the settings of the system to fit the patient’s needs best.Priority: must (high)Overall Priority Rank: 2Estimate: 4

3) As a system administrator/ instructor, I

want the system to be user-friendly and easy to utilize, so that I can teach the patients, caretakers, and medical professionals basics of working with the system, so that they can utilize it efficiently.Priority: must (high)Overall Priority Rank: 4Estimate: 2

Testing cases and tools;

Additional tools that would allow reporting and monitoring patient’s metrics (to be designed).

Additional: Vital signs

measurement specifications and medical instructions;

Patient’s home layout plan.

4) As a system administrator, I need be aware of any reported by patient/ provider/ caretaker, current issues with the system, so that I can troubleshoot them as soon as possible.Priority: must (high)Overall Priority Rank: 4Estimate: 4

5) As a system administrator, I need to be able to maintain a dynamic process of constant system support, testing and change management, so that the system can be constantly improved and the associated quality of care can be ensured. Priority: should (medium)Overall Priority Rank: 5Estimate: 8

“Healthcare professionals”

Lindsay Cheslock, RN, Oswego Hospital

1.) As a healthcare professional, I want to be able to access the patient’s blood sugar levels, blood pressure, pulse rate, and body temperature that are being accurately recorded and tracked, in order for me to recommend diet



Additional reporting

10) Medical Professionals are expected to install the Client-side software of Giraff Home Health System (Pilot, and Reporting Tools) and

changes or medication based on the results.

Priority: must (high)Overall Priority Rank: 1

Estimate: 3

tools that would allow reporting, viewing and monitoring patient’s metrics (to be designed).

Interface class between EHR system and Giraff.

Additional: Training Giraff

System Manuals;

utilize them on constant basis, to follow the patients’ condition dynamics.

11) Medical Professionals will have access to only those patient’s Home Health System metrics who they are taking care of.

12) Medical Professionals must follow HIPAA guidelines while accessing, processing and evaluating patients’ information.

2.) As a healthcare professional, I would like to be notified when a patient administers insulin with the time and amount.


Estimate: 2

3.) As a healthcare professional, I would like to be notified when my patient misses a blood test, to be able to immediately check-in with them and ensure their safety.

Priority: must (high)Overall Priority Rank: 1Estimate: 4

4.) As a healthcare professional, I would like an automatic emergency warning to myself and the patient when the blood sugar levels are low, with the message specific to how low the levels are.

Priority: should (medium)Overall Priority Rank: 2Estimate: 8

5.) As a healthcare professional, I would like the expiration dates for newly opened insulin were noted in the

system, so a notification or alarm could be used for refill reminders or to warn for outdated vials.

Priority: should (medium)Overall Priority Rank: 3

Estimate: 5“Project Manager”

Cassie Breen, graduate student working on the current project.

1.) As a project manager, I the system to be customizable and scalable, in accordance with the needs of the users, so that I can correctly indicate the project scope.

Priority: must (high)Overall Priority Rank: 1Estimate: 8



wristband; System of Sensors.



Giraff-based Sentry Administration system;



Testing cases and tools;

Additional tools that would allow reporting and monitoring patient’s metrics (to be designed).

2.) As a project manager, I need to be aware of any issues with the system in order to troubleshoot the issues as soon as possible and ensure the users’ safety.


Estimate: 43.) As a project manager, I need to the

system to allow adjustments, corresponding on any additional needs required by the users in order to correctly adjust the project scope and keep the project on track.


Estimate: 54.) As a project manager, I need to know

the technical aspects of the system in order to properly plan for the

implementation and post-implementation activities.

Priority: should (medium)Overall Priority Rank:3

Estimate: 5

Additional: Vital signs

measurement specifications and medical instructions;

Patient’s home layout plan.

5.) As a project manager, I have to understand the users’ struggles post-implementation in order to explore performance improvements that can be made.

