Prelim Story 2009 - Interoperability Showcase by dandanhuanghuang

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									                                                                                                                                                                                                                                                                                               259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



HIMSS09 Interoperability Showcase: HIMSS09 IS Scenarios_Version 16_Mar 30 2009_This is a working DRAFT and should NOT be considered a final. This document will be revised to reflect changes as they occur. For
more information , about this version of the storyline contact jtdonnelly@intepro.biz

Theme       ACT# Act                Sce Setting       Story / Clinical Discussion             Profile / Actor -        Potential       Profile / Actor -   Potential          Clinical         Comments /                     02/11   Showings   Showings Expl          HITSP Related
                                    ne                                                        Inbound                  Vendors         Outbound            Vendors            Considerations & Variants                                                                 Comments
                                                                                                                                                                              Content Needed

Patient-   A-1        ER            1   Home          28yo woman, routinely enters family     [Pt ID ADT Trigger for                   XDS.b (Doc Source) Allscripts-C        Out=XPHR                                                  10[2]    PHR Vendors
Provider              Referral                        and social history in PHR. She          PIX (if PIX variant)]                    [XDM Variant]      Allscripts-E[xdm]   Summary (Content                                                   CapMed, NMC,
Partnering                                            experiences some abdominal pain                                                                     Allscripts-P[xdm]   Creator)                                                           and Epic (XDM
                                                      and creates a summary of her                                                                        Blueware
                                                                                                                                                                                                                                                 variant only)
                                                      personal information in preparation                                                                 Capmed[xdm]
                                                                                                                                                                                                                                                 selected
                                                      for her visit to her primary care                                                                   Epic_PHR[xdm
                                                      physician and deposits this                                                                         only]
                                                      summary in the Health Information                                                                   GE(1)
                                                      Exchange (also XDM variant).                                                                        Greenway[xdm]
                                                      -----                                                                                               McKesson[xdm]
                                                      Developed mild pain around my belly                                                                 MIE[xdm]
                                                      button last night after dinner. This                                                                NMC[xdm]
                                                      morning it worsened and moved to                                                                    Phreesia
                                                      my right lower side. I feel nauseated                                                               Sage[xdm]
                                                      but haven‘t vomited. I have a low
                                                      grade fever. I generally feel poorly.
                                                      I‘ve had no diarrhea.
Patient-   A-1        ER            2   PCP Office    PCP retrieves the woman's               XDS.b (Doc Consumer) Allscripts-C        XDS.b (Doc Source) Allscripts-C        In=XPHR          Phressia is a special                    8[7]     Phressia is a          Add Eligibility
Provider              Referral                        information from the Health Info        [XDM Variant]        Allscripts-E[xdm]                      Allscripts-E        Summary (Content variant on inbound of                             special variant on     inquiry as a variant
Partnering                                            Exchange (also XDM variant).                                 Allscripts-P[xdm]                      Allscripts-P        Consumer)        ACT                                               inbound of ACT to      supporting HITSP
                                                      Conducts an exam and suspects                                Blueware                               Blueware            Out=EDR                                                            inbound MS and         Consultations and
                                                      acute appendicits. Refers her to the                         CapMed[xdm]                            Epic
                                                                                                                                                                              Summary (Content                                                   generate new MS;       transfers of care
                                                      ER.                                                          Epic                                   Greenway
                                                      -----                                                        GE(5)                                  Mckesson            Creator)                                                           Outbound               (MIE, others?)
                                                      No history of appendectomy noted.                            Greenway[xdm]                          MIE                                                                                    Constrained
                                                      Tender with guarding in the right                            Mckesson[xdm]                          NextGen
                                                      lower quadrant. Rectal examination                           MIE[xdm]                               Sage
                                                      tender on the right side, hemoccult                          NextGen[xdm]
                                                      negative. Pelvic exam normal.                                NMC[xdm]
                                                      Remainder of general medical exam                            Phreesia
                                                      normal.                                                      Sage[xdm]
                                                                                                                   SAIC
Patient-   A-1        ER            3   Hosp1 ER      In ER, pt records reviewed              XDS.b (Doc Consumer) Alert               None (end of Act)                      In=EDR Summary                                            9[5]     ED EMR systems         Add Eligibility
Provider              Referral                        expediently and pt treated in time to                        Allscripts-C                                               (Content                                                           Alert, Allscripts-E,   inquiry as a variant
Partnering                                            prevent personal emergency.                                  Allscripts-E                                               Consumer)                                                          Blueware, Epic,        supporting HITSP
                                                      -----                                                        Allscripts-P
                                                                                                                                                                                                                                                 GE_CIS and SMS         Consultations and
                                                      CT of abdomen done, reveals acute                            Blueware
                                                                                                                                                                                                                                                 selected               transfers of care
                                                      appendicitis, surgeon contacted,                             CapMed
                                                      patient taken to operating room and                          Epic                                                                                                                                                 (GE, others?)
                                                      successful appendectomy                                      GE(5)
                                                      performed. Patient recovered                                 Greenway
                                                      without sequelae.                                            MIE
                                                                                                                   NextGen
                                                                                                                   Sage
                                                                                                                   SMS
Patient-   A-1        ER            4   Infrastructure Wizard of OZ explains
Provider              Referral
Partnering


