1. Storyboards and Activty Diagrams Dan Russler, M.D. July 19, 2005

2. Tutorial Objectives Develop a strategy for building a communication bridge between domain experts and engineers Develop a strategy for building a communication bridge between domain experts and engineers Define the borders between problem-space and solution space analysis Define the borders between problem-space and solution space analysis Introduce HL7 Storyboards Introduce HL7 Storyboards Introduce Unified Modeling Language (UML) Activity Diagrams Introduce Unified Modeling Language (UML) Activity Diagrams

3. Tools for Requirements Analysis Basic Modeling Environment Basic Modeling Environment Pen Pen Paper Paper Intermediate Modeling Environment Intermediate Modeling Environment Microsoft Word Microsoft Word Microsoft Visio Microsoft Visio Microsoft Excel Microsoft Excel High-end Modeling Environment High-end Modeling Environment Rational Rose Rational Rose

4. ` The Communication Pyramid Communication Models Free-text Documents Structured Documents ad hoc Drawings Non-standard Graphics Discussions Standardized Process Analysis (UML) Implementation-Independent Implementation-Specific Level of Abstraction

5. Problem-Space Artifacts Storyboard Text* Storyboard Text* UML Storyboard Activity Diagram* UML Storyboard Activity Diagram* Domain Glossary Domain Glossary UML Domain Analysis Model UML Domain Analysis Model Static Model Cross-Reference (to HL7 RIM) Static Model Cross-Reference (to HL7 RIM)

6. HL7 Reference Information Model Where does it fit into the process? Storyboards HL7 RIM Problem-Space Analysis Process (a la HDF) Level of Abstraction Message Artifacts

7. Why Storyboards? Domain experts can usually write narrative, free- form descriptions of how the domain works Domain experts can usually write narrative, free- form descriptions of how the domain works An inexpensive method for gathering requirements that documents the business process An inexpensive method for gathering requirements that documents the business process Able to describe a series of actions/interactions between one or many persons and/or systems Able to describe a series of actions/interactions between one or many persons and/or systems Focuses on the problem space Focuses on the problem space

8. Sample Storyboard Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic. Storyboard: Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

9. Why Activity Diagrams? Clarifies the roles of people and systems in the storyboard Clarifies the names of the activities Clarifies the sequence of activities Clarifies the decision points Identifies opportunities for messages Clarifies the data communicated at each point Clarifies the trigger events for specific processes

10. Sample Activity Diagram

11. Why Glossaries? Domain experts dont agree on the meaning of terms Domain vocabularies and mappings often poorly understood, e.g. ICD, CPT, SNOMED Engineers dont understand domain terms Multi-word terms not defined in dictionaries Term meanings needed for later steps in analysis process

12. Sample Glossary

13. Why Domain Analysis Models? (A UML Class Model or Static Model or Information Model) Each domain has evolved an independent world view Each domain has evolved an independent world view Domain experts can only validate what is familiar to them Domain experts can only validate what is familiar to them Domains tend to see themselves as unique Domains tend to see themselves as unique Domain world view is filled with jargon Domain world view is filled with jargon Domain world view (Information Model) Domain world view (Information Model) Best way to teach people about a domain Best way to teach people about a domain Best view of the requirements for a domain Best view of the requirements for a domain

14. Sample Domain Analysis Model +timing -code -vocabulary -vtext -stext Action -code -vocabulary -vtext -stext Site -hasSite -code -vocabulary -vtext -stext Route -hasRoute -code -vocabulary -vtext -stext Means -code -vocabulary -vtext -stext Object of Action -has Means -actsOn -name -role -code -vocabulary -vtext Recipient of Care -hasRecipientOfCare OtherObjects -degree -potentiality -acuity -timing Judgement -timing -focusType Focus -code -vocabulary -vtext -stext Subject of information -hasSubjec tOfInformation -hasSite -name -role -code -vocabulary -vtext Provider Role -Result Finding Diagnosis Supply -hasSupply * focusType Value Set = Patient Functioning Environment ICF and other similar concepts in other vocabularies Finding includes the concepts of Goal and Outcome depending on relationship timing and other actions Subject is coded for individual, family, or other physical entity -code -vocabulary -vtext -stext -hasFocus -has Judgement

15. Why Cross-Reference to the RIM? Domain analysis models support communication within a domain Domain analysis models support communication within a domain Communications between domains requires an abstract, domain-independent model such as the HL7 RIM Communications between domains requires an abstract, domain-independent model such as the HL7 RIM Cross-reference tables build the mappings from the narrow world of the individual domain to the cross-domain interoperability supported by the HL7 RIM Cross-reference tables build the mappings from the narrow world of the individual domain to the cross-domain interoperability supported by the HL7 RIM

