Data Provenance –Use Case (Discovery) Ahsin Azim– Use Case Lead Presha Patel – Use Case Lead

1. Data Provenance –Use Case (Discovery) Ahsin Azim– Use Case Lead Presha Patel – Use Case Lead

2. ONC Standards and Interoperability (S&I) Framework Lifecycle • Our Missions • Promote a sustainable ecosystem that drives increasing interoperability and standards adoption • Create a collaborative, coordinated, incremental standards process that is led by the industry in solving real world problems • Leverage “government as a platform” – provide tools, coordination, and harmonization that will support interested parties as they develop solutions to interoperability and standards adoption. Pilot Demonstration Projects Standards Development Support Reference Implementation Use Case Developmentand Functional Requirements Harmonization ofCore Concepts Implementation Specifications Certificationand Testing Tools and Services Architecture Refinement and Management

3. S&I Framework Phases outlined for Data Provenance

4. Use Case Development Objectives • Engage Stakeholders as Committed Members, Invite Experts, or Interested Parties in the creation of a Use Case  This is you all! • Identify Scenarios and User Stories that address real-world problems • Keep it simple • Focus on the business and functional requirements: Focus on “what” the requirements should be rather than “how” • 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

5. Use Case OutlineTailored for each Initiative • 10.0 Scenario: Workflow • 10.1 User Story 1, 2, x, … • 10.2 Activity Diagram • 10.2.1 Base Flow • 10.2.2 Alternate Flow (if needed) • 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 • 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 (Stakeholders)** • 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 ** Leverage content from Charter

6. Review of Key Use Case SectionsAssumptions, Pre-conditions and Post-conditions Assumptions • Outlines what needs to be in place to meet or realize the requirements of the Use Case • These points are more functional in nature and state the broad overarching concepts related to the Initiative • The Use Case assumptions will serve as a starting point for subsequent harmonization activities Pre Conditions • Describes the state of the system, from a technical perspective, that must be true before an operation, process, activity or task can be executed • It lists what needs to be in place before executing the information exchange as described by the Functional Requirements and Dataset requirements Post Conditions • Describes the state of the system, from a technical perspective, that will result after the execution of the operation, process activity or task

7. Review of Key Use Case SectionsUse Case Diagrams • Conceptually represents the Business Actors interacting with the Use Case and the User Stories • Provides a pictorial representation of the environment where the exchange takes place • Characterizes the types of interactions that an actor has with a specific system • Shows the association and interaction between the business actors and the Use Case • It provides an overview of the actors (users or external systems) and the interactions between them Example: Transitions of Care

8. Review of Key Use Case SectionsDefining 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. • 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. Example

9. Review of Key Use Case SectionsScenarios • The scenario is a comprehensive description of the actors, interactions, activities, and requirements associated with the information exchange • Scenarios pertain to supporting the health information exchange and describing key flows, and they are supplemented by User Stories • Example: Specialist requests a patient’s Clinical Care Summary from Primary Care Provider (PCP) Scenario 1 Scenario 2 User Story 2 User Story 1 User Story 1 User Story 2

10. Review of Key Use Case SectionsUser Story • User Stories describe the real world application as an example or instantiation of the Scenario • User Stories summarize the interaction between the actors of the Use Case, and specify what information is exchanged from a contextual perspective • These interactions are further described in subsequent sections. Historically, user stories have been utilized to provide clinical context • Example Scenario (from previous slide): Specialist requests a patient’s Clinical Care Summary from Primary Care Provider (PCP) • Example User Story: A Specialist receives a referral and requires more information to treat the patient properly at the point of care. Using an EHR System, the Specialist sends a request to the PCP for the patient’s Clinical Care Summary. The PCP successfully receives the requests, understands the requests, and sends the patient’s Clinical Care Summary back to the Specialist via the EHR System. The Specialist successfully receives the patient information, understands it, and makes an informed decision that can provide better quality of care to the patient.