Maternal    A-2       Ob-Gyn to 1       Home          34yo pregnant woman, routinely          [Pt ID ADT Trigger for                   XDS.b (Doc Source) Allscripts-C        Out=XPHR                                                  9[2]     PHR Vendors
Health                L&D                             enters family and social history and    PIX (if PIX variant)]                    [XDM Variant]      Allscripts-E[xdm]   Summary (Content                                                   CapMed, NMC,
                                                      results of her visits to her                                                                        Allscripts-P[xdm]   Creator)                                                           and Epic (XDM
                                                      obstertrician in her PHR.                                                                           Blueware
                                                                                                                                                                                                                                                 variant only)
                                                                                                                                                          Capmed[xdm]
                                                                                                                                                                                                                                                 selected
                                                                                                                                                          Epic_phr[XDM
                                                                                                                                                          only]
Maternal    A-2       Ob-Gyn to 2       OB-Gyn        Pt's Obstetrician determines that her XDS.b (Doc Consumer) Allscripts-C          XDS.b (Doc Source) Blueware            In=XPHR Summary         Need more XDR                     3[3]     Phressia is a
Health                L&D               Office        pregnancy has complications and       [XDM Variant]        Allscripts-E[xdm]     [XDR variant]      Epic                (Content Consumer)      DocSources that also                       special variant on
                                                      recommends that she check in at the                        Allscripts-P[xdm]                        Greenway[xdr]       Out=PCC APS /APR        support APR Content                        inbound of ACT
                                                      hospital. Completes an APS/APR on                          Blueware                                 MIE                 (Content Creator)       Creator
                                                      the pt and sends the information to                        CapMed[xdm]                                                  ----                    ----
                                                                                                                                                                                                                                                 Ambul EMR
                                                      the local hospital.                                        Epic                                                         Phressia variant will   Phressia is a special
                                                                                                                 GE(5)                                                        have                    variant on inbound of                      vendors Epic,
                                                                                                                 Greenway                                                     Out= XPHR               ACT                                        Greenway, & MIE
Maternal    A-2       Ob-Gyn to 2a      OB-Gyn        Pt's Gynocologist determines that     XDS.b (Doc Consumer) Alert (XD-Lab only) XDS.b (Doc            Blueware           In=XPHR Summary         Check if GE EHR can               3[3]     selected; outbound Personalized HC
                                                                                                                                                                                                                                                 Use EHR's Epic,
Health                L&D               Office        due to her genetic history and lab    [XDM Variant]        CapMed              Source), BPPC,        Epic               (Content Consumer),     support APR as a                           Greeway, and MIE (IS08), IS05,
                                                      results indicating that the fetus has                      GE(4)               [XDR variant]         Greenway[xdr]      XD*Lab from             Content                                    (see note)         HISPC (AUT- 3,
                                                      (XXX), the gynocologist and                                NextGen                                   MIE                preload or XDS-SD,
                                                                                                                                                                                                      Creator…than they                                             AUT-4, AUT-5,
                                                      recommends that she check in at the                        SAIC                                                         BPPC Sensitivity
                                                                                                                                                                                                      can provide XD-Lab                                            AUT-7, DAT-1,
                                                      hospital. Completes an APS/APR on                          UWA (XD-Lab                                                  Out=PCC APS /APR
                                                      the pt and sends the information to                        only)                                                        (Content Creator)       showing.                                                      DAT-6, DAT-7,
                                                      the local hospital.                                        ----                                                                                 -----                                                         DAT-8, DAT-13,
                                                                                                                 XDS-SD Only                                                                          Confirm that MIE can                                          SYS-1, SYS-9,
                                                                                                                 Allscripts-C                                                                         show/consume XDS-                                             SYS-10, SYS-11,
                                                                                                                 Allscripts-P                                                                         SD                                                            POL-2, POL-8,
                                                                                                                 Epic                                                                                 -----                                                         POL-10, POL-11,
                                                                                                                 GE(1)                                                                                The XD-Lab or XDS-                                            POL-14, POL-12,
                                                                                                                 Greenway                                                                             SD version of the lab                                         BPPC document
                                                                                                                 Mckesson
                                                                                                                                                                                                      report needs to be                                            sensitivity)
                                                                                                                 Sage
                                                                                                                                                                                                      created as a seed
                                                                                                                                                                                                      document




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                                                                                                                                                                                                                                                                                              259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme         ACT# Act                Sce Setting       Story / Clinical Discussion            Profile / Actor -           Potential             Profile / Actor -   Potential           Clinical         Comments /                 02/11   Showings   Showings Expl         HITSP Related
                                      ne                                                       Inbound                     Vendors               Outbound            Vendors             Considerations & Variants                                                            Comments
                                                                                                                                                                                         Content Needed

Maternal      A-2       Ob-Gyn to 3       Hosp1 OB      In Hosp OB department, records         XDS.b (Doc Consumer) Blueware                     XDS.b (Doc Source) Allscripts-C         In=PCC APS /APR                                       9[2]     Hosp EMR
Health                  L&D               Dept          received from OB-Gyn office and        [XDR Variant]        Capmed                       [XDR variant]      Allscripts-E[xdr]    (Content Consumer)                                             vendors Blueware,
                                                        expediently registers the pt in the                         Epic                                            Allscripts-P         Out=XDS-MS                                                     Epic, GE_CPN
                                                        hospital labor and delivery system.                         GE(5)                                           Blueware             Discharge (Content                                             selected
                                                                                                                    Greenway[xdr]                                   CPSI[xdr]            Creator)
                                                                                                                    MIE                                             EMDS
                                                                                                                    Sage                                            Epic
                                                                                                                                                                    GE(3)[xdr][(1)xds-
                                                                                                                                                                    I]
                                                                                                                                                                    Greenway[xdr]
                                                                                                                                                                    Mckesson
                                                                                                                                                                    MIE
                                                                                                                                                                    NextGen[xdr]
Maternal      A-2       Ob-Gyn to 4       PCP Office    Two days later, patient delivers        XDS.b (Doc Consumer)       Alert[xd-lab]         None (end of Act)                       In=XDS-MS                                            21[10]    Although 10 EMR's
Health                  L&D                             normal healthy baby boy. Discharge [XDR Variant]                   Allscripts-C                                                  Discharge (Content                                             are eleigible, the
                                                        summary is sent to primary care                                    Allscripts-E[xdr]                                             Consumer)                                                      EMR's that were
                                                        family practictioner for follow-up care                            Allscripts-P                                                                                                                 not used in step 2
                                                        four week post delivery. Primary                                   Blueware
                                                                                                                                                                                                                                                        would be applic, ie
                                                        care provider, who was not present                                 CapMed[xd-lab]
                                                        at birth is able to review details of                              CPSI[xdr]                                                                                                                    Allscripts, EMDS,
                                                        delivery and provide postpartum                                    EMDS                                                                                                                         GE, MIE, NextGen,
                                                        follow-up care to patient.                                         Epic                                                                                                                         and Sage
                                                                                                                           GE(5)[xds-I(3)][xd-
                                                                                                                           lab]
                                                                                                                           Greenway[xdr]
                                                                                                                           Mckesson
                                                                                                                           MIE
                                                                                                                           NextGen[xds-
                                                                                                                           I][xdr][xd-lab]
                                                                                                                           Sage
                                                                                                                           SAIC[xd-lab]
                                                                                                                           Wellogic
Maternal      A-2       Ob-Gyn to 5       Infrastructure Wizard of OZ explains
Health                  L&D

