# Presentation: 034870

## AHIC 2008 “Draft Detailed”

**AHIC 2008 “Draft Detailed”**
**Use Cases Stakeholder Overview**
**Office of the National Coordinator**
- February 1, 2008

## Agenda

- Use Case Development Process Overview
- Feedback Received from 2008 Prototypes
- 2008 Draft Detailed Use Cases Overview
- Consultations & Transfers of Care
- Remote Monitoring
- Personalized Healthcare
- Patient – Provider Secure Messaging
- Immunizations & Response Management
- Public Health Case Reporting
- Feedback Process
- 2008 Draft Detailed Feedback Due February, 15th 2008

## AHIC Priorities and Use Cases

**Use Cases**
- Use cases are descriptions of events that detail what a system (or systems) need to do to achieve a specific mission or stakeholder goals
- Use cases convey how individuals and organizations (actors) interact with the involved systems and strive to provide enough detail and context for follow-up activities to occur
- Usually, the follow-up from a use case is work that leads to the development or implementation of a specific software system

## AHIC Priorities and Use Cases

**AHIC Use Cases**
- ONC has been using high-level use cases that are not about the development of a specific software system, but are about the needs of many systems, stakeholder organizations, and individuals
- The use cases are based on the priorities expressed by the American Health Information Community working groups and describe involved stakeholders, information flows, issues, and systems needs that apply to the multiple organizations participating in these areas
- The use cases strive to provide enough detail and context for standards harmonization, architecture specification, certification consideration, and detailed policy discussions to advance the national HIT agenda
- These high-level use cases focus, to a significant degree, on the exchange of information between organizations and systems rather than the internal activities of a particular organization or system

## AHIC Priorities Into Use Cases

**AHIC workgroup **
**priorities and**
** ****issues**

**Consumer Empowerment:**
**Consumer Access to Clinical Information**
**Prototype Use Case**
**March 22****nd****, 2007**

**Priorities and areas clustered for coordination and synergy**

**Use case options for AHIC prioritization**

**Prototype**
**Use Case**

**Detailed**
**Use Case**

**Public Feedback**

**Public Feedback**

## Prototype Use Case
High-level overview of use case direction
Does not document all events and actions
Opportunity for feedback before detailed use case
Detailed Use Case 
Fully describes events and activities from different perspectives
Adds alternative flows of events
Based on feedback from prototype use case 
More detail regarding relevant data sets 
Includes information flows

- High-level overview of use case direction
- Does not document all events and actions
- Opportunity for feedback before detailed use case
**Detailed Use Case**
- Fully describes events and activities from different perspectives
- Adds alternative flows of events
- Based on feedback from prototype use case
- More detail regarding relevant data sets
- Includes information flows

**Use Case Deliverables Prototype vs. Detailed**

## Components of Draft Detailed Use Cases

**Preface**
**Introduction ***(Including Scope)*
**Stakeholders**
**Issues & Obstacles**
**Perspectives**
**Scenarios**
**Information Exchanges**
**Data Set Considerations**
**Appendices**
- Glossary
- Detailed Data Set Considerations

## AHIC Priorities and Use Case Roadmap

**AHIC Priorities and Use Case Roadmap**

## 	Embryonic nature of the prototype use case was intended to encourage more formative feedback early in the development process.

- Received Responses from 57 organizations/Individuals
- Consisting of 126 feedback documents
- Containing over 1150 feedback items

**Prototype Feedback**

## Consultations & Transfers of Care 
Remote Monitoring 
Personalized Healthcare 
Patient – Provider Secure Messaging
Immunizations & Response Management
Public Health Case Reporting

- Remote Monitoring
- Personalized Healthcare
- Patient – Provider Secure Messaging
- Immunizations & Response Management
- Public Health Case Reporting

**Highlights of Draft Detailed Use Cases**

## Consultations and Transfers of CareDraft Detailed Use Case - Overview

**Roles and information flows to support consultations**
- Initiate a request for consultation by a provider or patient
- Communicate relevant clinical findings back to the requestor, patient, and authorized recipients
**Roles and information flows to support transfers of care**
- Exchange of core information needed to accomplish a transition in care between care settings such as emergent, acute, long-term care, homecare between the sending and receiving organizations
- Exchange of core information for transfer of care between organizations is the focus; information exchange needs for Intra-organizations transfers may be similar and included in the use case
- Communicate transfer of care information back to the patient and authorized recipients

## Prototype Feedback has been analyzed and incorporated as appropriate into the Draft Detailed Use Case document
Information exchange diagrams have been included
Events and Actions are described in detail
Datasets are described with Detailed Dataset Considerations included in Appendix B; The core dataset is still being developed and is expected to involve a coordinated process involving the various efforts in progress in the industry 
Access to additional information not included within the core consultation or transfer dataset is identified as a contextual information flow, which is not a primary focus of this use case

- Information exchange diagrams have been included
- Events and Actions are described in detail
- Datasets are described with Detailed Dataset Considerations included in Appendix B; The core dataset is still being developed and is expected to involve a coordinated process involving the various efforts in progress in the industry
- Access to additional information not included within the core consultation or transfer dataset is identified as a contextual information flow, which is not a primary focus of this use case

