Storyboards Storyboards and and

Activty DiagramsActivty Diagrams

Dan Russler, M.D.Dan Russler, M.D.

July 19, 2005July 19, 2005

Tutorial ObjectivesTutorial Objectives

Develop a strategy for building a Develop a strategy for building a communication bridge between communication bridge between domain experts and engineersdomain experts and engineers

Define the borders between Define the borders between problem-space and solution space problem-space and solution space analysisanalysis

Introduce HL7 StoryboardsIntroduce HL7 Storyboards Introduce Unified Modeling Introduce Unified Modeling

Language (UML) Activity DiagramsLanguage (UML) Activity Diagrams

Tools for Requirements Tools for Requirements AnalysisAnalysis

Basic Modeling EnvironmentBasic Modeling Environment PenPen PaperPaper

Intermediate Modeling EnvironmentIntermediate Modeling Environment Microsoft WordMicrosoft Word Microsoft VisioMicrosoft Visio Microsoft ExcelMicrosoft Excel

High-end Modeling EnvironmentHigh-end Modeling Environment Rational RoseRational Rose

`

The Communication The Communication PyramidPyramid

Communication Models

Free-text Documents

Structured Documents

ad hoc Drawings

Non-standard Graphics

Discussions

Standardized Process Analysis (UML)Pro

blem

Probl

em

Space

Space

Solution

Solution

Space

SpaceIm

plem

enta

tion-

Inde

pend

ent

Implem

entation-Specific

Lev

el o

f A

bst

ract

ion

Problem-Space ArtifactsProblem-Space Artifacts

Storyboard Text*Storyboard Text*

UML Storyboard Activity Diagram*UML Storyboard Activity Diagram*

Domain GlossaryDomain Glossary

UML Domain Analysis ModelUML Domain Analysis Model

Static Model Cross-Reference (to HL7 Static Model Cross-Reference (to HL7 RIM)RIM)

HL7 Reference HL7 Reference Information ModelInformation Model

Where does it fit into the process?Where does it fit into the process?

Storyboards

HL7 RIM

Problem-Space Analysis Process (a la HDF)

Lev

el o

f Abs

trac

tion

Message Artifacts

Probl

em

Probl

em

Space

Space

Solution

Solution

Space

Space

Why Storyboards?Why Storyboards?

Domain experts can usually write Domain experts can usually write narrative, free-form descriptions of how narrative, free-form descriptions of how the domain worksthe domain works

An inexpensive method for gathering An inexpensive method for gathering requirements that documents the requirements that documents the business processbusiness process

Able to describe a series of Able to describe a series of actions/interactions between one or many actions/interactions between one or many persons and/or systemspersons and/or systems

Focuses on the problem spaceFocuses on the problem space

Sample StoryboardSample Storyboard Precondition: Precondition: Christine, age 46, was recently

diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Susan reviews Christine’s chart including the problem list, allergies, Christine’s chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education education plan. She schedules Christine for education on the disease and on the side effects of on the disease and on the side effects of chemotherapy.chemotherapy.

Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Why Activity Diagrams?Why Activity Diagrams? Clarifies the roles of people and systems in

the storyboard Clarifies the names of the activities Clarifies the sequence of activities Clarifies the decision points Identifies opportunities for messages

Clarifies the data communicated at each point Clarifies the trigger events for specific processes

Sample Activity DiagramSample Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

Person, procedure, reason : Request

Why Glossaries? Domain experts don’t agree on the

meaning of terms Domain vocabularies and mappings

often poorly understood, e.g. ICD, CPT, SNOMED

Engineers don’t understand domain terms

Multi-word terms not defined in dictionaries

Term meanings needed for later steps in analysis process

Sample GlossarySample GlossarySource Term Term Source Storyboard Sentence Nominalized

VerbGeneral Dictionary Definition

Domain Dictionary Definition

Inferred Question

SNOMED CT

Lexical Match

Meaning Match

Christine Storyboard: Single-word Term

Christine, age 46, was recently diagnosed with stage II breast cancer.

not applicable Not Applicable What was the name?

diagnosed Storyboard: Single-word Term

Christine, age 46, was recently diagnosed with stage II breast cancer.

diagnosis The act or process of determining the nature and cause of a disease or injury through examination of the patient

The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data

What was the diagnosis?