Chronic       A-3       Complicati 1      Home          The patient establishes a personal    Pt ID ADT Trigger for                              XDS.b (Doc Source) Allscripts-C (XDS-   Out=XPHR                                               1       NMC is used here. NOTE -
Care                    ons of                          health record where he tracks his     PIX (if PIX variant)                                                  SD only)             Summary (Content                                                                 Medication
                        Diabetes                        blood glucose levels, diet, and                                                                             Allscripts-E (no     Creator)                                                                         Management
                                                        exercise at the recommendation of                                                                           XDS-SD)
                                                                                                                                                                                         Out=XDS-SD                                                                       opportunity
                                                        his PCP. The patient retrieves the                                                                          Allscripts-P (no
                                                                                                                                                                                         (Content Ctreator)
                                                        recent eye exam summary details                                                                             XDS-SD)
                                                        and imports the data into the PHR.                                                                          Blueware
                                                        The patient publishes this                                                                                  Capmed               Review for clinical
                                                        information to the Health Information                                                                       CPSI (XDS-SD         accuracy and XDS-
                                                        exchange to make this information                                                                           only)                MS and XD-Lab
                                                        available to the care management                                                                            GE(1)                requirements
                                                        team. The patient also publishes a                                                                          Greenway
                                                        summary document to the exchange                                                                            Healthvision (XDS-
                                                        indicating that he is a diabetic in                                                                         SD only)
                                                        case of an emergency.                                                                                       HSI (XDS-SD only)
                                                                                                                                                                    McKesson
                                                                                                                                                                    MIE
                                                                                                                                                                    NextGen (XDS-SD
                                                                                                                                                                    only)
                                                                                                                                                                    NMC
                                                                                                                                                                    Phreesia
                                                                                                                                                                    Sage (no XDS-SD)
                                                                                                                                                                    SMS (XDS-SD
                                                                                                                                                                    only)
Chronic       A-3       Complicati 1a     Home          The patient establishes a personal    Pt ID ADT Trigger for                              XDR                Capmed               Out=XPHR            HISPC AUT- 3, AUT-                 1       CapMed is used to     NOTE -
Care                    ons of            [Gluocose     health record where he tracks his     PIX (req for this variant)                         XDS.b (Doc Source)                      Summary (Content    4, AUT-5, AUT-7, DAT-                      demonstrate           Medication
                        Diabetes          measure       blood glucose levels, diet, and                                                                                                  Creator)            1, DAT-6, DAT-7, DAT-                      support for           Management
                                          variant]      exercise at the recommendation of                                                                                                Out=XDS-SD          8, DAT-13, SYS-1,                          is12 for the          opportunity
                                                        his PCP. The patient has recorded                                                                                                                    SYS-9, SYS-10, SYS-
                                                                                                                                                                                         (Content Ctreator)                                             glucose
                                                        his glucose measurements and diet                                                                                                                    11, POL-2, POL-8,
                                                        & exercise particulars into the PHR.                                                                                                                 POL-10, POL-11, POL-                       measurements in
                                                        The patient sends the summary of                                                                                                 Review for clinical 14 (ATNA, PIX,                             an SD document.
                                                        these measurements to the provider.                                                                                              accuracy and XDS- Metadata identifiers,
                                                        The patient publishes this                                                                                                       MS and XD-Lab       sensitivity)
                                                        information to the Health Information                                                                                            requirements
                                                        exchange to make this information
                                                        available to the care management
                                                        team. The patient also publishes a
                                                        summary document to the exchange
                                                        indicating that he is a diabetic in
                                                        case of an emergency.




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Theme         ACT# Act                Sce Setting      Story / Clinical Discussion               Profile / Actor -         Potential         Profile / Actor -      Potential           Clinical         Comments /                   02/11   Showings   Showings Expl          HITSP Related
                                      ne                                                         Inbound                   Vendors           Outbound               Vendors             Considerations & Variants                                                               Comments
                                                                                                                                                                                        Content Needed

Chronic       A-3       Complicati 2      PCP Office   The patient returns to his PCP and        XDS.b (Doc Consumer)      Alert (XD-Lab only) XDS.b (Doc Source)   Allscripts-C        In=XPHR             Medication                           1       Only NextGen           HISPC AUT- 3,
Care                    ons of                         he reviews the HbA1C results (show        Lab (Doc Consumer)        CapMed              [XDR variant]        Allscripts-E[xdr]   Summary (Content    Management -                                 satisfies both in &    AUT-4, AUT-5,
                        Diabetes                       directly interfaced into EMR from         [XDS-SD variant for lab   GE(4)                                    Allscripts-P        Consumer)           outpatient medication                        out req.               AUT-7, DAT-1,
                                                       lab) which also are within the            rpt]                      NextGen                                  Blueware            In=XD-Lab           reconciliation                               -----                  DAT-6, DAT-7,
                                                       abnormal range. The physician also                                  SAIC                                     CPSI[xdr]                               -----
                                                                                                                                                                                        (Content                                                 8       Can have more          DAT-8, DAT-13,
                                                       notes low levels of microalbuminuria                                UWA (XD-Lab                              EMDS                                    Need to confirm what
                                                       (60 μg/min) from the annual                                         only)                                    Epic                Consumer)           option of XDS-MS                             showings if we use     SYS-1, SYS-9,
                                                       screening. This lab value is of                                     ----                                     GE(3)[xdr]          Out=XDS-MS          each vendor supports                         an XDS-SD for the      SYS-10, SYS-11,
                                                       concern and the PCP refers the                                      XDS-SD Only                              Greenway[xdr]       Referral (Content                                                inbound lab report     POL-2, POL-8,
                                                       patient for further consultation with a                             Allscripts-C                             Mckesson            Source)                                                                                 POL-10, POL-11,
                                                       nephrologist for further testing. The                               Allscripts-P                             MIE                                                                                                         POL-14 (ATNA,
                                                       patient also reports wide fluctuation                               Epic                                     NextGen[xdr]                                                                                                PIX, PDQ,
                                                       in blood sugar levels. Due to these                                 GE(1)                                    Sage                                                                                                        Metadata
                                                       new findings, the PCP decides to                                    Greenway                                                                                                                                             identifiers,
                                                       refer the patient to an                                             Mckesson
                                                                                                                                                                                                                                                                                sensitivity, DSG
                                                       endocrinologist for a review of the                                 Sage
                                                       insulin and metabolic regimen. The                                                                                                                                                                                       option - Greenway
                                                       laboratory results are submitted to                                                                                                                                                                                      variant for HISPC
                                                       the Health Information Exchange for                                                                                                                                                                                      Support)
                                                       further review by the endocrinologist
                                                       along with the patient medical
                                                       summary including current
                                                       medications and latest observations.
Chronic       A-3       Complicati 2a     PCP Office   The provider receives data from the       XDR (Doc Recipient)       ALLSCRIPTS_P      XDS.b (Doc Source) Allscripts-C            In=XPHR (Content    HISPC AUT- 3, AUT-                   4       Allscripts,
Care                    ons of            (inbound     patient. The patient visits the PCP       ----                      GREENWAY                             Allscripts-E[xdr]       Consumer)           4, AUT-5, AUT-7, DAT-                        Greenway,
                        Diabetes          variant)     and she reviews the abnormal widely       (XDS.b (Doc               NEXTGEN                              Allscripts-P            In=XDS-SD           1, DAT-6, DAT-7, DAT-                        NextGen consume
                                                       varying glucose levels which she has      Consumer)                                                      Blueware                                    8, DAT-13, SYS-1,
                                                                                                                                                                                        (Content                                                         XPHR….eMDS
                                                       retrieved from the Health Info                                                                           CPSI[xdr]                                   SYS-9, SYS-10, SYS-
                                                                                                                                                                                        Consumer)                                                        starts with XDS-
                                                       Exchange. She refers the patient to                                                                      EMDS                                        11, POL-2, POL-8,
                                                       commence oversight by an                                                                                 Epic                    In=XD-Lab           POL-10, POL-11, POL-                         MS output
                                                       Endocronologist as soon as                                                                               GE(3)[xdr]              (Content            14 (ATNA, PIX, PDQ,
                                                       possible. The PCP completes a                                                                            Greenway[xdr]           Consumer)           Metadata identifiers,
                                                       patient referral set and stores it on                                                                    Mckesson                Out=XDS-MS          sensitivity, DSG option
                                                       the Health Info Exchange                                                                                 MIE                     Referral (Content   - Greenway variant for
                                                                                                                                                                NextGen[xdr]            Source)             HISPC Support)
                                                                                                                                                                Sage                    -----
                                                                                                                                                                                        ACT variant will
                                                                                                                                                                                        start here and
                                                                                                                                                                                        demo the PCP-
                                                                                                                                                                                        Spec-PCP
                                                                                                                                                                                        exchange only

