S&I SimplificationUse Case Authoring Tool (UCAT)

Introduction

In collaboration with NIST and AHRQ25 March 2013

S&I Simplification/UCAT Intro 2

S&I Simplification

Cross Initiative Effort to…• Compile and Distill Components from All S&I Initiatives

– For easy reference, organization, comparison– 13 Use Cases with 33 Multi-Step Scenarios– Initiatives: TOC, LCC, LRI, LOI, PD, esMD, QH, DS4P, PHRI, HeD

• Convey Uniform and Integrated Patterns of:– Patient Flow – with Patient as Actor– Provider (Work/Process) Flow – with Provider as Actor– Information Flow – including System as an Actor

• Show:– Event Steps with Actions taken – by Actors in Roles – to support

individual health and provide healthcare– Health record entries resulting from Actions taken

• Show Commonalties, Patterns of Repetition/Re-Use– Both Current and Potential

24 March 2013

S&I Simplification/UCAT Intro 3

Components selected from S&I Initiative Use Cases

Is it… Potentially Computable for…In Common?

Re-Usable?

Computable?

Identity

Accountability

Permission, Consent

Access,Data Use

Performance/ Fulfillment

Capture, Provenance

Content:Struct/Unstruct

Coding,Classification

Completeness

Signature

Audit

Requirements Y Y Y • •Actors, Roles Y Y Y • • • • • • • •

Events, Actions Y Y Y• • • • • • • • As standards-based software services

Data Objects, Elements Y Y Y

• • • • • • • • • As standards-based data objects, messages, documents…

S&I Simplification

Component Selection

24 March 2013

S&I Simplification/UCAT Intro 424 March 2013

S&I Simplification/UCAT Intro 5

(LINK to Core Matrix Spreadsheet v2.4)

• Status – of S&I Initiative Analysis• Key – Contents of All Tabs• Assertions – Basis for Initial Requirements• *Common Requirements• *Common Actors• *Scenarios, Events – w/Action examples• *Common Actions• *Common Data Objects

* Re-usable Components

24 March 2013

S&I Simplification

Core Matrix

S&I Simplification/UCAT Intro 624 March 2013

S&I Simplification/UCAT Intro 7

(LINK to Progression Spreadsheet)

• To Date– S&I Simplification + AHRQ– Core Matrix + USHIK Registry

• Future– S&I Use Case Requirements Phase with Use Case Authoring

Tool (UCAT)– S&I Use Case Harmonization Phase with NIST Tools

• Standards Selection• Implementation Guide (Tools)• Testing (Tools)

24 March 2013

S&I Simplification

Progression

S&I Simplification/UCAT Intro 8

Source Contribution

Use Case Authoring Tool (UCAT) Prototype

Developed by:Art Griesser

Prometheus Computing

NIST Cross Industry Perspective, SmartGrid Project (2010)

S&I Simplification

Consensus Approved Core Simplification Matrix (.xlsx)

S&I Use Case Requirements Template (.docx)

S&I Lab Results Initiative (LRI)

Consensus Approved LRI Use Case Requirements Template (.docx)

HL7 EHR WGISO/HL7 10781/16527, EHR/PHR System Functional Models

AHRQ

ISO 11179 USHIK Registry of S&I Simplification Components

24 March 2013

S&I Simplification

Ingredients – UCAT Prototype

S&I Simplification/UCAT Intro 9

S&I Simplification

Use Case HierarchyGenerally UCAT Prototype – Example

An Initiative… Lab Results Interface (LRI) Initiative

Has one or moreUse Cases… 1) Lab Results Interface

With one or more Scenarios… 1) Send/Receive/View Test Results

With one or more Events (Steps)… 1) Send 2) Receive 3) View

With one or more Actions.