Establish-ed diagnosis 14657009

breast cancer Storyboard: Multi-word Term

Christine, age 46, was recently diagnosed with stage II breast cancer.

none none What was the diagnosis?

254837009 Malignant tumour of breast

RN Activity Diagram: Role A graduate trained nurse who has passed a state registration examination and has been licensed to practice nursing

A nurse who has graduated from an accredited school of nursing and licensed to practice by a state authority

224535009 Registered nurse

reviews chart Activity Diagram: Action State

chart review Review: An inspection or examination for purposes of evaluation

Chart: A recording, in tabular form, of clinical data relating to a case

Review of 55210009 medical

records review, 312853008

requests education appointment

Activity Diagram: Action State

education appointment request

Patient education 311401005

request Activity Diagram: Flow Class

Why Domain Analysis Why Domain Analysis Models?Models?

(A UML Class Model or Static Model or Information Model)(A UML Class Model or Static Model or Information Model)

Each domain has evolved an Each domain has evolved an independent “world view”independent “world view” Domain experts can only validate what is Domain experts can only validate what is

familiar to them familiar to them Domains tend to see themselves as unique Domains tend to see themselves as unique Domain “world view” is filled with jargonDomain “world view” is filled with jargon

Domain “world view” (Information Domain “world view” (Information Model)Model) Best way to teach people about a domainBest way to teach people about a domain Best view of the requirements for a domainBest view of the requirements for a domain

Sample Domain Analysis Sample Domain Analysis ModelModel

+timing-code-vocabulary-vtext-stext

Action

-code-vocabulary-vtext-stext

Site

-hasSite

-code-vocabulary-vtext-stext

Route

-hasRoute

-code-vocabulary-vtext-stext

Means

-code-vocabulary-vtext-stext

Object of Action

-hasMeans

-actsOn

-name-role-code-vocabulary-vtext

Recipient of Care-hasRecipientOfCare

OtherObjects

-degree-potentiality-acuity-timing

Judgement

-timing-focusType

Focus

-code-vocabulary-vtext-stext

Subject of information

-hasSubjectOfInformation

-hasSite

-name-role-code-vocabulary-vtext

Provider Role

-Result

Finding

Diagnosis

Supply

-hasSupply*

focusType Value Set =

• Patient Functioning• Environment• ICF and other similar concepts in other vocabularies

Finding includes theconcepts of Goal andOutcome dependingon relationship timingand other actions

Subject is coded forindividual, family,or other physical entity

-code-vocabulary-vtext-stext

-hasFocus

-hasJudgement

Why Cross-Reference to the Why Cross-Reference to the RIM?RIM?

Domain analysis models support Domain analysis models support communication within a domaincommunication within a domain

Communications between domains Communications between domains requires an abstract, domain-requires an abstract, domain-independent model such as the HL7 RIMindependent model such as the HL7 RIM

Cross-reference tables build the Cross-reference tables build the mappings from the narrow world of the mappings from the narrow world of the individual domain to the cross-domain individual domain to the cross-domain interoperability supported by the HL7 interoperability supported by the HL7 RIMRIM

Static Model Cross-Static Model Cross-ReferenceReference

1

Domain Analysis Model HL7 Reference Model Cross-Reference Specification

Model Element Element Type

Model Element Element Type

Mapping Strength

Mapping Rule

Participant Class Entity

Entity.ClassCode

Participation

Role

Role.ClassCode

Act

Observation

Class

Attribute

Class

Class

Attribute

Class

Class

Restriction (<)

Participant is equivalent to an Entity with a Entity.ClassCode = “Person” or “organization” that is the player of a Role with a Role.ClassCode equal to “patient” or “provider” that is associated with a Participation related to an Observation Act.

Participant.Name Attribute Entity.name

Role.name

Attribute

Attribute

Equivalent (=)

Entity.name is a repeating attribute. It may be necessary to identify a specific name use or to use Role.name instead.

2

Problem-Space ArtifactsProblem-Space Artifacts

Storyboard TextStoryboard Text

UML Storyboard Activity DiagramUML Storyboard Activity Diagram

Domain GlossaryDomain Glossary

UML Domain Analysis ModelUML Domain Analysis Model

Static Model Cross-Reference (to HL7 Static Model Cross-Reference (to HL7 RIM)RIM)

HL7 Reference HL7 Reference Information ModelInformation Model

Where does it fit into the process?Where does it fit into the process?