Chronic       A-3       Complicati 2b     PCP          The patient contacts the PCP and      XDS.b (Doc Consumer)     Allscripts-C      XD-Lab (Doc                 GE(1)               In=XPHR             GE-EHR is the only XD-               1       Only GE can be an      NOTE -
Care                    ons of            Office/Lab   she reviews the abnormal                                       Allscripts-E[xdm] Source) [variant]                               Summary (Content    Lab Source which can                         XD-Lab source.         Medication
                        Diabetes          (outbound    retinopathy results which she has                              Allscripts-P[xdm]                                                 Consumer)           regenerate / pass thru                       Ambul EMR's:           Management
                                          variant)     retrieved from the Health Info                                 Blueware                                                          [Variant Out=XD-    an XD-Lab report. For                        Allscripts(2), Epic,   opportunity
                                                       Exchange. She orders a lab panel to                            CapMed[xdm]                                                                           the rest, the lab
                                                                                                                                                                                        Lab (Content                                                     GE(1), Greenway,
                                                       obtain current HbA1C and other                                 Epic                                                                                  document is created at
                                                       related readings and instructs the pt                          GE(5)                                                             Source)]            registration                                 Mckesson, MIE,
                                                       to have them completed as soon as                              Greenway[xdm]                                                                         ----                                         NextGen, Sage,
                                                       possible.                                                      Mckesson[xdm]                                                                         No more !!!                                  SAIC
                                                                                                                      MIE[xdm]
                                                                                                                      NextGen[xdm]
                                                                                                                      NMC[xdm]
                                                                                                                      Phreesia
                                                                                                                      Sage[xdm]
                                                                                                                      SAIC
Chronic       A-3       Complicati 3      Endocrinolog The patient presents to the               XDS.b (Doc Consumer) Alert             XDS.b (Doc Source)          Allscripts-C        In=XDS-SD           Need to confirm what                 2       Only 1xGE and
Care                    ons of            ist          endocrinologist as a result of the        Lab (Doc Consumer)   CapMed                                        Allscripts-E        (Content            option of XDS-MS                             NextGen systems
                        Diabetes                       PCP referral. (Option: The patient        [XDR variant]        GE(4)                                         Allscripts-P        Consumer)           each vendor supports                         are candidates
                                                       has been using a PHR for journaling                            NextGen                                       Blueware            In=XD-Lab                                                        with XD-Lab for
                                                       diet and blood sugar values). The                              SAIC (No xds-SD)                              CPSI
                                                                                                                                                                                        (Content                                                         this step.
                                                       Endocrinologist retrieves the                                  ----                                          EMDS
                                                       laboratory result data and the patient                         XDS-SD Only                                   Epic                Consumer)
                                                       medical summary from the Health                                Allscripts-C                                  GE(3)               In=XDS-MS                                                7       Using the XDS-MS
                                                       Information Exchange. The                                      Allscripts-P                                  Greenway            Referral (Content                                                variant for inbound,
                                                       endocrinologist reviews and imports                            Epic                                          Mckesson            Consumer)                                                        we pick up 5
                                                       the medication list provided by the                            GE(1)                                         MIE                 --------                                                         additional
                                                       PCPs medical summary and reviews                               Greenway                                      NextGen             Out=XDS-MS
                                                       the patient's diet journal and adds a                          Mckesson                                      Sage                Referral / XPHR
                                                       new Alpha-glucosidase inhibitor to                             Sage                                                              (Content Source)
                                                       better manage the blood glucose
                                                       fluctuations. The endocrinologist
                                                       further councils the patient on proper
                                                       diet and recommends continued
                                                       journalling and a 4-week follow-up.
                                                       The Endocrinologist publishes the
                                                       medical summary to the Health
                                                       Information Exchange where it will
                                                       be available to the PCP and other
                                                       care providers involved in the patient
                                                       care and diabetes management.
Chronic       A-3       Complicati 4      PCP          The patient returns to his PCP and     XDS.b (Doc Consumer) eMDS                                                                                     Variant which only
Care                    ons of                         he reviews the medical summary                                                                                                                       demo's the clinical
                        Diabetes                       submitted by the Endochronologist                                                                                                                    exchange between a
                                                       to the Health Information Exchange                                                                                                                   PCP and a specialist




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Theme         ACT# Act                Sce Setting        Story / Clinical Discussion             Profile / Actor -   Potential        Profile / Actor -   Potential      Clinical         Comments /                   02/11   Showings   Showings Expl   HITSP Related
                                      ne                                                         Inbound             Vendors          Outbound            Vendors        Considerations & Variants                                                        Comments
                                                                                                                                                                         Content Needed

Chronic       A-3       Complicati 5       Infrastructure All of the information exchange and
Care                    ons of                            interoperability has been made
                                                          possible through the Health
                        Diabetes
                                                          Information Exchange Infrastructure.
                                                          The infrastructure Patient Identity
                                                          Cross-reference Indexing and
                                                          document sharing infrastructure are
                                                          reviewed.

MHS-Priv A-4            Out-of-       2    PHR Service A soldier stationed away from home None: Direct onliine       MS Healthvault                                                           Direct online entry of
Partnering              Network                        has been informed of new service to creation of an MS                                                                                  anew MS Healthvault
                                                       make his MHS medical information Healthvault account                                                                                   account for the
                        Military
                                                       available to local care providers.                                                                                                     showcase attendee.
                        Care                           This capability is provided by an
                                                       internet based PHR Service (herein
                                                       MS Healthvault) which has been
                                                       indicated by his unit leadership as
                                                       having an information exchange
                                                       capability with his MHS records. The
                                                       soldier establishes an account for
                                                       himself on this PHR Service.
MHS-Priv A-4            Out-of-       1    MHS         A soldier returns home on leave to                                             C32                 MHS Hospital   Prior to the C32
Partnering              Network            Hospital    visit his family. His medical records                                                              (MiCare)       being generated,
                                                       from the MHS EMR are critical to                                                                                  the MHS EMR
                        Military
                                                       local clinicians being aware of prior
                        Care                                                                                                                                             receives an ADT
                                                       treatments and conditions. Prior to
                                                                                                                                                                         feed for the
                                                       going home, he accesses his MHS
                                                       EMR system and associates his                                                                                     showcase attendee
                                                       medical records account with the                                                                                  and establsihes an
                                                       account he has established on his                                                                                 MHS account. The
                                                       local PHR service.                                                                                                MHS and the MS
                                                                                                                                                                         Healthvault acct
                                                                                                                                                                         are then linked
                                                                                                                                                                         online by the
                                                                                                                                                                         showcase
                                                                                                                                                                         attendee.

