mass hiway use case workshop - sept, 2013
DESCRIPTION
Sean Kennedy, MeHI Director of the Health Information Exchange, shares tips on how to develop a use case.TRANSCRIPT
Mass HIway Use Case Workshop
Sean Kennedy Mass eHealth Institute Director, Health Information Exchange
Learning Objectives
Communicate the benefits of a use case
Identify a use case scenario / ‘user story’
Develop a use case with recommended elements
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Agenda
Use Case Introduction
Elements of a Use Case
Development Guidance
Use Case Examples
Discussion
Key Takeaways
Resources
Use Case Introduction
What is a Use Case? – A use case is an easy to understand description detailing the
interaction between an actor (human, organization, system) and a system under consideration.
– For HIway purposes, it identifies a set of ‘trading partners’ and source and destination systems and describes how they intend to use the Mass HIway.
Why do we use them? – Use cases are developed with the goal in mind, which makes
them a valuable planning tool. – A well-crafted use case communicates the functional
requirements that may then inform technical planning. – Having them available prior to technical discussions helps scope
the technical solution and accelerates the technical evaluation process.
Use Case Introduction (cont.)
How they should help you? – Use case development requires an understanding of the
business need – the issue you seek to resolve or opportunity on which you intend to capitalize.
– Defining your need early in the process will accelerate later development efforts and provide a basis for evaluating success.
• Examples: – “I need to join the HIway”
» Way too ambiguous – “Our Practice needs to generate and securely send summary of
care records to my patients’ specialists to meet MU2, Transition of Care criteria.”
» Provides initial needed details to guide plan development, scope the effort and establish priorities
“Our Practice needs to generate and securely send summary of care records to my patients’ specialists to meet MU2, Transition of Care criteria.”
Use Case Context with the HIway
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A key milestone on the HIway connection path
Use Case Benefits
Identifies the clinical / business need before solution development…mitigating rework and delays
Facilitates initial scoping, project planning and effort prioritization
Supports ‘selling’ your request to management – you have done your due diligence to articulate value, not just functionality
Supports identifying the project team / stakeholders
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Use Case Elements
Use case name
Goal
Story
Actors
Data to exchange
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Minimum required to get going
Important detail
Use Case Elements | Minimum required to get going
Use case name – A brief summary of your use case (limit to 100-characters)
• Patient referral from PCP to Specialist
Goal – What is your end goal?
• To attest for MU2, Transition of Care criteria
Use Case Elements | Minimum required to get going
Story – How do you intend to use the Mass HIway?
• Perspective > A provider referring a patient to a specialist • Context > The referring provider has made the determination that it
is clinically and legally appropriate to send a referral and summary of care to the specialist.
• Story – Dr. Jones (the referring provider) searches for a patient in the
practice EHR and initiates a referral message. The referral reason is described in the message. In some cases the referral is directed to a specific specialist, and in other cases to a specialist practice. Dr. Jones attaches a summary of care for reference, and then sends the referral.
– Dr. Smith (the specialist) sees the new referral in her local practice EHR. If this is a new patient for the practice, a new patient is created in the EHR. The core referral and the various documents are imported into the new patient's chart
10 Reference: The Direct Project, User Stories http://wiki.directproject.org/Primary+care+provider+refers+patient+to+specialist+including+summary+care+record
Use Case Elements | Minimum required to get going
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Moved to Production Live
(Actively Exchanging Patient data) (Connected, but not exchanging data)
1. Beaumont Rehab and Skilled Nursing
2. Brockton Neighborhood Health Center 3. Pediatric Care Associates 4. Jessica Foley, LMHC 5. Notre Dame Long Term Care 6. Millbury Health Care Center
7 – 22. Holyoke HM Connect HIE • Holyoke Medical Center • Western MassachusePs Physicians Associates
(29 providers)
• Holyoke Medical Center SpecialVes (12 providers)
• 12 Individual, independent pracVces
1. Partners Healthcare
2. Atrius Health 3. Boston Children’s Hospital 4. Metrowest Medical Center – Vanguard 5. St. Vincent Hospital – Vanguard 6. Heywood Hospital
7. Care Tenders 8. Medway Country Manor 9. CMIPA – Dr. Sunita Godiwal 10. CMIPA -‐ Dr. George Abraham 11. Milford Regional 12. Holy Trinity Nursing and Rehab 13. Greg Harris
• Potential Trading Partners on the HIway
As of 9/6/2013
Use Case Elements | Important details
Actors – Who are the senders or receivers, e.g. people, roles,
organizations? • People = Dr. Jones, Nurse Thompson • Roles = Case Manager, Triage Nurse • Organizations = Hospital ABC, Medical Associates of XYZ
– When describing the organization include size indicators, e.g. number of beds, providers, visits per month.
– What are the source, destination and intermediary systems? • When describing systems include vendor names and versions.
– The Mass HIway is an intermediary system
Data to Exchange – What data do you intend to exchange?
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Example of a data set
Common Meaningful Use Data Set – All data that may be
exchanged as part of MU2
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1. Patient name 2. Sex 3. Date of birth 4. Race ** 5. Ethnicity ** 6. Preferred language 7. Care team member(s) 8. Allergies ** 9. Medications ** 10. Care plan 11. Problems ** 12. Laboratory test(s) ** 13. Laboratory value(s)/result(s) ** 14. Procedures ** 15. Smoking status ** 16. Vital signs
NOTE: Data requirements marked with a double asterisk (**) also have a defined vocabulary which
must be used.
