1. S&I Simplification Use Case Authoring Tool (UCAT) Introduction In collaboration with NIST and AHRQ 25 March 2013

2. S&I Simplification Cross Initiative Effort to… Compile and Distill Components from All S&I Initiatives –For easy reference, organization, comparison –13 Use Cases with 33 Multi-Step Scenarios –Initiatives: TOC, LCC, LRI, LOI, PD, esMD, QH, DS4P, PHRI, HeD Convey Uniform and Integrated Patterns of: –Patient Flow – with Patient as Actor –Provider (Work/Process) Flow – with Provider as Actor –Information Flow – including System as an Actor Show: –Event Steps with Actions taken – by Actors in Roles – to support individual health and provide healthcare –Health record entries resulting from Actions taken Show Commonalties, Patterns of Repetition/Re-Use –Both Current and Potential 24 March 2013S&I Simplification/UCAT Intro2

3. Components selected from S&I Initiative Use Cases Is it…Potentially Computable for… In Common? Re-Usable? Computable? Identity Accountability Permission, Consent Access, Data Use Performance/ Fulfillment Capture, Provenance Content: Struct/Unstruct Coding, Classification Completeness Signature Audit RequirementsYYY Actors, RolesYYY Events, ActionsYYY  As standards-based software services Data Objects, Elements YYY  As standards-based data objects, messages, documents… S&I Simplification Component Selection 24 March 2013S&I Simplification/UCAT Intro3

4. 24 March 2013S&I Simplification/UCAT Intro4

5. (LINK to Core Matrix Spreadsheet v2.4) Status – of S&I Initiative Analysis Key – Contents of All Tabs Assertions – Basis for Initial Requirements *Common Requirements *Common Actors *Scenarios, Events – w/Action examples *Common Actions *Common Data Objects * Re-usable Components 24 March 2013S&I Simplification/UCAT Intro5 S&I Simplification Core Matrix

6. 24 March 2013S&I Simplification/UCAT Intro6

7. (LINK to Progression Spreadsheet) To Date –S&I Simplification + AHRQ –Core Matrix + USHIK Registry Future –S&I Use Case Requirements Phase with Use Case Authoring Tool (UCAT) –S&I Use Case Harmonization Phase with NIST Tools Standards Selection Implementation Guide (Tools) Testing (Tools) 24 March 2013S&I Simplification/UCAT Intro7 S&I Simplification Progression

8. SourceContribution Use Case Authoring Tool (UCAT) Prototype Developed by: Art Griesser Prometheus Computing NIST Cross Industry Perspective, SmartGrid Project (2010) S&I Simplification Consensus Approved Core Simplification Matrix (.xlsx) S&I Use Case Requirements Template (.docx) S&I Lab Results Initiative (LRI) Consensus Approved LRI Use Case Requirements Template (.docx) HL7 EHR WG ISO/HL7 10781/16527, EHR/PHR System Functional Models AHRQ ISO 11179 USHIK Registry of S&I Simplification Components 24 March 2013S&I Simplification/UCAT Intro8 S&I Simplification Ingredients – UCAT Prototype

9. S&I Simplification Use Case Hierarchy GenerallyUCAT Prototype – Example An Initiative…Lab Results Interface (LRI) Initiative Has one or more Use Cases… 1) Lab Results Interface With one or more Scenarios… 1) Send/Receive/View Test Results With one or more Events (Steps)… 1) Send2) Receive3) View With one or more Actions. (Simplification Examples) Identify Patient, Provider, Lab System Originate/Attest/Retain - Lab Results Report Verify - Lab Results Report Set Data Access Permissions  Transmit - Lab Results Report Identify (EHR) System  Receive/Retain - Lab Results Report Identify, Authenticate Provider Check User Data Access Permissions Access/View - Lab Results Report 24 March 2013S&I Simplification/UCAT Intro9