MHS-Priv A-4            Out-of-       3a   Home          While at home, he experiences some C32                      NMC              XDS Doc Source      NMC            In=C32
Partnering              Network                          severe abdominal pain. The soldier                                                                              Out=XPHR
                                                         updates his personal PHR at home                                                                                Content Creator
                        Military
                                                         with his medical information from the
                        Care                             MHS EMR. He retrieves the
                                                         summary from his MHS EMR and
                                                         also creates a summary of this
                                                         personal information in preparation
                                                         for his visit to the Emergency Dept at
                                                         a local community hospital and
                                                         deposits this summary in the Health
                                                         Information Exchange of his
                                                         community.
MHS-Priv A-4            Out-of-       3b   PCP Office    While at home, she experiences         C32                  Greenway         XDS Doc Source      Greenway       In=C32
Partnering              Network                          some abdominal pain and decides to                          NextGen                              NextGen        Out=EDR
                                                         visit her local PCP to have it                                                                                  Summary
                        Military
                                                         checked out. At the beginning of the
                        Care                             encounter, the PCP retrieves the
                                                         soldier's information from the PHR
                                                         Service which served as a gateway
                                                         to the MHS EMR. The physician
                                                         conducts an exam and suspects
                                                         acute appendicits. Refers her to the
                                                         ER and deposits a medical summary
                                                         of this encounter in the community
                                                         HIE for use by the ER clinicians.

MHS-Priv A-4            Out-of-       4    Hospital ER   In ER, pt records reviewed              XDS Doc Consumer    Epic                                                In=XPHR Content
Partnering              Network                          expediently and pt treated in time to                                                                           Consumer
                                                         prevent personal emergency.                                                                                     In=EDR Summary
                        Military
                                                         -----
                        Care                             CT of abdomen done, reveals acute
                                                         appendicitis, surgeon contacted,
                                                         patient taken to operating room and
                                                         successful appendectomy
                                                         performed. Patient recovered
                                                         without sequelae.




          Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                         4/17
                                                                                                                                                                                                                                                                                       259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme         ACT# Act                Sce Setting       Story / Clinical Discussion             Profile / Actor -         Potential      Profile / Actor -    Potential        Clinical         Comments /                        02/11   Showings   Showings Expl     HITSP Related
                                      ne                                                        Inbound                   Vendors        Outbound             Vendors          Considerations & Variants                                                               Comments
                                                                                                                                                                               Content Needed

Chronic       A-5       Remote     1      Home          Background:                                                                      IS77(sde#1)          Medical devices for Out=Device           • Chronic diseases
Care                    Monitoring                      • Person with type II diabetes (PwD)                                                                  BP, Weight, Glu     measurements         typically require
                                                        on two oral medications for diabetes:                                                                 ---                                      monitoring of multiple
                                                        • Metformin, which reduces glucose                                                                                                             parameters.
                                                        production by the liver. Dose: 850                                                                                                             • Knowing that relevant
                                                        mg tablet taken orally once a day.                                                                                                             information related to
                                                        • Repaglinide (Prandin®), which                                                                                                                his health condition is
                                                        stimulates insulin secretion by the                                                                                                            reliably captured for
                                                        pancreas. Dose: 1 mg tablet taken                                                                                                              review is very valuable.
                                                        orally before each meal.                                                                                                                       The electronic record is
                                                        • Patient also takes                                                                                                                           far superior to the
                                                        hydrochlorothiazide (Lasix®), a                                                                                                                paper diary he used
                                                        diuretic (increases urine output) for                                                                                                          before. The information
                                                        hypertension. Dose: 40 mg taken                                                                                                                is more complete and
                                                        orally twice a day.                                                                                                                            accurate.
                                                        • Patient also takes aspirin to                                                                                                                • Concentrating all this
                                                        prevent cardiovascular disease, a                                                                                                              information in one
                                                        potential complication of diabetes.                                                                                                            health management
                                                        Dose: 81 mg tablet taken orally once                                                                                                           software provides a
                                                        a day.                                                                                                                                         nice overview and
                                                        • Patient is overweight to obese and                                                                                                           keeps track of his
                                                        was put on a diet 2 weeks ago by his                                                                                                           progress all in one
                                                        physician.                                                                                                                                     place.
                                                        • Daily monitoring of weight was                                                                                                               • Therapy decisions
                                                        recommended by the physician.                                                                                                                  require contextual
                                                        • Physician provided patient with PC-                                                                                                          information, i.e.,
                                                        based health diary software to track                                                                                                           putting data in context.
                                                        his health status.                                                                                                                             Example: Weight
                                                                                                                                                                                                       reduction brings the
                                                                                                                                                                                                       additional benefits of
                                                                                                                                                                                                       lower average glucose
                                                                                                                                                                                                       levels as well as lower
Chronic       A-5       Remote     2      Home          A care program has been              IS77(sde#1) device           Device         IS77(sde#2) works-   Device           In=Device               blood pressures. the
                                                                                                                                                                                                       This transfer from
Care                    Monitoring                      established by the primary care      data                         Intermediary   in-progress          Intermediary     measurements            device intermediary to
                                                        physician to maximize the oversight                               (= Intel)                           (= Intel)        Out=HITSP C73           the care coordinator's
                                                        of this diabetic pts conditions via                                                                                                            RMMS (=remote
                                                                                                                                                                               (WIP)
                                                        ongoing use of appropriate medical                                                                                                             monitoring
                                                        devices by the consumer while at                                                                                                               management system)
                                                        home. Data/measurements from                                                                                                                   is done this year via a
                                                        these devices are regularly captured                                                                                                           "behind the scenes
                                                        and fed to a device intermediary hub                                                                                                           transport"…the
                                                        networked in the pts home.                                                                                                                     standards-based
                                                        The data is then forwarded to the                                                                                                              transfer is under
                                                        care coordinator's system via a wide                                                                                                           development between
                                                        area network data transfer.                                                                                                                    Continua & IHE.
                                                                                                                                                                                                       ---
                                                                                                                                                                                                       The content and format
                                                                                                                                                                                                       of the transfer from the
                                                                                                                                                                                                       RMMS to the PCP's
                                                                                                                                                                                                       EMR is using the
                                                                                                                                                                                                       HITSP C74 construct.
Chronic       A-5       Remote     3      RMON Care     At Care coordinator's system                                      IBM            IS77(sde#4) [HL7     IBM              Out=HITSP C74
Care                    Monitoring        Coordinator   • Show summary of care plan rules                                                PHM]                                  (HL7 PHM)
                                                        configured for this patient.
                                                        Demonstrate event firing on rule
                                                        match – no device readings received
                                                        from this patient in 24 hours.
                                                        • Show dashboard with KPIs and
                                                        status across a set of patients in a
                                                        care program
                                                        • Nurse views patient device data (
                                                        glucose and weight ) trended across
                                                        a 2 week period. ( the canned PHM
                                                        data )
                                                         • Nurse sends aggregated data (
                                                        glucose and weight ) to patient‘s
                                                        provider system ( Greenway ) in time
                                                        for patient‘s appt with doctor.
Chronic       A-5       Remote     4      PCP           Render aggregated patient data in    IS77(sde#4)                  Greenway                                             In=HL7 PHM
Care                    Monitoring                      PCP's EMR system. Provider can
                                                        use device data as an input to
                                                        decision making re: care plan
                                                        updates, including adjustments to
                                                        insulin medications and dosages.

