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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