Priority: should (medium)Overall Priority Rank: 3

Estimate: 4

Use Case Diagram

Please see the use case diagram below. Besides main actors their functions, and connections, it also represents the portions of system interfaces, engaged at every point of system function.

Project Artifacts/ Objects

Project Artifacts and Objects can be logically split into Devices/ Objects and Software/ Interfaces and are a part of User Stories, table. Please see below for the alternative view:

Name of the User Role Objects/ “Artifacts”“Diabetic Patients” Devices/ Objects:

Giraff Mobile Robotic Telepresence System; Empatica E4 wristband; System of Sensors. Medications, medical tools, insulin vials and syringes.

Software/ Program Interfaces: Giraff-based Embedded Windows XP system; Empatica wristband Connect embedded system;Additional tools that would allow reporting and monitoring patient’s metrics (to be designed).

Additional: Training Giraff System Manuals

“Other caretakers” Software/ Program Interfaces: Giraff-based Pilot 4.0 system; Additional reporting tools that would allow reporting,

viewing and monitoring patient’s metrics (to be designed).Additional:

Training Giraff System Manuals“System Administrator/ Instructor” Devices/ Objects:

Giraff Mobile Robotic Telepresence System; Empatica E4 wristband; System of Sensors.

Software/ Program Interfaces: Giraff-based Embedded Windows XP system; Giraff-based Sentry Administration system; Giraff-based Pilot 4.0 system; Empatica wristband embedded system; Testing cases and tools; Additional tools that would allow reporting and

monitoring patient’s metrics (to be designed).

Additional: Vital signs measurement specifications and medical

instructions; Patient’s home layout plan.

“Healthcare professionals” Software/ Program Interfaces:

Giraff-based Pilot 4.0 system; Additional reporting tools that would allow reporting, viewing and monitoring patient’s metrics (to be designed).

Interface class between EHR/ Giraff.Additional:

Training Giraff System Manuals

“Project Manager” Devices/ Objects: Giraff Mobile Robotic Telepresence System; Empatica E4 wristband; System of Sensors.

Software/ Program Interfaces: Giraff-based Embedded Windows XP system; Giraff-based Sentry Administration system; Giraff-based Pilot 4.0 system; Empatica wristband embedded system; Testing cases and tools; Additional tools that would allow reporting and monitoring

patient’s metrics (to be designed).

Additional: Vital signs measurement specifications and medical

instructions; Patient’s home layout plan.

Project Set of Business Rules.

Project Business Rules are a part of User Stories, table, in association with user types. Please see below for the alternative view:

a. A Patient is expected to comply with all regulations and procedures for using the Giraff Home Care System: ensure that the MRT and Empatica systems are charged, turned on and utilized in a proper manner to ensure continuity of care.

b. Normal blood pressure for a patient is less than 120/80 mm Hg (less than 120 systolic AND less than 80 diastolic) for an adult age 20 or over.

c. Normal resting heart rate ranges from 60 to 100 beats per minute for adults.d. Patients are expected to contact medical provider/ aide or other taker immediately in case of emergency.e. Patients’ caretakers/ family members are expected to install the Client-side software of Giraff Home Health System (Pilot, and

Reporting Tools) and utilize them on constant basis, to follow the patients’ condition dynamics.f. Patients’ caretakers will have access to only those patient’s Home Health System metrics who they are taking care of.g. System Administrator/ Instructor is to have access to Home Health Management system patient’s profile settings, but not to its

medical records.h. System Administrator/ Instructor is to create associating settings for a particular patient/ patients with a particular provide/

providers, in a safe manner.i. Medical Professionals are expected to install the Client-side software of Giraff Home Health System ( Pilot, and Reporting

Tools) and utilize them on constant basis, to follow the patients’ condition dynamics.j. Medical Professionals will have access to only those patient’s Home Health System metrics who they are taking care of.k. Medical Professionals must follow HIPAA guidelines while accessing, processing and evaluating patients’ information.