Storyboards

HL7 RIM

Problem-Space Analysis Process (a la HDF)

Lev

el o

f Abs

trac

tion

Message Artifacts

Probl

em

Probl

em

Space

Space

Solution

Solution

Space

Space

Let’s Take a BreatherLet’s Take a BreatherAny Questions?Any Questions?

StoryboardStoryboardSkill-buildingSkill-building

Sample StoryboardSample Storyboard Precondition: Precondition: Christine, age 46, was recently

diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Susan reviews Christine’s chart including the problem list, allergies, Christine’s chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education education plan. She schedules Christine for education on the disease and on the side effects of on the disease and on the side effects of chemotherapy.chemotherapy.

Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

SourcesSources

Interviews with domain experts!!!!Interviews with domain experts!!!! Watching people workWatching people work Case studiesCase studies In healthcare, chart reviewsIn healthcare, chart reviews Literature reviewsLiterature reviews

How do you write a How do you write a Storyboard?Storyboard?

Determine and Narrow the TopicDetermine and Narrow the Topic

Identify the PreconditionIdentify the Precondition SettingSetting Roles of the participants/actorsRoles of the participants/actors Name the charactersName the characters

Sequence of EventsSequence of Events Write the storyWrite the story Simple sentences: subject, verb, object and linearSimple sentences: subject, verb, object and linear Describe interactions with systems (if part of story)Describe interactions with systems (if part of story)

Check the flow of the storyCheck the flow of the story Send out for review and validation by domain expertsSend out for review and validation by domain experts Iterative process with other problem-space artifactsIterative process with other problem-space artifacts

Declare PostconditionDeclare Postcondition

AdvantagesAdvantages

Facilitates validation with domain Facilitates validation with domain expertsexperts

Lack of formal structureLack of formal structure Domain experts can easily read, Domain experts can easily read,

write and editwrite and edit Knowledge transferKnowledge transfer

Storyboard ExerciseStoryboard Exercise Precondition: Precondition: Christine, age 46, was recently

diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Susan reviews Christine’s chart including the problem list, allergies, Christine’s chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education education plan. She schedules Christine for education on the disease and on the side effects of on the disease and on the side effects of chemotherapy.chemotherapy.

Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Storyboard Exercise #2Storyboard Exercise #2

Precondition: I’m need to log Precondition: I’m need to log into e-mail from the hotel….into e-mail from the hotel….

Storyboard:Storyboard:

Postcondition:Postcondition:

UML Activity DiagramsUML Activity Diagrams Skill-buildingSkill-building

Activity Diagram Activity Diagram Dynamic ViewDynamic View

Activity Diagram

Visualizing the activities and flow of a healthcare business process

Activity Diagram Activity Diagram 9 Components9 Components

1. Swim Lane• Partitions activities according to the responsible

party or entity associated with the activity2. Activity State

• Action (single step in a process or procedure)

3. Transition• Way to sequentially link actions

4. Data Object• Activities operate on and by objects that serve as

inputs or output to a specific activity• Become datagrams transmitted in messages

Iteration #1 StoryboardIteration #1 Storyboard Precondition: Precondition: Christine, age 46, was recently

diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Susan reviews Christine’s chart including the problem list, allergies, Christine’s chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education education plan. She schedules Christine for education on the disease and on the side effects of on the disease and on the side effects of chemotherapy.chemotherapy.

Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

11stst Iteration Activity Iteration Activity DiagramDiagram

SchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

Person, procedure, reason : Request

11stst Iteration Activity Iteration Activity DiagramDiagram

SchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

Person, procedure, reason : Request

?