(Simplification Examples)

• Identify Patient, Provider, Lab System

• Originate/Attest/Retain - Lab Results Report

• Verify - Lab Results Report

• Set Data Access Permissions

• Transmit - Lab Results Report

• Identify (EHR) System

• Receive/Retain - Lab Results Report

• Identify, Authenticate Provider

• Check User Data Access Permissions

• Access/View - Lab Results Report

24 March 2013

S&I Simplification/UCAT Intro 10

S&I Simplification – Demonstration of Concept

Use Case Tool StatusCurrent Capabilities• Imported Core Matrix• Captured use case template structure

– Populated completely for LRI• Can construct new use cases from

reusable components• Can create human readable use cases (in

UC template)• Can curate underlying UC information• Can use underlying info programmatically

– SQL query• Import: CSV

– UCAT Native– Simplification Core Matrix– ISO/HL7 10781/16527 EHR/PHR System

Functional Models• Export: JSON, CSV• Ability to clone

Additional Capabilities and Refinements• Ability to track status of information

– Component Lifecycle Management• Agreement to Productize UCAT

Next Steps• Add remaining 14 S&I Use Cases

– One-time manual entry– Resolving differences from template

• Refine existing master template• USHIK integration• CEDD integration• Evaluate handoff to downstream tools

– Implementation Guide, Testing…

24 March 2013

S&I Simplification/UCAT Intro 11

• Capture Once, Re-Use Many Times– Component + Standard + Imp Guide + Testing– Each Re-Use Instance: x 2 Savings– Facilitates Cross Agency– Facilitates S&I Cross Initiative– Unlocks Value of S&I (maximizing re-use, return)

• Experience Shows:– AHIC/HITSP: 5 Years, 17 Use Cases (3+/yr)– S&I: 2 Years, 13 Use Cases (6+/yr)– Now w/UCAT: ?

24 March 2013

S&I Simplification

Benefits

Tools to Automate the S&I Platform

A ProposalMarch 29, 2013

DRAFT

DRAFT 13

Growing Portfolio of Module Based Initiatives

But this has led to growing complexity and diverse designs, models and solutions

Doug Fridsma to HITPC – 3/14/13

DRAFT 14

S&I Core Matrix Has Captured and Standardized S&I Initiatives . . .

. . . as Shared, Reusable and Computable Components . . . Now we need a tool to use the Core Matrix

DRAFT 15

Tools to Automate the S&I Platform

USHIKRegistr

yReposit

oryLink to NLM

NISTTest

Methods

S&ICore

Matrix UCAT IGAT

Business Requirements and

SMEs

Implementable Solutions

CEDD/FHIM/CIMI Data Models and

Mapping

Standards Developers and

Stewards

DRAFT 16

Why UCAT First?

• Foundational to all downstream automation and tools

• Highest leverage is at the beginning analysis and design of an initiative– COnstructive COst Model – Overall effort is doubled if analysis is shortchanged– Correct is hard... but easier than later fix – Ounce of prevention – Measure twice, cut once – “By failing to prepare, you are preparing to fail” Ben Franklin

• Use Cases– Study how users get value from system– Define how users interact with system – Help subsequent efforts deliver value – Are contracts between users & developers

• Refer to Art Griesser Presentation in Appendix

DRAFT 17

Use Case Authoring Tool

DRAFT 18

NIST Role (Kevin – maybe quotes from Frederick

• Experience with Use Case Authoring through Smart Grid

• Developed automated test procedures, methods and tools for CEHRT and Mod Specs

• UCAT is based on NIST platform with further specialization for the S&I Core Matrix by Art Greisser

DRAFT 19

Brief Overview of Process Flow

DRAFT 20

UCAT Demonstration

• NEED OUTLINE FROM ART• Show how to create a human readable,

machine computable UC example from Core Matrix and UCAT

DRAFT

S&I Simplification – Demonstration of ConceptUse Case Tool Status

Current Capabilities• Imported Core Matrix• Captured use case template

structure– Populated completely for LRI

• Can construct new use cases from reusable components

• Can create human readable use cases (in UC template)

• Can curate underlying UC information

• Can use underlying info programmatically– SQL query

• Import: CSV– UCAT Native– Simplification Core Matrix– ISO/HL7 10781/16527 EHR/PHR

