Sean Kennedy, MeHI Director of the Health Information Exchange, shares tips on how to develop a use case.

1. Mass HIway
Use Case Workshop
Sean Kennedy
Mass eHealth Institute
Director, Health Information Exchange

2. Learning Objectives
 Communicate the benefits of a use case
 Identify a use case scenario / ‘user story’
 Develop a use case with recommended elements
2

3. Agenda
 Use Case Introduction
 Elements of a Use Case
 Development Guidance
 Use Case Examples
 Discussion
 Key Takeaways
 Resources

4. 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.

5. 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.”

6. Use Case Context with the HIway
6
A key milestone on the
HIway connection path

7. 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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8. Use Case Elements
 Use case name
 Goal
 Story
 Actors
 Data to exchange
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Minimum required to get going
Important detail

9. 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

10. 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
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Reference: The Direct Project, User Stories
http://wiki.directproject.org/Primary+care+provider+refers+patient+to+specialist+including+summary+care+record

11. Use Case Elements | Minimum required to get going
11
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

12. 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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13. 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.

14. 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

15. Use Case Examples

16. 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

17. Care Coordination Uses Cases
Provider to Provider

18. 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 NotePCP Specialist

19. Care Coordination Uses Cases
Hospital to Provider/Provider to Hospital

20. 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

21. 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

22. 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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23. 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

24. Public Health Use Cases – Coming Soon
 Immunization Reporting
 Electronic Lab Reporting
 Syndromic Surveillance
 CBHI

25. Recent use case additions
 School immunizations
 Bed availability
 Structured lab results to ambulatory providers
 Eligibility verification
 Authorization for care
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26. 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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27. 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

28. 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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