Project Non-Functional Requirements

Please see the list of the project non-functional requirements below:

1) Maintainability of the system in connection with the physical layout of a patient’s home: it is important that there are no objects like stairs, floor major cracks, furniture/ blocking objects or thresholds, that would prevent the robot from moving and cannot be easily seen or accounted for while utilizing the system.

2) Security of the system in connection with HIPAA rules and information protection aspects: messages and reports are to be housed within the website, and a recipient will only get a notification by email (secure sharing), the information will be encrypted when shared between the parties and secure emails list feature will be utilized allowing sharing the information only with the trusted addressees. The system portions login procedures (Empatica Connect, Giraff Reporting Tool, Pilot) can be completed only with the use of correct email/ login and password, which will be required to be reset every 3 months.

3) Reliability of the system in connection with necessity to ensure the well-functioning of the system physical parts, including Giraff motors and Empatica charging accumulators, that may be needed to be replaced at some point.

4) Portability of the system in connection with ensuring all plug-ins codes utilize Java as a primary programming language and that the planned extensions are compatible with the Giraff-based Windows operating system.

5) Ensuring necessarily that the system is properly maintained and activated by user: Giraff robot is charged and turned on, Empatica band is charged and placed into the recording mode. Failure to charge the system elements may imply significant dangers to a patient’s health, since his condition will not be tracked in that case.

6) Ensuring proper education of the parties that utilize the system in terms of how it functions, what actions need to be done as periodic operations (charging, activation, taking metrics), and how different parties and system elements would interact with one another.

Paper Prototypes SlidesPaper prototypes for the four of high-priority scenarios are completed using MS Powerpoint and tools and are presented as a separate attachment (-s).

Supplementary Materials.

Use Case Stories and Interview Notes

The purpose of this interview was to gain a better understanding of the needs and concerns of the users of the Giraff Mobile Robotic Telepresence system. We contacted Virginia Cole, an 83-year old resident of Holy Trinity Nursing and Rehabilitation Center in Worcester, MA, who was relocated there from Assisted Living Condo Apartments, due to her acute condition.

After explaining the background of the Giraff telepresence system and the project as a whole, I asked Mrs. Cole to provide me with 5 items/uses she would expect from a system of this nature as a diabetic patients. Her answers were provided as follows (*):

“As a patient, I want to see my vital sign levels within the normal range, and I want to be able to measure some of them myself, so that I can ensure my condition is not worsening.”

“As a patient, I want to make sure that there’s both a medical professional and family member I can easily reach out to at any moment if I don’t feel well or in case of emergency, so that they can take timely measures.”

“As a patient, I want to be supervised and reminded when to take my medications, administer insulin injections, and do some of my prophylactic activities, so that I don’t forget to accomplish these tasks.”

“As a patient, I want to receive feedback on my medical metrics and day-to-day activities, if something is abnormal or outside of the accepted range, so that I can be aware of my condition and ask for further recommendations if needed.”

“As a patient, who lives alone and far away from my children and family, I want to be able to talk to them more often, and experience their presence, even in a teleconversation/ video format, so that I don’t feel lonely, depressed and can socialize and address any urgent issues.”

The purpose of this interview was to gain a better understanding of the needs and concerns of the users of the Giraff Mobile Robotic Telepresence system. We contacted Lindsay Cheslock, RN for a knowledgeable discussion of what the Giraff system is and what the expectations of a medical professional are when utilizing this system. Lindsay Chelslock works with many elderly patients, including those with diabetes and has over 5 years of nursing experience.

After explaining the background of the Giraff telepresence system and the project as a whole, I asked Cheslock to provide me with 5 items/uses she would expect from a system of this nature when dealing with her elderly diabetic patients. Her answers were provided as follows:6.)

“As a healthcare professional, I want to be able to access the patient’s blood sugar levels, blood pressure, pulse rate, and body temperature that are being accurately recorded and tracked, in order for me to recommend diet changes or medication based on the results.”