16. Static Model Cross-Reference

17. Problem-Space Artifacts Storyboard Text Storyboard Text UML Storyboard Activity Diagram UML Storyboard Activity Diagram Domain Glossary Domain Glossary UML Domain Analysis Model UML Domain Analysis Model Static Model Cross-Reference (to HL7 RIM) Static Model Cross-Reference (to HL7 RIM)

18. HL7 Reference Information Model Where does it fit into the process? Storyboards HL7 RIM Problem-Space Analysis Process (a la HDF) Level of Abstraction Message Artifacts

19. Lets Take a Breather Any Questions?

20. Storyboard Skill-building

21. Sample Storyboard Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic. Storyboard: Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

22. Sources Interviews with domain experts!!!! Interviews with domain experts!!!! Watching people work Watching people work Case studies Case studies In healthcare, chart reviews In healthcare, chart reviews Literature reviews Literature reviews

23. How do you write a Storyboard? Determine and Narrow the Topic Determine and Narrow the Topic Identify the Precondition Identify the Precondition Setting Setting Roles of the participants/actors Roles of the participants/actors Name the characters Name the characters Sequence of Events Sequence of Events Write the story Write the story Simple sentences: subject, verb, object and linear Simple sentences: subject, verb, object and linear Describe interactions with systems (if part of story) Describe interactions with systems (if part of story) Check the flow of the story Check the flow of the story Send out for review and validation by domain experts Send out for review and validation by domain experts Iterative process with other problem-space artifacts Iterative process with other problem-space artifacts Declare Postcondition Declare Postcondition

24. Advantages Facilitates validation with domain experts Facilitates validation with domain experts Lack of formal structure Lack of formal structure Domain experts can easily read, write and edit Domain experts can easily read, write and edit Knowledge transfer Knowledge transfer

25. Storyboard Exercise Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic. Storyboard: Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

26. Storyboard Exercise #2 Precondition: Im need to log into e-mail from the hotel…. Precondition: Im need to log into e-mail from the hotel…. Storyboard: Storyboard: Postcondition: Postcondition:

27. UML Activity Diagrams Skill-building

28. Activity Diagram Dynamic View Activity Diagram Visualizing the activities and flow of a healthcare business process

29. Activity Diagram 9 Components 1. 1. Swim Lane Partitions activities according to the responsible party or entity associated with the activity 2. 2. Activity State Action (single step in a process or procedure) 3. 3. Transition Way to sequentially link actions 4. 4. Data Object Activities operate on and by objects that serve as inputs or output to a specific activity Become datagrams transmitted in messages

30. Iteration #1 Storyboard Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic. Storyboard: Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects of chemotherapy. Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

31. 1 st Iteration Activity Diagram

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33. Activity Diagram 9 Components Decision Point Point where decision is make and flow is directed based on that decision Guard Way to control the flow once a transition has started Evaluates a true/false once associated with a specific transition or decision point

34. 2 nd Iteration Activity Diagram

35. Iteration #2 Storyboard Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic. Storyboard: Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan and decides she needs additional education. She schedules Christine for education on the disease and on the side effects of chemotherapy. Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan and decides she needs additional education. She schedules Christine for education on the disease and on the side effects of chemotherapy. Alt Flow: Susan educates patient immediately >>P.C. Christine waits for chemotherapy Alt Flow: Susan educates patient immediately >>P.C. Christine waits for chemotherapy Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

36. 2 nd Iteration Activity Diagram

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38. 3 rd Iteration Activity Diagram

39. Iteration #3 Storyboard Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic. Storyboard: Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan and decides she needs additional education. She schedules requests an appointment for Christine for education on the disease and on the side effects of chemotherapy. Scheduling responds with an appointment, and Susan gives Christine directions and other appointment information. Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews Christines chart including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan and decides she needs additional education. She schedules requests an appointment for Christine for education on the disease and on the side effects of chemotherapy. Scheduling responds with an appointment, and Susan gives Christine directions and other appointment information. Alt Flow: Susan educates patient immediately >>P.C. Christine waits for chemotherapy Alt Flow: Susan educates patient immediately >>P.C. Christine waits for chemotherapy Postcondition: Postcondition: Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

40. Activity Diagram Take-Home The process of storyboard refinement and activity diagram definition is iterative

41. Activity Diagram 9 Components Fork Allows activities to spawn into two or more threads Join Allows synchronization of the forks to arrive at a common point Signal Receipt / Signal Send (not illustrated) Specific information associated with a transition

42. Parallel Flow Control LabCardiologistObstetrician Perform Lab Schedule Patient Request Service Evaluate Patient Consult Order Form Lab Form--CBC & Protime Routine Ob Care Payor Authorization Evaluate Patient Protime Goal Ob Care with Calculation Goal Variance Protime Result [Protime In Range] Continue Ob Care Reduce Coumadin [Protime High] Increase Coumadin [Protime Low] Set Protime Goal

43. Activity Diagram Exercise What are the swimlane titles for your e-mail storyboard? What are the swimlane titles for your e-mail storyboard?

44. Thats All, YAll And Thanks! Any Remaining Questions?