System Functional Models• Export: JSON, CSV• Ability to clone

Additional Capabilities• Ability to track status of

information– Component Lifecycle Management

Next Steps• Add remaining 14 S&I Use Cases

to UCAT– One-time manual entry– Resolving differences from template

• Refine Core Matrix master template

• USHIK Integration• S&I Data Integration

– CEDD, FHIM, or CIMI . . .• Evaluate and design handoff to

downstream tools– Implementation Guide Authoring– Testing Tools, MDHT, V2 …

DRAFT 22

• Capture Once, Re-Use Many Times– Each Re-Use Instance = x 1 Savings– Facilitate Cross S&I Initiative

Coordination– Facilitate Cross Agency/Domain

Coordination– Unlocking Value of S&I (maximizes re-

use, return)• Experience Shows:

– AHIC/HITSP: 4 Years, 17 Use Cases/Initiatives (4+/yr)

– S&I: 2 Years, 13 Use Cases/Initiatives (6+/yr)

– With UCAT: ?• With IGAT, With Test Methods?

Simplification – Automating the S&I PlatformBenefits

UC Requirements

Implementation Guides Test Methods

Faster, real world adoption

S&I Platform

Automated Tools

DRAFT 23

Appendices

• Gary Dickinson Presentation - DRAFT Use Case Authoring Tool - Simplification Introduction

• Art Greisser Presentation - "Use Cases" Slide Set

• Frederick’s Presentation - ?• Link to USHIK S&I Pilot Site• Link UCAT Portal TBD

Use Cases

• Arthur Griesser, PhD

• Prometheus Computing, LLC

What reduces development time the most?

• Better tools for developers?• More training for developers?• More experience in domain?• Better understanding of

requirements?

What reduces development time the most?

• Better tools for developers?• More training for developers?• More experience in domain?• Better understanding of

requirements?

✓

COnstructive COst MOdel

Effort is Doubled if analysis is shortchanged

Why Is Analysis So Important?

• Correct is hard... but easier than later fix

• Ounce of prevention• Measure twice, cut once• By failing to prepare, you are

preparing to fail Ben Franklin

• Police in Gumperda, Germany, arrested a 64-year-old retired do-it-yourselfer in November after he drilled through a neighbor's wall in their duplex home. The man had spent two days trapped in his own basement, where he had laid bricks and mortar for a room but apparently forgot to leave himself an exit. [BBC News, 11-25-10] Chuck Shepherd’s News of the

Weird, week of Dec 12, 2010

Use cases...

• Study how users get value from system

• Define how users interact with system

• Help subsequent efforts deliver value

• Are contracts between users & developers

UML?

• Suitable for parts of a use case:• Use case diagram• Activity diagram• Communication diagram

• Usually a small fraction of a use case

• UML does not define use case structure

Beware

• Analysis Paralysis• Duplication• Conflicting Requirements• Excessive Complexity

The Next Level

What if...

• We could just “run” use cases as tests?• Traceability guaranteed• Tests & use cases always in synch• Less effort, expense• Tests are as complete as use cases

Today

TodayBetter

Executable

Verify >

Use cases

• Specify how user gets value from system

• Describe interaction of user & system

• Abstractly

Use cases

• Specify how user gets value from system

• Describe interaction of user & system

• Abstractly

Ensure

Verify

Tests

Concretely (specific test data)

Simplification/UCAT Intro 39

S&I Simplification

General High Level Goals• [G1] Decrease | limit waste

– Time spent working on artifacts– Unused or unreachable artifacts

• [G2] Increase domain penetration– The more use cases and scenarios, the more fully the domain issues can be

understood and addressed• [G3] Centralize information

– Create a network of specialized information that can be shared• [G4] Increase | facilitate collaboration

– Manage centralized information so it stimulates collaboration (i.e. online services)

• [G5] Facilitate integration of information in process– Information generated at a point in the process should flow and be easily

usable by underlying processes• [G6] Reuse of existing infrastructure21 March 2013

Simplification/UCAT Intro 40

S&I Simplification

Use Case Authoring Tool• Facilitates use case components capture (G1-2)• Facilitates use case components reuse (G1-2)• Creates a repository of use case components (G3)• Is accessible online (G4)• Allows for developed use cases to be electronically

handled by underlying processes (i.e. implementation guides) (G5)

• Helps the developed use cases to stay consistent (G1-3-5)

• Allows full access of the underlying data to trusted members for integration with the existing infrastructure (G6)

21 March 2013