1. ToC Use Case Components Lightning Overview Presented to LCC WG December 1, 2011 1

2. Purpose of the Use Case 2 The Use Case describes: The operational context for the data exchange The stakeholders with an interest in the Use Case The information flows that must be supported by the data exchange The types of data required in the data exchange

3. Use Case Outline 3

4. Use Case Development Process 4

5. Review of Key Use Case Sections Defining the Actors This section of the Use Case outlines the business actors that are participants in the information exchange requirements for each scenario. A business actor is a person or organization that directly participates in a scenario. Thus, as a person or organization, the actor can (and should) be a stakeholder. The business actor must use a system to perform the functions and to participate in the information interchange. The system or system actor has roles (send, receive, publish, subscribe or in some cases display) and actions which involve exchanging content. Please see the table below for an example of these designations. NOTE: A Business Actor may be a Stakeholder and also can have more than one role. 5 ActorSystemRole PCPEHR SystemSender SpecialistEHR SystemReceiver PatientPHR SystemReceiver

6. Transitions of Care – Use Case Diagram 6 http://wiki.siframework.org/file/view/SIFramework_ToC_UC_v%201.1.docx

7. Transitions of Care – Context Diagram 7 Actors & Roles Context Diagram ActorSystemRole Provider (Person)Electronic Health Record (EHR) SystemSender/Receiver or Source/Destination HISPHealth Information Service ProviderThe “wire” across which the health information is sent from the sender to the receiver PatientPersonal Health Record (PHR) SystemSender/Receiver or Source/Destination Provider OrganizationElectronic Health Record (EHR) SystemSender/Receiver or Source/Destination CaregiversPersonal Health Record (PHR) SystemSender/Receiver or Source/Destination http://wiki.siframework.org/file/view/SIFramework_ToC_UC_v%201.1.docx

8. Transitions of Care – Summary of Scenarios and User Stories 8 ScenarioUser Story/StoriesSetting Scenario One: The Exchange of Clinical Summaries from Provider to Provider The Exchange of Information to Support the Transfer of Patient Information from One Provider to Another Hospital or Emergency Department from where patient is discharged (sends discharge summary to PCP or Care Team) Patient's PCP or Care Team (receives discharge summary from Hospital or ED clinical system) Closed Loop Referral PCP's office (sends consultation request clinical summary to specialist) Specialist's office (receives referral request clinical summary from PCP; send consultation summary to PCP) Complex Series of Care Transactions Emergency Department Hospital Rehabilitation Facility Scenario Two: The Exchange of Clinical Summaries between Provider to Patient in Support of Transitions of Care The Exchange of Discharge Instructions and Discharge Summary between a Provider and Patient to Support the Transfer of a Patient from One Care Setting to Another Hospital or ED from where patient is discharged (sends discharge instructions to patient). Patient The Exchange of Clinical Summaries between Provider and Patients to Support the Closed-loop Transfer of a Patient from One Care Setting to Another Consultation Referral. PCP’s Office Specialists Office Patient

9. ToC Sequence Diagram 9

10. Review of Key Use Case Sections Functional Requirements 10 Functional Requirements for Information Interchange Scenario 1 Initiating System Information Interchange Requirement Name Receiving/Responding System Hospital/ED EHR System Send (A.XFER.1)Discharge Summary Receives (A.XFER.2)PCP EHR System Send (A.XFER.1)Consultation Request Clinical Summary Receives (A.XFER.2)Specialist EHR System Send (A.XFER.1)Consultation SummaryReceives (A.XFER.2)PCP EHR System Scenario 2 Initiating System Information Interchange Requirement Name Receiving/Responding System Electronic Health Record System Send (A.XFER.1)Discharge Summary Receives (A.XFER.2)Personal Health Record System Electronic Health Record System Send (A.XFER.1Discharge InstructionsReceives (A.XFER.2)Personal Health Record System Electronic Health Record System Send (A.XFER.1) Consultation Request Clinical Summary Receives (A.XFER.2)Personal Health Record System Electronic Health Record System Send (A.XFER.1) Clinical SummaryReceives (A.XFER.2)Personal Health Record System [1] [1] This identifier comes from ONC-SI-UC Simplification spreadsheet. See references. [1] [1] This identifier comes from ONC-SI-UC Simplification spreadsheet. See references.

11. Review of Key Use Case Sections Data Sets 11 [1] [1] This identifier comes from ONC-SI-UC Simplification spreadsheet. See references. Ref.SectionContentAdditional Notes T.CC.1Personal Information Name, DOB, Next of Kin, Address, Phone Number, Gender, Marital Status, Religion, Race, Ethnicity T.CC.5Allergies and Other Adverse Reactions Allergy Type; and Date Substance intolerance Associated Adverse Events List of allergies which might include allergy to what (e.g., medication. food, environment). Sensitivity. Past and those that have arisen T.CC.6Problem ListCurrent Diseases & Conditions monitored for the patient and status  List of problems/complaints (what was diagnosis, complaint and/or descriptor of problem/complaints, symptoms).  How do these problems/complaints impact interventions, orders or instructions. [1] [1] This identifier comes from ONC-SI-UC Simplification spreadsheet. See references.