10. S&I Simplification – Demonstration of Concept Use Case Tool Status Current Capabilities Imported Core Matrix Captured use case template structure –Populated completely for LRI Can construct new use cases from reusable components Can create human readable use cases (in UC template) Can curate underlying UC information Can use underlying info programmatically –SQL query Import: CSV –UCAT Native –Simplification Core Matrix –ISO/HL7 10781/16527 EHR/PHR System Functional Models Export: JSON, CSV Ability to clone Additional Capabilities and Refinements Ability to track status of information –Component Lifecycle Management Agreement to Productize UCAT Next Steps Add remaining 14 S&I Use Cases –One-time manual entry –Resolving differences from template Refine existing master template USHIK integration CEDD integration Evaluate handoff to downstream tools –Implementation Guide, Testing… 24 March 2013S&I Simplification/UCAT Intro10

11. Capture Once, Re-Use Many Times –Component + Standard + Imp Guide + Testing –Each Re-Use Instance: x 2 Savings –Facilitates Cross Agency –Facilitates S&I Cross Initiative –Unlocks Value of S&I (maximizing re-use, return) Experience Shows: –AHIC/HITSP: 5 Years, 17 Use Cases (3+/yr) –S&I: 2 Years, 13 Use Cases (6+/yr) –Now w/UCAT: ? 24 March 2013S&I Simplification/UCAT Intro11 S&I Simplification Benefits

12. Tools to Automate the S&I Platform A Proposal March 29, 2013 DRAF T

13. Growing Portfolio of Module Based Initiatives But this has led to growing complexity and diverse designs, models and solutions Doug Fridsma to HITPC – 3/14/13 13DRAFT

14. S&I Core Matrix Has Captured and Standardized S&I Initiatives...... as Shared, Reusable and Computable Components... Now we need a tool to use the Core Matrix 14DRAFT

15. Tools to Automate the S&I Platform USHIK Registry Reposito ry Link to NLM NIST Test Methods S&I Core Matrix UCAT IGAT Business Requirements and SMEs Implementable Solutions CEDD/FHIM/CIMI Data Models and Mapping Standards Developers and Stewards 15DRAFT

16. Why UCAT First? Foundational to all downstream automation and tools Highest leverage is at the beginning analysis and design of an initiative – COnstructive COst Model – Overall effort is doubled if analysis is shortchanged – Correct is hard... but easier than later fix – Ounce of prevention – Measure twice, cut once – “By failing to prepare, you are preparing to fail” Ben Franklin Use Cases – Study how users get value from system – Define how users interact with system – Help subsequent efforts deliver value – Are contracts between users & developers Refer to Art Griesser Presentation in Appendix DRAFT16

17. Use Case Authoring Tool 17DRAFT

18. NIST Role (Kevin – maybe quotes from Frederick Experience with Use Case Authoring through Smart Grid Developed automated test procedures, methods and tools for CEHRT and Mod Specs UCAT is based on NIST platform with further specialization for the S&I Core Matrix by Art Greisser DRAFT18

19. DRAFT19 Brief Overview of Process Flow

20. UCAT Demonstration NEED OUTLINE FROM ART Show how to create a human readable, machine computable UC example from Core Matrix and UCAT DRAFT20

21. S&I Simplification – Demonstration of Concept Use Case Tool Status Current Capabilities Imported Core Matrix Captured use case template structure –Populated completely for LRI Can construct new use cases from reusable components Can create human readable use cases (in UC template) Can curate underlying UC information Can use underlying info programmatically –SQL query Import: CSV –UCAT Native –Simplification Core Matrix –ISO/HL7 10781/16527 EHR/PHR System Functional Models Export: JSON, CSV Ability to clone Additional Capabilities Ability to track status of information –Component Lifecycle Management Next Steps Add remaining 14 S&I Use Cases to UCAT –One-time manual entry –Resolving differences from template Refine Core Matrix master template USHIK Integration S&I Data Integration –CEDD, FHIM, or CIMI... Evaluate and design handoff to downstream tools –Implementation Guide Authoring –Testing Tools, MDHT, V2 … DRAFT

