Mass HIway Use Case Workshop - Sept, 2013

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Sean Kennedy, MeHI Director of the Health Information Exchange, shares tips on how to develop a use case.

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Mass HIway Use Case Workshop - Sept, 2013

  1. 1. Mass HIway Use Case Workshop Sean Kennedy Mass eHealth Institute Director, Health Information Exchange
  2. 2. Learning Objectives   Communicate the benefits of a use case   Identify a use case scenario / ‘user story’   Develop a use case with recommended elements 2
  3. 3. Agenda   Use Case Introduction   Elements of a Use Case   Development Guidance   Use Case Examples   Discussion   Key Takeaways   Resources
  4. 4. 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.
  5. 5. 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.”
  6. 6. Use Case Context with the HIway 6 A key milestone on the HIway connection path
  7. 7. 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 7
  8. 8. Use Case Elements   Use case name   Goal   Story   Actors   Data to exchange 8 Minimum required to get going Important detail
  9. 9. 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
  10. 10. 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
  11. 11. Use Case Elements | Minimum required to get going 11 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
  12. 12. 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? 12
  13. 13. Example of a data set   Common Meaningful Use Data Set –  All data that may be exchanged as part of MU2 13 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.
  14. 14. 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
  15. 15. Use Case Examples
  16. 16. 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
  17. 17. Care Coordination Uses Cases Provider to Provider
  18. 18. Use Case Scenario 1.1/1.2 – Referral 18 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 NotePCP Specialist
  19. 19. Care Coordination Uses Cases Hospital to Provider/Provider to Hospital
  20. 20. Use Case Scenario 2.1/2.2 – Hospital Referral 20 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
  21. 21. Use Case Scenario 3.1 – ED Notification 21 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
  22. 22. Use Case Scenario 3.2/3.3 – Discharge Summary 22 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 The image cannot be displayed. Your computer may not have Specialist The image cannot be displayed. Your computer may not have PCP SNF
  23. 23. Use Case Scenario 4.1/4.2 – Referral 23 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
  24. 24. Public Health Use Cases – Coming Soon   Immunization Reporting   Electronic Lab Reporting   Syndromic Surveillance   CBHI
  25. 25. Recent use case additions   School immunizations   Bed availability   Structured lab results to ambulatory providers   Eligibility verification   Authorization for care 25
  26. 26. Discussion   What are some other use cases?   Where may we look for ‘User Stories’?   How may MeHI further support use case development? 26
  27. 27. 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 27 Minimum required to get going Important detail
  28. 28. 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 28

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