**Consultations and Transfers of Care*****Updates to the Prototype***

## Example: Scenario  

***Figure 7-1. Consultations**** *

## Example: Events & Actions

***Figure 7-3.  Consultations, Requesting Clinician Perspective***

| Code | Description | Comments |
| --- | --- | --- |
| 7.1.1 | Event: Evaluate patient and determine need for consult |  |
| 7.1.1.1 | Action: Evaluate patient and document patient encounter.  | The patient is routinely evaluated by the clinician who documents each encounter in an EHR.  During the normal course of care the clinician may have ordered tests and received results electronically and prescribed medications.  The clinician may have access to additional patient information which could be gathered electronically via the patient’s PHR, health information exchange, from other provider EHRs and other sources that hold information about the patient.   |
| 7.1.1.2 | Action: Determine need for consultation. | The clinician evaluates the patient and reviews any relevant results received for previously ordered tests.  The clinician determines a need to send the patient to a provider outside of the clinician’s institution for a consultation.  The clinician may seek another provider’s opinion as a specialist or expert in a particular care area or a second opinion. |
| 7.1.2 | Event: Discuss with patient and identify consulting clinician |  |
| 7.1.2.1 | Action: Discuss with patient the recommendation for a consultation with another provider. | The clinician discusses the need and reason for consultation with the patient.     |
| 7.1.2.2 | Action: Identify consulting clinician. | The clinician may provide the patient with the name(s) of recommended clinicians or assist the patient in identifying a particular clinician based upon the patient’s insurance coverage network and/or preferences.   |

## Remote MonitoringDraft Detailed Use Case - Overview

**Roles and information flows to support communication of data from home monitoring devices to EHRs and PHRs**
- Transmit measurement data to EHRs and PHRs
- Review of monitoring information by clinicians and care coordinators
- Communicate monitoring-related information from care coordinators to clinicians (e.g. assessment information, patient coordination details, summary data)

## Prototype Feedback has been analyzed and incorporated as appropriate into the Draft Detailed Use Case document
Information exchange diagram is included
Events and Actions are described in detail
Datasets describing data types, measurement metadata, alerts, and assessment information
The three original candidate workflows have been combined into a single scenario: 
Remote Monitoring

- Information exchange diagram is included
- Events and Actions are described in detail
- Datasets describing data types, measurement metadata, alerts, and assessment information
- The three original candidate workflows have been combined into a single scenario:
- Remote Monitoring

**Remote Monitoring*****Updates to the Prototype***

## Personalized HealthcareDraft Detailed Use Case - Overview

**Roles and information flows to support Personalized Healthcare**
- Clinician intake of patient’s past medical history, current medical status, and family health history
- Clinician assessment and selection of appropriate genetic/genomic test
- Exchange between clinicians and medical testing laboratories
- Integration of personal and family health history and genetic/genomic testing results into electronic health records
- Reporting to authorized clinicians and consumers

## Prototype Feedback has been analyzed and incorporated as appropriate into the Draft Detailed Use Case document
The three original candidate workflows have been combined into two scenarios: 
Clinical Assessment. 
Genetic Testing, Reporting, and Clinical Management. 
Information exchange diagrams are included
Events and Actions are described in detail
Datasets are described, including Family Health History
“Family Health History Multi-Stakeholder Data Requirements Summary” has been included as a companion document
At the suggestion of the Personalized Healthcare Workgroup, Newborn Screening and Secondary Use of Genetic Information has been deferred to future use cases

- The three original candidate workflows have been combined into two scenarios:
- Clinical Assessment.
- Genetic Testing, Reporting, and Clinical Management.
- Information exchange diagrams are included
- Events and Actions are described in detail
- Datasets are described, including Family Health History
- “Family Health History Multi-Stakeholder Data Requirements Summary” has been included as a companion document
- At the suggestion of the Personalized Healthcare Workgroup, Newborn Screening and Secondary Use of Genetic Information has been deferred to future use cases

**Personalized Healthcare*****Updates to the Prototype***

## Patient – Provider Secure MessagingDraft Detailed Use Case - Overview

**Roles and information flows to support communications of secure information between patients and their providers**
- Secure structured or unstructured patient messages to providers asking health-related questions or providing health information without requiring both parties to be available at the same time
- Clinician responses to those communications and the ability to initiate communications as necessary to promote patient health
- Clinician use of reminders within secure messages to support patient health and wellness

## Prototype Feedback has been analyzed and incorporated as appropriate into the Draft Detailed Use Case document
Information exchange diagrams are included
Events and Actions are described in detail
On-line, live communications are excluded from the scope of this use case as are communications between providers
The three original candidate workflows have been combined into two: 
Patient-Initiated Communications
Clinician-Initiated Communications
Datasets are described, including 10 sample message types that may be included in secure messaging

- Information exchange diagrams are included
- Events and Actions are described in detail
- On-line, live communications are excluded from the scope of this use case as are communications between providers
- The three original candidate workflows have been combined into two:
- Patient-Initiated Communications
- Clinician-Initiated Communications
- Datasets are described, including 10 sample message types that may be included in secure messaging

