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

2. 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 2

3. Use Case Development within the S&I Framework Tools and Services Use Case Development and Functional Requirements Standards Development Support Standards Development Support Certification and Testing Harmonization of Core Concepts Implementation Specifications Pilot Demonstration Projects Reference Implementation Architecture Refinement and Management 3

4. 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 4

5. 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 Outline Tailored 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 5

6. 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 6 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)

7. 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 7

8. 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. 8 * Clinical Guidance is the output of the application of the knowledge artifact to a specific patient

9. Actors RoleActorSystemCore Functions CDS Guidance SupplierCDS Service Vendor, CDS Service Provider CDS Service Receives Patient Data Evaluates the data Sends guidance CDS Guidance RequestorUser or Automated System Consumes a service (?) Sends patient data Makes service call (?) Receives guidance 9

10. 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) 10

11. 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+Servicehttp://wiki.siframework.org/UC+2+- +CDS+Guidance+Service –Link to Feedback Form: https://docs.google.com/a/siframework.org/spreadsheet/viewform?f ormkey=dHJuWnp2SlFOYXBoa2I2Mi03SnJpbEE6MQ https://docs.google.com/a/siframework.org/spreadsheet/viewform?f ormkey=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%20Meet ing%20Materials%2006_21_12_final.pdf/346944394/HeD%20All%20 Hands%20Meeting%20Materials%2006_21_12_final.pdf http://wiki.siframework.org/file/view/HeD%20All%20Hands%20Meet ing%20Materials%2006_21_12_final.pdf/346944394/HeD%20All%20 Hands%20Meeting%20Materials%2006_21_12_final.pdf 11

12. Appendix 12

13. 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 RoleActorSystemCore 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 service Sends patient data Makes service call Receives guidance 13

14. UC1 Actors (for reference) RoleActorSystemCore Functions CDS Knowledge Artifact SupplierCDS 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 14