“As a healthcare professional, I would like it to keep record of blood sugar levels and how much insulin was required if any. Dates and times of day, so we could watch for a trend in case a change in medication or diet counseling is needed.”

“As a healthcare professional, I would like the patient to be able to input how many units of insulin administered, so I could review.”

“As a healthcare professional, if a low reading were to be obtained I would like an alarm set for the patient to either eat 15 grams of carbs or retest in 15 minutes depending on how low the reading was. If it were dangerously low or high 911 should automatically be called. Perhaps the system should prompt the patient to eat a snack if reading was low. “

“As a healthcare professional, I would like the expiration dates for newly opened insulin be added, so that I can be alarmed for outdated vials or even receive a signal when a refills needed when getting close to the end of the vial.”

“Confusion and lethargy are common symptoms for too high or too low of a blood sugar. As a healthcare provide, I would like an alarm or notification to automatically sound when a finger stick is missed, especially in case the patient was already unconscious and wasn't able to test blood sugar.”

The purpose of this interview was to gain a better understanding of the needs and concerns of the users of the Giraff Mobile Robotic Telepresence system. We contacted Melissa Frechette, RN, caretaker at Samaritan Summit Village and home health aide for her grandparents, for a knowledgeable discussion of what the Giraff system is and what the expectations of a medical professional are when utilizing this system. Melissa works with many elderly patients, including those with diabetes and has over 8 years of nursing experience, including her time in the US Army as a medical specialist, and is currently a primary caretaker for her elderly grandparents, both of whom suffer from diabetes.

After explaining the background of the Giraff telepresence system and the project as a whole, I asked Frechette to provide me with 5 items/uses she would expect from a system of this nature when dealing with her elderly diabetic patients. Her answers were provided as follows:

“As a caretaker, I want to ensure my family member’s/ patient’s diabetes health monitoring metrics are being constantly taken, assessed, are sent as a report to me, and are under control, so that I can act quickly in case of emergency or consult a provider.”

“As a caretaker, I want to ensure that my family member/ patient can easily and effortlessly call/ contact me or healthcare provider in case if they don’t feel well, since it may not be obvious to us, so that we can arrive at the patient’s home as soon as possible and provide the needed treatment.”

“As a caretaker, I want to know how my family member is doing at any moment of time, so that I know that they are pursuing the needed daily activities, taking medications, and remember administering insulin injections, as prescribed.”

“As a caretaker, I want to be able to make video calls and explore my family member’s place at any moment, so that I can make sure my family member can socialize and is not feeling forgotten or lonely, and that I can see if everything is in order in their place and they are not missing anything.”

“As a caretaker, I would like to ensure that my family member receives notifications about important home environment related issues: smoke and carbon monoxide detectors activation, daily meals, etc., so that they stay safe and organized in their home.”

I communicated with Melissa over the phone and via email, and her written notes, containing a major portion of what was discussed, are, as well available:

1) What would be the expected benefits of the system in your opinion for a perspective user (elderly diabetic patient)? – The major benefit is that diabetes will be controlled. Patients sometimes forget to take their diabetic meds or insulin shots, so in a way this could be their virtual reminder.

2) What features of the system do you think would be especially beneficial for you, as a provider/ caretaker? - Personally, I think, all features are great. We are in the society where robotic and virtual help are really needed. People are getting older longer and some are not lucky to have family members around 24/7.

3) Are there any additional elements to the system/ uses you can think of? - Does it have non-health benefits such as smoke and carbon monoxide detectors? Elderly sometimes don’t pay attention to that stuff. If this robot is going to be in my Grandparents’ home, I would love for it to detect main issues around my house, other than only health-related issues.

4) What patient-related data would you like to see generated with the help of the system and transmitted/ transferred to you (vital signs, if yes, which)? - V/S is always great to receive; bp, pulse ox, fsbs and medication administration (to see if patients are compliant taking their medications) would also be great.