**Patient – Provider Secure Messaging*****Updates to the Prototype***

## Immunization and Response ManagementDraft Detailed Use Case - Overview

**Roles and information flows to support routine and emergency immunization**
- Reporting to immunization registries
- Exchange between registries
- Patient status queries of immunization registries
- Integration of immunization schedules into electronic health records or registries
- Information awareness for location status of immunization supply
- Apportionment and distribution

## Prototype Feedback has been analyzed and incorporated as appropriate into the Draft Detailed Use Case document
Information exchange diagrams included
Events and Actions are described in detail
The two original candidate workflows have been refined to focus on routine care activities which can also support non-routine or emergency situations
Vaccine and Drug Administration and Reporting
Vaccine and Drug Inventory Management
Dataset needs are described
Reporting of vaccine adverse events is described and linked to the Public Health Case Reporting Use Case
Clinical care for public health cases is also described and linked to the Public Health Case Reporting Use Case

- Information exchange diagrams included
- Events and Actions are described in detail
- The two original candidate workflows have been refined to focus on routine care activities which can also support non-routine or emergency situations
- Vaccine and Drug Administration and Reporting
- Vaccine and Drug Inventory Management
- Dataset needs are described
- Reporting of vaccine adverse events is described and linked to the Public Health Case Reporting Use Case
- Clinical care for public health cases is also described and linked to the Public Health Case Reporting Use Case

**Immunization and Response Management *****Updates to the Prototype***

## Public Health Case ReportingDraft Detailed Use Case - Overview

**Roles and information flows to support public health reporting, investigation, and information sharing**
- Incorporating pre-determined criteria into EHRs and LISs
- Electronic reporting of notifiable conditions/diseases, public health cases, and adverse events
- Exchange of information between clinicians and public health including feedback on submitted reports, focused population health information, or general population health information.

## Prototype Feedback has been analyzed and incorporated as appropriate into the Draft Detailed Use Case document
Information exchange diagram included
Events and Actions are described in detail
The two original candidate workflows have been combined into a single scenario: 
Reporting, Investigation, and Information Sharing
Dataset needs are described, including those addressing:
Pre determined criteria
Reporting requirements
Submitted Reports
Focused Population Health Information
General Population Health Information
Processes and examples specific to adverse events have been included in the document
Reporting of vaccine adverse events is described and linked to the Immunizations & Response Management Use Case
Clinical care for public health cases is also described and linked to the Immunizations & Response Management Use Case

- Information exchange diagram included
- Events and Actions are described in detail
- The two original candidate workflows have been combined into a single scenario:
- Reporting, Investigation, and Information Sharing
- Dataset needs are described, including those addressing:
- Pre determined criteria
- Reporting requirements
- Submitted Reports
- Focused Population Health Information
- General Population Health Information
- Processes and examples specific to adverse events have been included in the document
- Reporting of vaccine adverse events is described and linked to the Immunizations & Response Management Use Case
- Clinical care for public health cases is also described and linked to the Immunizations & Response Management Use Case

**Public Health Case Reporting *****Updates to the Prototype***

## Please send your feedback no later than close of business, Friday, February 15th, 2008.
Public Health Case Reporting
URL = http://www.hhs.gov/healthit/usecases/phcr.html
Feedback address = usecase1@hhs.gov
Consultation & Transfers of Care
URL = http://www.hhs.gov/healthit/usecases/reftx.html
Feedback address = usecase2@hhs.gov
Personalized Healthcare
URL = http://www.hhs.gov/healthit/usecases/phc.html
Feedback address = usecase3@hhs.gov

**Public Health Case Reporting**
- URL = http://www.hhs.gov/healthit/usecases/phcr.html
- Feedback address = usecase1@hhs.gov
**Consultation & Transfers of Care**
- URL = http://www.hhs.gov/healthit/usecases/reftx.html
- Feedback address = usecase2@hhs.gov
**Personalized Healthcare**
- URL = http://www.hhs.gov/healthit/usecases/phc.html
- Feedback address = usecase3@hhs.gov

**Feedback Process **

## Please send your feedback no later than close of business, Friday, February 15th, 2008.
Immunizations & Response Management
URL = http://www.hhs.gov/healthit/usecases/respmgmt.html
Feedback address = usecase4@hhs.gov
Remote Monitoring
URL = http://www.hhs.gov/healthit/usecases/remon.html
Feedback address = usecase5@hhs.gov
Patient – Provider Secure Messaging
URL = http://www.hhs.gov/healthit/usecases/remcon.html
Feedback address = usecase6@hhs.gov

**Immunizations & Response Management**
- URL = http://www.hhs.gov/healthit/usecases/respmgmt.html
- Feedback address = usecase4@hhs.gov
**Remote Monitoring**
- URL = http://www.hhs.gov/healthit/usecases/remon.html
- Feedback address = usecase5@hhs.gov
**Patient – Provider Secure Messaging**
- URL = http://www.hhs.gov/healthit/usecases/remcon.html
- Feedback address = usecase6@hhs.gov

**Feedback Process**