Emergncy Rx-1           U/S           1   Hosp1 ER      In ER,physican views/imports the        XDS (Doc_Consumer)        GE_CIS         SWF (OP) RAD-2       GE_CIS           EDR Med Summary         Need more Order                       1       Only GE_CIS can
Care                    Trauma                          relevant Pt Med Summary elements        - Prefed or cont'd from                                                        (Content Consumer),     Placers.                                      be Order Placer
                        Case                            and Ultrasound ordered.                 Primary Care Visit                                                             U/S Order (need         ----
                                                        (Pt presents with abdomenal pain )      SWF(ADT) RAD-1                                                                 storyline for why the   Trauma ACT will
                                                                                                                                                                               pt presented in the     require a Pt Info
                                                                                                                                                                               ER and needed an        Reconcilation piece
                                                                                                                                                                               U/S stat)




          Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                      5/17
                                                                                                                                                                                                                                                                                   259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme       ACT# Act                Sce Setting       Story / Clinical Discussion            Profile / Actor -      Potential          Profile / Actor -   Potential     Clinical         Comments /                       02/11   Showings   Showings Expl        HITSP Related
                                    ne                                                       Inbound                Vendors            Outbound            Vendors       Considerations & Variants                                                                 Comments
                                                                                                                                                                         Content Needed

Emergncy Rx-1         U/S           2    Hosp1 Rad    In Rad, Technologists aquires          SWF (MOD) RAD-5        Sonosite           SWF (IM) RAD-8      Sonosite      Relevant clinical       Images captured as a                 1       Only Sonosite will
Care                  Trauma                          images, annotates and sends to                                                   SWF (IM) RAD-10                   information for         "John Doe" study                             provide U/S
                      Case                            PACS with any confirmed Pt                                                       SWF (MPPS) RAD-                   whatever reason         Procedure code                               images
                                                      identification (use John/Jane Doe)                                               6                                 we make for why         selected
                                                                                                                                       SWF (MPPS) RAD-                                           Indications (in
                                                                                                                                                                         the pt presented at
                                                                                                                                       7                                                         Additional Pt History
                                                                                                                                                                         the ER                  element [10,21B0] )
                                                                                                                                                                         -----
                                                                                                                                                                         Image capture
                                                                                                                                                                         Storage commit,
                                                                                                                                                                         PPS status
Emergncy Rx-1         U/S           3    Hosp1 Rad    MPPS received from modality and        *WF/SWF (OF) RAD-2     GE_OF              SWF(OP) RAD-3       GE_OF         Sends Order upd to      Need to work in the                  3
Care                  Trauma                          completes a pt ID reconcilation.       SWF(MOD) RAD-5         Philips_OF         SWF (IM) RAD-4      Philips_OF    OP for Pt ID            step for getting the
                      Case                            Order filled on RIS                    (MPPS)                 TSG                                    TSG           HL-7 ORM order +        results from the PIR
                                                                                             SWF (PIR)                                                                   Clinical Information    back to the OP
Emergncy Rx-1         U/S           4    Hosp1 Rad    Images received from modality and      SWF (IM) RAD-8         Agfa               SWF (OF) RAD-6      Agfa          images                  Agfa PACs does not                   2
Care                  Trauma                          stored on PACS.                        SWF (IM) RAD-10        GE_PACS            SWF (OF) RAD-7      GE_PACS       Stor Commit             support PIR
                      Case                                                                   SWF (MPPS) RAD-6       TSG                SWF (OF) RAD-49     TSG           Procedure Step
                                                                                             SWF (MPPS) RAD-7                          CPI (ID) RAD-14                   Status
                                                                                             SWF (PIR)                                 CPI (ID) RAD-15                   Presentation States
                                                                                                                                       CPI (ID) RAD-16                   Instance Availability
                                                                                                                                       CPI (ID) RAD-17                   Notification
Emergncy Rx-1         U/S           4+   Hosp1 Rad    Study Read and report created.        CPI (ID) RAD-14         Agfa                                   Agfa          Query/Retrieve                                               2
Care                  Trauma                                                                CPI (ID) RAD-15         GE_PACS            Other Rad reporting GE_PACS       images
                      Case                                                                  CPI (ID) RAD-16         TSG                profiles EC, SINR? TSG            Query/Retrieve
                                                                                            CPI (ID) RAD-17                                                              Presentation States
Emergncy Rx-1         U/S           4a   Hosp1 Rad    In Rad, images and reports are sent (same system as step      Agfa               XDS-I               Agfa          image pointer msg See note in Rx-2….                        1+1      Only Agfa PACS
Care                  Trauma                          to XDS-I repository or stored on CD 4)                        GE_OF              (IMG_DOC_Source)    GE_OF         diagnostic rpt    PDI variant -                                      can be XDS-I
                      Case                            media for sneaker net to phys office.                         GE_PACS            XDS-I               GE_PACS                               expectation is that a                        source. Only
                                                                                                                    Sorna [PDI]        (DOC_Source)        Sorna [PDI]                           CD can be burnt within
                                                                                                                                                                                                                                              Sorna can be PDI
                                                                                                                                       XDS-I                                                     2 minutes by Sorna
                                                                                                                                                                                                                                              source.
                                                                                                                                       (DOC_Repository)                                          ----
                                                                                                                                                                                                 Only Agfa PACS can
                                                                                                                                                                                                 be XDS-I source
                                                                                                                                                                                                 ----
                                                                                                                                                                                                 With TSG PACS, the
                                                                                                                                                                                                 GE_OF will need to be
                                                                                                                                                                                                 the XDS-I source
Emergncy Rx-1         U/S           5    PCP Office   The pt visits the PCP who reviews      XDS-I                  GE_EHR             None (end of Act)                 EMR will need to        Want to do a IRWF                    3       Two AEMRs + 1
Care                  Trauma                          the images to demo how these           (IMG_DOC_Consume)      GE_CIS                                               view XDS-MS (for        (import reconciliation                       variant with Sorna
                      Case                            images and report would be able to     XDS-I                  ----                                                 discharge               workflow) piece for the                      showing PACS
                                                      be viewed when a pt would be           (DOC_Consumer)         PDI variant this                                                             PDI inbound
                                                                                                                                                                         summary) & XDS-                                                      import of PDI
                                                      discharged or transferred to another   ----                   can be any AEMR                                                              ----
                                                                                                                                                                         MS (for imaging                                                      images at another
                                                      facility (XCA variant?). Note: XDM     PDI + XDS-MS variant   system that can be                                                           Would likely need to
                                                      does not support autorun feature so                           XDM Consumer                                         report)                 have the inbound                             hospital
                                                      PDI viewer needs to be launched                               plus Sorna WS                                                                setting being a
                                                      manually.                                                     Reviewer                                                                     hospital, due to PACS
                                                                                                                                                                                                 system req