11. Review of Key Use Case SectionsActivity Diagram • An Activity Diagram is a special form of a state transition diagram in which all or most of the states are activity states or action states • The Activity Diagram illustrates the Use Case flows graphically, and represents the flow of events and information between the actors • It also displays the main events/actions that are required for the data exchange and the role of each system in supporting the change

12. Review of Key Use Case SectionsFunctional Requirements • Functional Requirements identify the capabilities a system in a role must have in order to enable interoperable exchange of the healthcare data of interest • They provide a detailed breakdown of the requirements in terms of the intended functional behaviors of the application • The Functional Requirements include: • Information Interchange Requirements • System Requirements • The Information Interchange Requirements define the system’s name and role. They also specify the actions associated with the actual transport of content from the sending system to the receiving system • System Requirements include the requirements internal to the system necessary to participate successfully in the transaction. System requirements may also detail a required workflow that is essential to the Use Case

13. Review of Key Use Case SectionsSequence Diagram • A Sequence Diagram is primarily used to show the interactions between objects in the sequential order that they occur • This representation can make it easy to communicate how the exchange works by displaying how the different components interact • The primary use of the diagram is in the transition from requirements expressed as use cases to the next and more formal level of refinement • Note: Horizontal lines are used to identify the specific activity between the systems

14. Review of Key Use Case SectionsDataset Requirements & Issues, Risks& Obstacles Dataset Requirements • Include the data elements and data element sets that will be available within the message or document. Each data element included is necessary for some aspect of the Use Case; however, the requirements do not specify exactly how they may be used together. All data element sets may contain multiple data elements unless otherwise stated. • The identification of data elements forms the foundation for harmonization activities. The data elements identified in the Use Case set constraints on the contents of documents and messages. Issues Risks and Obstacles • Lists the concerns that might interfere with meeting the requirements of the Use Case • Note: This list takes into consideration risks outlined in the Charter

15. S&I Community Enabling Toolkit (CET)Use Case Overview

16. Proposed Use Case & Functional Requirements Development Timeline

17. In/Out Scope Items Out of Scope • Patient identity matching*** • Third party mechanisms for checking patient consent and the relative merits of existing policies or regulations (such as privacy policies or jurisdictional considerations)*** • Policy-based decisions (such as records management based policies on record retention) • Non-clinical data (such as environmental data) *** Leveraged from Charter In Scope • To identify and define guidance on use of standards to facilitate provenance capabilities by specifying the following: *** • Standards for the provenance (e.g. origin, source, custodian(s), FHIR resources, CDA, etc.) • Supportive standards (e.g. integrity, non-repudiation) • Vocabulary standard metadata tags for data provenance • Variance in granularity to which data provenance can be collected, the way it is encoded, and how that provenance is communicated to consuming systems • Define system requirements that allow applications to generate, persist and retrieve provenance data and maintain associations with the target record • Ensure sufficient granularity to support chain of custody

18. Assumptions Clinical information that already exists within the EHR system (without the use of the CDA artifact) is found at the level appropriate for the implementation

19. Draft Use Case Context Diagram True Source (EHR) Aggregator (EHR, HIE, other systems) End Point (EHR) True Source (Lab) True Source (Other)

20. A look ahead: Data Provenance Next Week • June 16th , 2014 – Tiger Team (3-4 pm ET) • June 19th , 2014 – All Hands Community Meeting (2:30-3:30) • Review In/Out Scope and Assumptions

21. Support Team and Questions Please feel free to reach out to any member of the Data Provenance Support Team: • Initiative Coordinator: Johnathan Coleman: jc@securityrs.com • OCPO Sponsor: Julie Chua: julie.chua@hhs.gov • OST Sponsor: Mera Choi: mera.choi@hhs.gov • Subject Matter Experts: Kathleen Conner: klc@securityrs.com and Bob Yencha: bobyencha@maine.rr.com • Support Team: • Project Management: Jamie Parker: jamie.parker@esacinc.com • Use Case Development: Presha Patel: presha.patel@accenture.comand Ahsin Azim: ahsin.azim@accenturefederal.com • Harmonization: Rita Torkzadeh:rtorkzadeh@jbsinternational.com • Standards Development Support: Amanda Nash: amanda.j.nash@accenturefederal.com • Support: Lynette Elliott:lynette.elliott@esacinc.com