Activity Diagram Activity Diagram 9 Components9 Components

Decision Point Point where decision is make and flow is

directed based on that decision

Guard Way to control the flow once a transition

has started Evaluates a true/false once associated

with a specific transition or decision point

SchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Waits for chemotherapy

22ndnd Iteration Activity Iteration Activity DiagramDiagram

Iteration #2 StoryboardIteration #2 Storyboard Precondition: Precondition: Christine, age 46, was recently

diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Susan reviews Christine’s chart including the problem list, allergies, Christine’s chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient chemotherapy protocol, orders, results and the patient education plan education plan and decides she needs additional and decides she needs additional educationeducation. She schedules Christine for education on . She schedules Christine for education on the disease and on the side effects of chemotherapy.the disease and on the side effects of chemotherapy. Alt Flow: Alt Flow: Susan educates patient immediately Susan educates patient immediately

>>P.C. Christine waits for chemotherapy>>P.C. Christine waits for chemotherapy Postcondition: Postcondition: Christine is scheduled to receive

education on side effects related to the chemotherapy and education on the disease.

SchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Waits for chemotherapy

22ndnd Iteration Activity Iteration Activity DiagramDiagram

SchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Waits for chemotherapy

22ndnd Iteration Activity Iteration Activity DiagramDiagram

?

33rdrd Iteration Activity Iteration Activity DiagramDiagram SchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Responds with Appt

Accepts ApptCommunicates Appt Information

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Procedure, time : Appt

Waits for chemotherapy

Procedure, time, directions : Appt

Iteration #3 StoryboardIteration #3 Storyboard Precondition: Precondition: Christine, age 46, was recently diagnosed

with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Christine’s Susan reviews Christine’s chart including the problem list, allergies, chemotherapy chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan and protocol, orders, results and the patient education plan and decides she needs additional education. She schedules decides she needs additional education. She schedules requests an appointment for requests an appointment for Christine for education on the Christine for education on the disease and on the side effects of chemotherapy. disease and on the side effects of chemotherapy. Scheduling Scheduling responds with an appointment, and Susan gives Christine responds with an appointment, and Susan gives Christine directions and other appointment information.directions and other appointment information. Alt Flow: Alt Flow: Susan educates patient immediately >>P.C. Susan educates patient immediately >>P.C.

Christine waits for chemotherapy Christine waits for chemotherapy Postcondition: Postcondition: Christine is scheduled to receive education

on side effects related to the chemotherapy and education on the disease.

Activity Diagram Take-Activity Diagram Take-HomeHome

“The process of storyboard refinement and activity diagram definition is iterative”

Activity Diagram Activity Diagram 9 Components9 Components

Fork Allows activities to spawn into two or more

threads

Join Allows synchronization of the forks to arrive

at a common point

Signal Receipt / Signal Send (not illustrated) Specific information associated with a

transition

Parallel Flow ControlParallel Flow ControlLabCardiologistObstetrician

Perform Lab

Schedule Patient

Request Service

Evaluate Patient

Consult Order Form

Lab Form--CBC & Protime

Routine Ob Care

Payor Authorization

Evaluate Patient

Protime Goal

Ob Care with Calculation Goal Variance

Protime Result

[Protime In Range][Protime High][Protime Low]

Set Protime Goal

Activity Diagram Activity Diagram ExerciseExercise

What are the swimlane titles for your What are the swimlane titles for your e-mail storyboard?e-mail storyboard?

Atkin's EHR SystemSmith's EHR System Dr Atkins (Specialist)Dr Smith (GP)

Builds Care Provision Summary

Receive Request

Receives Promise

Compile Event MessageReceive Report

[PaperConsultation]

Generates Report

Receive Reject

[reject request]

Care Provision : Request

Care Provision : Promise

Care Provision Update : Request

Care Provision : Event

Promises Care

[Accept Request]

Initiates Consultation

Dr. Smith is a general practitioner who has been seeing a patient regularly forsome time and utilizing his standard care plans for the condition. The patient’s condition is worsening, and Dr. Smith wishes to obtain the opinion of a specialist, Dr. Atkins.

Identifies Reason, etc & Sends Compiles Message

Reviews Request

Compiles Reject Message Composes RejectionReceives Reject

Care Provision : Reject

Compile Promise Message

Sees Patient

Reviews Update

Notes Promise

Sends More Information Compiles Update Message Receives Update

Reviews Report

Updates Care Plans

Tries another specialist

Returns to seeing the patient on a regular basis, now utilizing the altered care plans for the patient

That’s All, Y’AllThat’s All, Y’AllAnd Thanks!And Thanks!

Any Remaining Questions?Any Remaining Questions?