Use Case Guidance
Guidance – Limit the use case to 1-2 page(s) – Engage your clinical and business leaders early – Align to business objectives, e.g. meaningful use criteria – Complete all identified elements, but in 2 phases:
1. Part 1 – Name, Perspective, Context, Story o includes trading partners
2. Part 2 – Actors, Data to Exchange
– Do not describe technical connectivity (i.e. S/MIME vs. XDR), rather tell the story of how you will use the solution once built
– Do not make the use case too general – select a well-defined area of focus and add in appropriate detail
Use Case Examples
List of Use Cases
Use Case Type of Transaction Care Setting To Care Setting
1.1 Referral -- Summary of care record PCP Specialist
1.2 Consult note -- Summary of care record Specialist PCP
2.1 Referral -- Summary of care record PCP or specialist Hospital
2.2 Hospital admission notification Hospital Referring physician and/or PCP
3.1 Hospital ED visit summary Hospital Referring physician and/or PCP
3.2 Hospital discharge summary Hospital Referring physician and/or PCP
3.3 Hospital discharge summary Hospital Other care settings (i.e. SNF)
4.1 Hospital admission notification Hospital Referring Hospital
4.2 Hospital discharge summary Hospital Hospital
5.1 Public Health Reporting (coming soon) PCP or specialist Public health
5.2 Public Health Reporting (coming soon) Hospital Public Health
Care Coordination Uses Cases Provider to Provider
Use Case Scenario 1.1/1.2 – Referral
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Patient Scenario
1. Patient sees PCP
2. PCP’s plan includes a referral to a Cardiac specialist
3. Referral to specialist is authorized and generated via Direct with a summary of care document
4. Referral and summary of care is sent via HIway to Cardiac specialist
Specialist
A. Receives Direct message with summary of care document
B. Provides necessary care
C. Generates a consult note for delivery to PCP
D. Consult note is attached to a Direct message and sent via the HIway to PCP
Referral
Consult Note PCP Specialist
Care Coordination Uses Cases Hospital to Provider/Provider to Hospital
Use Case Scenario 2.1/2.2 – Hospital Referral
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Patient Scenario
1. Patient sees PCP or specialist
2. Treatment plan includes a referral to a local hospital
3. Referral to hospital is authorized and generated via Direct with a summary of care document
4. Referral is sent via HIway to hospital
Hospital
A. Receives Direct message with summary of care document
B. Provides necessary care
C. Generates an admission notification and summary of care document
D. Admission notification sent via HIway to PCP and/or specialist
PCP
Specialist
Use Case Scenario 3.1 – ED Notification
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Patient Scenario
1. Patient presents at ED
2. Patient is treated and released
Hospital
A. Provides necessary care
B. Generates an admission notification and summary of care document
C. Admission notification sent via HIway to PCP and/or specialist
PCP
Referring Physician
Use Case Scenario 3.2/3.3 – Discharge Summary
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Patient Scenario
1. Patient is discharged from hospital to the care of a referring physician, PCP or other care setting
Hospital
A. Provides necessary care
B. Generates a discharge summary and summary of care document
C. Discharge summary sent via HIway to referring physician, PCP, and/or other care setting
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Specialist
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PCP
SNF
Use Case Scenario 4.1/4.2 – Referral
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XYZ Hospital
1. Patient admitted to XYZ ED
2. Treatment plan calls for a tertiary level of care
3. Patient is referred to ABC hospital
4. Referral and summary of care are generated via Direct message
5. Direct message is sent via HIway to ABC hospital
ABC Hospital
A. Patient is received at ABC hospital
B. ABC hospital receives referral and summary of care document
C. Provides necessary care
D. Generates a discharge summary and summary of care via Direct
E. Sends discharge summary and summary of care via HIway to XYZ hospital
XYZ Hospital ABC Hospital
Public Health Use Cases – Coming Soon
Immunization Reporting
Electronic Lab Reporting
Syndromic Surveillance
CBHI
Recent use case additions
School immunizations
Bed availability
Structured lab results to ambulatory providers
Eligibility verification
Authorization for care
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Discussion
What are some other use cases?
Where may we look for ‘User Stories’?
How may MeHI further support use case development?
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Key Takeaways
Use cases are developed with the goal in mind and communicate the functional requirements
Identifies the clinical / business need before solution development …mitigating rework and delays
Facilitates initial scoping, project planning and effort prioritization
Elements of a use case include: – Use case name
– Goal – Story
– Actors – Data to exchange
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Minimum required to get going
Important detail
Resources
MeHI – Develop a Use Case website – http://mehi.masstech.org/health-information-exchange-0/mass-hiway/develop-hiway-use-
case
MeHI - Use Case Library – http://mehi.masstech.org/sites/mehi/files/images/HIway/Mass-HIway-Use-Case-
Examples-2013.pdf
HIway Implementation Grant – Press Release with user story descriptions
• http://mehi.masstech.org/press-releases/massachusetts-ehealth-institute-masstech-awards-235-million-grants-accelerate
– Summaries (coming soon)
HIway Interface Grantees – Press Release -
http://mehi.masstech.org/news/massachusetts-ehealth-institute-awards-vendor-grants-advance-accelerate-health-information
Direct Project - User Story website – http://wiki.directproject.org/User+Stories
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