Health eDecisions Use Case 2: CDS Guidance Service Strawman of Core Concepts Use Case 2 1.

Health eDecisions Use Case 2: CDS Guidance Service

Strawman of Core Concepts

Use Case 2

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Agenda

• Overview of Use Case Development Process• Review HeD Use Case 2: CDS Guidance Service Straw man of

Core Concepts – Conceptual Diagram– Scope– Assumptions– Actors– Review User Story

• Next Steps

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Use Case Development within the S&I Framework

Tools and ServicesTools and Services

Use Case Developmentand Functional Requirements

Use Case Developmentand Functional Requirements

Standards Development

Support

Standards Development

Support

Certificationand TestingCertificationand Testing

Harmonization ofCore Concepts

Harmonization ofCore Concepts

Implementation Specifications

Implementation Specifications

Pilot Demonstration Projects

Pilot Demonstration Projects

Reference Implementation

Reference Implementation

Architecture Refinement and ManagementArchitecture Refinement and Management

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Use Case Development Objectives

• Engage Stakeholders as Committed Members, Invited Experts, or Interested Parties in the creation of a Use Case

• Identify a Use Case and User Stories that address real-world problems • Keep it simple• Create a finalized Use Case that demonstrates value and supports the

proposed goals and success criteria for the Initiative • Publish a finalized Use Case that contains necessary content, supported by

artifacts, to enable Harmonization and subsequent S&I Framework efforts to occur

• Establish the Use Case and supporting artifacts in a reusable fashion to support future health information interchange Initiatives

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• 1.0 Preface and Introduction• 2.0 Initiative Overview

– 2.1 Initiative Challenge Statement

• 3.0 Use Case Scope– 3.1 Background– 3.2 In Scope– 3.2 Out of Scope– 3.3 Communities of Interest

• 4.0 Value Statement• 5.0 Use Case Assumptions• 6.0 Pre-Conditions• 7.0 Post Conditions• 8.0 Actors and Roles• 9.0 Use Case Diagram

Use Case OutlineTailored for each Initiative

• 10.0 Scenario 1, 2, x…• 10.1 User Story 1, 2, x, … • 10.2 Activity Diagram

• 10.2.1 Base Flow• 10.2.2 Alternate Flow

• 10.3 Functional Requirements• 10.3.1 Information Interchange

Requirements• 10.3.2 System Requirements

• 10.4 Sequence Diagram• 11.0 Dataset Requirements • 12.0 Risks, Issues and Obstacles• Appendices

• Related Use Cases• Previous Work Efforts• References

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Conceptual Use Case Diagram: CDS Guidance Service Diagram (Use Case 2)

CDS Guidance Requestor

CDS Guidance(guidance + service structure)

Out of Scope• Authoring, Creation and Maintenance of

Clinical Decision Support Knowledge• Internal Intervention Format of CDS

services supplier

Out of Scope• Workflow Integration• User Presentation• Direct Interaction with the User• How the Guidance Integrator will utilize

the information• Deciding what guidance is subscribed to

CDS Guidance Supplier

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In Scope• Interface Definitions for Sending Patient Data & CDS

Guidance• Patient Data Input to Service• Format of the CDS Guidance (output from CDS service) • Requirements to Support Service Transactions,

Transport & Security• Stateless Transactions

CDS Request (patient data + context)

Scope

• In Scope– Interface definitions for sending patient data and CDS guidance

• Patient data input to service• Format of the CDS Guidance (output of CDS service)

• Out of Scope– Workflow integration– User presentation– Authoring, creation, and maintenance of clinical decision

support knowledge– Internal intervention format of CDS Guidance Service Supplier– Stateful Transactions

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Assumptions

• The CDS Guidance Requestor determines when to make a guidance service call.

• This is a stateless CDS service. The service does not store patient data or the recommendations, it is made for the purpose of using those for future recommendations (it may store the data for auditing purposes). The client cannot be required to assume that the service is stateful, but the service itself is free to implement caching/auditing as part of the architecture.

• The interface contains enough information to allow the clinical guidance consumer to determine what information is required to perform an evaluation

• The role of the CDS Service Integrator (Technical Engineer on behalf of Clinical EHR System) and the associated functions are handled outside of this Use Case, prior to the CDS Guidance Requestor sending a request.

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* Clinical Guidance is the output of the application of the knowledge artifact to a specific patient

Actors

Role Actor System Core Functions

CDS Guidance Supplier CDS Service Vendor, CDS Service Provider

CDS Service Receives Patient DataEvaluates the dataSends guidance

CDS Guidance Requestor User or Automated System

Consumes a service (?)Sends patient dataMakes service call (?)Receives guidance

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User Story• User Story 1: CDS Requestor submits CDS Guidance request

– Request is submitted by the user or automatically by host system based on user actions (opening record, ordering, scheduling appointment) [core of the Use Case]

• Request includes patient data, and other contextual information such as the user role and type, encounter type, and type/scope of CDS being requested.

– CDS Guidance Supplier returns Guidance to the system [core of the Use Case]

– The system presents the Guidance to the CDS Requestor [system function – not a core part of the Use Case]

• Optionally, the system makes the guidance actionable locally (e.g., through CPOE)

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Next Steps• Review Use Case content posted to the wiki and provide

comments and/or suggested revisions using the feedback form– Link to Use Case Content: http://wiki.siframework.org/UC+2+-+

CDS+Guidance+Service– Link to Feedback Form: https://

docs.google.com/a/siframework.org/spreadsheet/viewform?formkey=dHJuWnp2SlFOYXBoa2I2Mi03SnJpbEE6MQ

• Continue Use Case 2 discussion during January 3 HeD WG meeting

• Additional information on the Use Case development process can be found in the 6/21/12 Presentation Materials: http://wiki.siframework.org/file/view/HeD%20All%20Hands%20Meeting%20Materials%2006_21_12_final.pdf/346944394/HeD%20All%20Hands%20Meeting%20Materials%2006_21_12_final.pdf

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Appendix

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CDS Service Integrator[Out of Scope]

• CDS Service Integrator enables CDS service within system– The CDS Service Integrator identifies the type of CDS Guidance

Service for specific scenarios (e.g., immunization reminders) – The Integrator specifies within the system the scenario in which

CDS Guidance must be requested– The Integrator checks if mappings of potential CDS Guidance

Responses to locally implementable actions are present• If not present, then these are defined

Role Actor System Core Functions

CDS Service Integrator* Assumption: The Use Case does not deal with this portion of the story

Technical Engineer on behalf of Clinical EHR System

EHR System, Clinical Workflow System

Consumes a serviceSends patient dataMakes service callReceives guidance

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UC1 Actors (for reference)

Role Actor System Core FunctionsCDS Knowledge Artifact Supplier CDS Vendor, Content Supplier CDS Knowledge Artifact

Repository Licensing (in/out) Testing Collection/Sharing Normalization Providing Search

Capabilities Tracking/Servicing Updates Facilitating Standardization

and Localization Value-added

transformation of CDS artifacts from multiple sources for republication

CDS Artifact Integrator

EHR Vendor, Healthcare Delivery System

CDS System Adapting and mapping CDS artifacts to be embedded within a CDS system

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