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 2
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
Use Case Context with the HIway A key milestone on the HIway connection path 6
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
Use Case Elements Use case name Goal Minimum required to get going Story Actors Data to exchange Important detail 8
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 Potential Trading Partners on the HIway 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 As of 9/6/2013 11
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. Data to Exchange The Mass HIway is an intermediary system What data do you intend to exchange? 12
Example of a data set Common Meaningful Use Data Set All data that may be exchanged as part of MU2 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. 13
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 3.1 Hospital ED visit summary Hospital 3.2 Hospital discharge summary Hospital Referring physician and/or PCP Referring physician and/or PCP 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 Referral PCP Consult Note Specialist Patient Scenario Specialist 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 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 18
Care Coordination Uses Cases Hospital to Provider/Provider to Hospital
Use Case Scenario 2.1/2.2 Hospital Referral Specialist PCP 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 20
Use Case Scenario 3.1 ED Notification Referring Physician PCP Patient Scenario Hospital 1. Patient presents at ED 2. Patient is treated and released 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 21
Use Case Scenario 3.2/3.3 Discharge Summary The image cannot be displayed. Your computer may not have Specialist PCP The image cannot be displayed. Your computer may not have SNF Patient Scenario Hospital A. Provides necessary care 1. Patient is discharged from hospital to the care of a referring physician, PCP or other care setting 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 22
Use Case Scenario 4.1/4.2 Referral XYZ Hospital ABC Hospital XYZ Hospital ABC 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 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 23
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 25
Discussion What are some other use cases? Where may we look for User Stories? How may MeHI further support use case development? 26
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 Minimum required to get going Important detail 27
Resources MeHI Develop a Use Case website http://mehi.masstech.org/health-information-exchange-0/mass-hiway/develop-hiway-usecase 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-masstechawards-235-million-grants-accelerate Summaries (coming soon) HIway Interface Grantees 28 Press Release - http://mehi.masstech.org/news/massachusetts-ehealth-institute-awards-vendor-grantsadvance-accelerate-health-information Direct Project - User Story website http://wiki.directproject.org/user+stories