Patient-   Rx-2       DR w          1    Hosp1 ER     Pt presents in the ER with shortness   XDS (Doc_Consumer) GE_CIS                 SWF (OP) RAD-2      GE_CIS        In= EDR Med             Need Intel to generate               1       Only GE_CIS can
Provider              Protocol                        of breadth. ER physican                - Prefed as part of ADT                                                     Summary or              the "seed" document                          be Order Placer
Partnering            Change                          views/imports the relevant Pt Med      Registration process                                                        equivalent CDA
                                                      Summary elements and CXR               SWF(ADT) RAD-1                                                              report (Content
                                                      ordered.                                                                                                           Consumer),
                                                      (EDR(pdf) would need to be                                                                                         Out=CXR Order
                                                      generated at pt registration)
Patient-   Rx-2       DR w          2    Hosp1 Rad    In Rad, Order filled on RIS            *WF/SWF (OF) RAD-2     GE_OF              SWF(OP) RAD-3       GE_OF         HL-7 ORM order +                                             3
Provider              Protocol                                                                                      Philips_OF         SWF (IM) RAD-4      Philips_OF    Clinical Information
Partnering            Change                                                                                        TSG                SWF(MOD) RAD-5      TSG           Modality Worklist


Patient-   Rx-2       DR w          3    Hosp1 Rad    Technologists notes the Clincial    SWF (MOD) RAD-5           Canon              SWF (IM) RAD-8      Canon         Relevant clinical                                            1       Only Canon can
Provider              Protocol                        Information. The tech reviews the   CPI(MOD)                                     SWF (IM) RAD-10                   information for                                                      be DR image
Partnering            Change                          planned procedure with the pt. The                                               SWF (MPPS) RAD-                   whatever reason                                                      modality
                                                      pt has arrived in a stretcher (as                                                6                                 we make for why
                                                      expected) but it was not known that                                              SWF (MPPS) RAD-
                                                                                                                                                                         the pt presented at
                                                      the pt could not stand up. As a                                                  7
                                                      result, the study needs to be                                                    CPI (IM) RAD-9                    the ER
                                                      conducted in prone position vs                                                                                     -----
                                                      standing (ie lateral) position                                                                                     Query modality
                                                      which was ordered. Tech changes                                                                                    worklist, Image
                                                      name of procedure, aquires                                                                                         capture
                                                      images, annotates and sends to                                                                                     Storage commit,
                                                      PACS.                                                                                                              PPS status,
                                                                                                                                                                         Presentation State
                                                                                                                                                                         stored
                                                                                                                                                                         ----
                                                                                                                                                                         MPPS info now
                                                                                                                                                                         reflects the change
                                                                                                                                                                         in protocol
Patient-   Rx-2       DR w          4    Hosp1 Rad    RIS processes the change from the      SWF(OP) RAD-3          GE_OF                                  GE_OF         Filler Order                                                 3
Provider              Order                           Ordered PPS from the Mod PPS           SWF (IM) RAD-4         Philips_OF                             Philips_OF    management
Partnering            Change                                                                                        TSG                                    TSG           Schedule update


Patient-   Rx-2       DR w          5    Hosp1 Rad    Images received from modality and      SWF (IM) RAD-8         Agfa               SWF (OF) RAD-6      Agfa          images                                                       2
Provider              Protocol                        stored on PACS.                        SWF (IM) RAD-10        GE_PACS            SWF (OF) RAD-7      GE_PACS       Stor Commit
Partnering            Change                                                                 SWF (PPSM) RAD-6       TSG                SWF (OF) RAD-49     TSG           Procedure Step
                                                                                             SWF (PPSM) RAD-7                          CPI (ID) RAD-14                   Status
                                                                                             CPI (IM)                                  CPI (ID) RAD-15                   Presentation States
                                                                                                                                       CPI (ID) RAD-16                   Instance Availability
                                                                                                                                       CPI (ID) RAD-17                   Notification



        Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                    6/17
                                                                                                                                                                                                                                                                                                   259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme       ACT# Act                Sce Setting         Story / Clinical Discussion               Profile / Actor -       Potential            Profile / Actor -   Potential            Clinical         Comments /                        02/11   Showings   Showings Expl        HITSP Related
                                    ne                                                            Inbound                 Vendors              Outbound            Vendors              Considerations & Variants                                                                  Comments
                                                                                                                                                                                        Content Needed

Patient-   Rx-2       DR w          5+   Hosp1 Rad      Study Read and report created.            CPI (ID) RAD-14         Agfa                                     Agfa                 Query/Retrieve                                                2
Provider              Protocol                                                                    CPI (ID) RAD-15         GE_PACS              Other Rad reporting GE_PACS              images
Partnering            Change                                                                      CPI (ID) RAD-16         TSG                  profiles EC, SINR? TSG                   Query/Retrieve
                                                                                                  CPI (ID) RAD-17                                                                       Presentation States
Patient-   Rx-2       DR w          5a   Hosp1 Rad      In Rad, images and reports are sent (same system as step          Agfa                 XDS-I               Agfa                 PDI-based media       GE-Enterprise to                       1+1      Only Agfa PACS
Provider              Protocol                          to XDS-I repository                 4)                            GE_OF                (IMG_DOC_Source)    GE_OF                with image viewer     generate an XDS-MS                              can be XDS-I
Partnering            Change                                                                                              GE_PACS              XDS-I               GE_PACS              Pt discharge          discharge summary.                              source. Only
                                                                                                                          Sorna [PDI]          (DOC_Source)        Sorna [PDI}                                Sorna have it pushed
                                                                                                                                                                                        summary                                                               Sorna can be PDI
                                                                                                                                               XDS-I                                                          to them...not using any
                                                                                                                                                                                                                                                              source.
                                                                                                                                               (DOC_Repository)                                               XD* transactions, will
                                                                                                                                               PDI [variant]                                                  use Intel to serve as an
                                                                                                                                                                                                              IE to translate the XDS-
                                                                                                                                                                                                              MS summary and push
                                                                                                                                                                                                              it to Sorna in a custom
                                                                                                                                                                                                              exchange "behind the
                                                                                                                                                                                                              scenes" or plus receive
                                                                                                                                                                                                              the Imaging rpt via an
                                                                                                                                                                                                              Hl7 MDM transactions
                                                                                                                                                                                                              to send the document
                                                                                                                                                                                                              to Sorna. Intel to
                                                                                                                                                                                                              provide a sample of
                                                                                                                                                                                                              documents to Sorna.
Patient-   Rx-2       DR w          6    PCP Office     The pt visits the PCP who reviews         XDS-I                   GE_EHR           None (end of Act)                                                  Need more XDS-I Doc                     3       Two AEMRs + 1
Provider              Protocol           [XCA variant   the images (Hosp Imaging dept             (IMG_DOC_Consume)       GE_CIS                                                                              Consumers that are                              variant with Sorna
Partnering            Change             in another     variant with hosp viewing discharge       XDS-I                   ----                                                                                EMR systems                                     showing PACS
                                         state]         summary from hosp1) to demo how           (DOC_Consumer)          PDI variant this
                                                                                                                                                                                                                                                              import of PDI
                                                        these images and report would be          ----                    can be any AEMR
                                                                                                                                                                                                                                                              images at another
                                                        able to be viewed when a pt would         PDI variant incl XDS-   system plus
                                                        be discharged or transferred to           MS Discharge            Sorna WS                                                                                                                            hospital
                                                        another facility (XCA variant?)           Summary                 Reviewer