22. Capture Once, Re-Use Many Times –Each Re-Use Instance = x 1 Savings –Facilitate Cross S&I Initiative Coordination –Facilitate Cross Agency/Domain Coordination –Unlocking Value of S&I (maximizes re-use, return) Experience Shows: –AHIC/HITSP: 4 Years, 17 Use Cases/Initiatives (4+/yr) –S&I: 2 Years, 13 Use Cases/Initiatives (6+/yr) –With UCAT: ? With IGAT, With Test Methods? Simplification – Automating the S&I Platform Benefits UC Requirements Implementation Guides Test Methods Faster, real world adoption S&I Platform Automated Tools DRAFT22

23. Appendices Gary Dickinson Presentation - DRAFT Use Case Authoring Tool - Simplification Introduction Art Greisser Presentation - "Use Cases" Slide Set Frederick’s Presentation - ? Link to USHIK S&I Pilot Site Link UCAT Portal TBD DRAFT23

24. Use Cases Arthur Griesser, PhD Prometheus Computing, LLC

25. What reduces development time the most? Better tools for developers? More training for developers? More experience in domain? Better understanding of requirements?

26. What reduces development time the most? Better tools for developers? More training for developers? More experience in domain? Better understanding of requirements? ✓

27. COnstructive COst MOdel Effort is Doubled if analysis is shortchanged

28. Why Is Analysis So Important? Correct is hard... but easier than later fix Ounce of prevention Measure twice, cut once By failing to prepare, you are preparing to fail Ben Franklin

29. Police in Gumperda, Germany, arrested a 64-year-old retired do-it- yourselfer in November after he drilled through a neighbor's wall in their duplex home. The man had spent two days trapped in his own basement, where he had laid bricks and mortar for a room but apparently forgot to leave himself an exit. [BBC News, 11-25-10] Chuck Shepherd’s News of the Weird, week of Dec 12, 2010

30. Use cases... Study how users get value from system Define how users interact with system Help subsequent efforts deliver value Are contracts between users & developers

31. UML? Suitable for parts of a use case: Use case diagram Activity diagram Communication diagram Usually a small fraction of a use case UML does not define use case structure

32. Beware Analysis Paralysis Duplication Conflicting Requirements Excessive Complexity

33. The Next Level

34. What if... We could just “run” use cases as tests? Traceability guaranteed Tests & use cases always in synch Less effort, expense Tests are as complete as use cases

35. Today

36. Better Executable Verify >

37. Use cases Specify how user gets value from system Describe interaction of user & system Abstractly

38. Use cases Specify how user gets value from system Describe interaction of user & system Abstractly Ensure Verify Tests Concretely (specific test data)

39. S&I Simplification General High Level Goals [G1] Decrease | limit waste –Time spent working on artifacts –Unused or unreachable artifacts [G2] Increase domain penetration –The more use cases and scenarios, the more fully the domain issues can be understood and addressed [G3] Centralize information –Create a network of specialized information that can be shared [G4] Increase | facilitate collaboration –Manage centralized information so it stimulates collaboration (i.e. online services) [G5] Facilitate integration of information in process –Information generated at a point in the process should flow and be easily usable by underlying processes [G6] Reuse of existing infrastructure 21 March 2013Simplification/UCAT Intro39

40. S&I Simplification Use Case Authoring Tool Facilitates use case components capture (G1-2) Facilitates use case components reuse (G1-2) Creates a repository of use case components (G3) Is accessible online (G4) Allows for developed use cases to be electronically handled by underlying processes (i.e. implementation guides) (G5) Helps the developed use cases to stay consistent (G1-3- 5) Allows full access of the underlying data to trusted members for integration with the existing infrastructure (G6) 21 March 2013Simplification/UCAT Intro40