5) In which format would you like to receive patient data? (report, waveform, etc). – We work with charts in many formats, and it would be helpful to receive this information any specifically designed format, for instance, chart report, as long as it is readable and someone with no medical background can comprehend it.

6) Which challenges, in your opinion, may the system have? - The challenges that I see is possible system failure due to complexity, and in conditions when a diabetic patient grows very dependent on it, it can be life-threatening. Is the robot battery operated? Mounted to a power cable? If yes, we need to ensure the robot is always charged, elderly can forget to do that.

7) Would the system be a beneficial home care solution, in your opinion, for those with diabetes? - Most Americans now have diabetes because of obesity, genetic factors and so forth (other comorbidities). If we talk about having this robot only to control diabetes, I don’t see this robot to be in lower and middle class’s homes. Things like this would, of course, be very costly to an individual patient.

The purpose of this interview was to gain a better understanding of the needs and concerns of the users of the Giraff Mobile Robotic Telepresence system. Cassie Breen, a SUNY Oswego Graduate student working on the project, was contacted for a knowledgeable discussion of what expectations she has as a project manager being involved in the project.

Breen was asked to provide a number of items/uses she would expect from a system project of this nature. The responses were as follows:

“As a project manager, I the system to be customizable and scalable, in accordance with the needs of the users, so that I can correctly indicate the project scope.”

“As a project manager, I need to be aware of any issues with the system in order to troubleshoot the issues as soon as possible and ensure the users’ safety.”

“As a project manager, I need to the system to allow adjustments, corresponding to any additional needs required by the users in order to correctly adjust the project scope and keep the project on track.”

“As a project manager, I need to know the technical aspects of the system in order to properly plan for the implementation and post-implementation activities.”

“As a project manager, I have to understand the users’ struggles post-implementation in order to explore performance improvements that can be made.”

“Any issues involved in the project and the system that could hurt the project scope or be harmful to the user need to be communicated with me immediately in order to adjust, troubleshoot and solve”

“If there are additional parts of the system or project that are needed, I should be aware of these in order to adjust the project scope and keep the project on track. Scope creep is always a possibility when working on projects, but communication is key to try to avoid and deal with it.”

“I need to understand from the system administrator what the technical aspects of the project are in order to properly schedule implementation and post-implementation activities, including training.”

“I would like to have feedback on any struggles or anything the users feel is missing post-implementation in order to explore any improvements that could be made and schedule those as appropriate.”

The purpose of this interview was to gain a better understanding of the needs and concerns of the users of the Giraff Mobile Robotic Telepresence system. Ekaterina Cole, a SUNY Oswego Graduate student working on the project, was contacted for a knowledgeable discussion of what expectations she has as a System Administrator/ Instructor, being involved in the project.

Cole was asked to provide 5 items/uses she would expect from a system project of this nature. The responses were as follows:

“As a system administrator, I want the system to be customizable for setup, in accordance with a plan/ layout of a person’s home, so that I can install the MRTP-based Home Health System.

“As a system administrator, I want the system to be customizable for setup, in accordance with a specifics of a patient’s lifestyle and the provider’s basic medical guidelines, so that I can adjust the settings of the system to fit the patient’s needs best.”

“As a system administrator/ instructor, I want the system to be user-friendly and easy to utilize, so that I can teach the patients, caretakers, and medical professionals basics of working with the system, so that they can utilize it efficiently.”

“As a system administrator, I need be aware of any reported by patient/ provider/ caretaker current issues with the system, so that I can troubleshoot them as soon as possible.”

“As a system administrator, I need to maintain a dynamic process of constant system support, testing and change management, so that the system can be constantly improved and the associated quality of care can be ensured.”

______________________________

* The additional information, associated with the users’ interviews, like priority, estimate, business rules and objects/ artifacts, can be found in the User Stories main chart.

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