            Rx-3      TCE                               Imaging export for clinical trials,                                                    TCE                 TSG                                        Research with cdisc for
                                                        Teaching Files and Clinical Export                                                                                                                    clinical trial application
                                                        (TCE)

Surgery     PCD-1 OR, pt was 1           OR             Male patient, 65 years, BMI 32            PIV: IOC and DOC;       Pumps: B Braun,
Care              scheduled                             (slightly overweight), coronary artery    DOC; AM; PAM; TC;       Hospira, Cardinal;
                  for                                   disease (AMI 6 months ago),               RTM                     CIS: GE, LiveData;
                  surgery, is                           moderate COPD (smoker),                                           EMR: Epic, GE;
                  being                                 compensated renal insufficiency
                  monitored                             (40% GFR). Adenocarcinoma of the
                  and treated                           lower esophagus (close to the entry
                                                        into the stomach), scheduled for
                                                        gastrectomy and distal,
                                                        transabdominal esophagectomy.
Surgery     PCD-1 OR, pt was 2           OR             Patient needs full invasive CV            PIV: IOC and DOC;       Pumps: B Braun, DEC: DOR, DOF;           Pumps: B Braun,                            DEC is Device
Care              scheduled                             monitoring starting at induction.         DOC; AM; PAM; TC;       Hospira, Cardinal; PIV: IOP, DOR,        Hospira, Cardinal;                         Enterprise
                  for                                   Patient will get peridural catheter for   RTM                     CIS: GE, LiveData; DOF; ACM: AR;         CIS: Philips; EMR:                         Communication
                  surgery, is                           postoperative pain management                                     EMR: Epic, GE;                           Epic; Middleware:
                                                                                                                                               TC; RTM                                                        SPD: Subscribe to
                  being                                 (continuous infusion on ICU, PCA on                                                                        Cerner; Gateway:
                                                                                                                                                                                                              Patient Data (filter)
                  monitored                             SDU).                                                                                                      GE
                  and treated                           Patient requires perioperative                                                                                                                        PIV: Point-of-Care
                                                        antibiotic prophylaxis with                                                                                                                           Infusion Verification
                                                        vancomycin (requires dose reduction                                                                                                                   IOP: Infusion Order
                                                        with renal impairment) and a third                                                                                                                    Programmer
                                                        generation cefalosporine (pharmacy                                                                                                                    IOC: Infusion Order
                                                        to recommend the most cost-                                                                                                                           Consumer
                                                        effective generic drug). Alarms to be                                                                                                                 RTM: Rosetta
                                                        added.                                                                                                                                                Terminology Mapping
                                                                                                                                                                                                              DOC: Device
                                                                                                                                                                                                              Observation
                                                                                                                                                                                                              Consumer
                                                                                                                                                                                                              DOR: Device
                                                                                                                                                                                                              Observation Reporter


Surgery     PCD-1 ICU               3    ICU            After surgery patient remains             PIV: IOC and DOC;       Pumps: B Braun,      DEC: DOR, DOF;      Pumps: B Braun,
Care              following                             intubated as planned and is               DOC; AM; PAM; TC;       Hospira, Cardinal;   PIV: IOP, DOR,      Hospira, Cardinal;
                  surgery                               transferred to ICU. After initial         RTM                     CIS: Philips; EMR:   DOF; ACM: AR;       CIS: Philips; EMR:
                                                        stabilization (some fluids according                              Epic; Middleware:    TC; RTM             Epic; Middleware:
                                                        to CO and SvO2, low dose                                          Cerner;                                  Cerner; Gateway:
                                                        dobutamine) rapid weaning of the                                                                           GE
                                                        ventilator on SmartCare/PS.
                                                        Tight glycemic control (if you like to
                                                        make it a little bit more fancy).
                                                        Extubation after 12 hours after
                                                        admission. Alarms to be added.
                                                        Discharge to SDU after 36 hours.




        Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                                    7/17
                                                                                                                                                                                                                                                                                                       259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme       ACT# Act                Sce Setting         Story / Clinical Discussion              Profile / Actor -        Potential            Profile / Actor -    Potential            Clinical         Comments /                        02/11   Showings   Showings Expl        HITSP Related
                                    ne                                                           Inbound                  Vendors              Outbound             Vendors              Considerations & Variants                                                                  Comments
                                                                                                                                                                                         Content Needed

Surgery     PCD-2 ICU and           1    ICU - Pt       After surgery patient remains            PIV: IOC and DOC;        Pumps: B Braun,      DEC: DOR, DOF;       Pumps: B Braun,
Care              OR w                   bedside        intubated as planned and is              DOC; AM; PAM; TC;        Hospira, Cardinal;   PIV: IOP, DOR,       Hospira, Cardinal;
                  Alarm                                 transferred to ICU. After initial        RTM                      CIS: Philips; EMR:   DOF; ACM: AR;        CIS: Philips; EMR:
                                                        stabilization (some fluids according                              Epic; Middleware:    TC; RTM              Epic; Middleware:
                                                        to CO and SvO2, low dose                                          Cerner; Gateway:                          Cerner; Gateway:
                                                        dobutamine) rapid weaning of the                                  GE                                        GE
                                                        ventilator on SmartCare/PS.
                                                        Tight glycemic control (if you like to
                                                        make it a little bit more fancy).
                                                        Extubation after 12 hours after
                                                        admission. Alarms to be added.
                                                        Discharge to SDU after 36 hours.

Surgery     PCD-2 Step Down 2            ICU - Pt       On SDU patient still requires        PIV: IOC and DOC;            Pumps: B Braun,      DEC: DOR, DOF;       Pumps: B Braun,
Care              Unit (SDU)             bedside        monitoring of HR, BP (NIBP or        DOC; AM; TC; RTM             Hospira, Cardinal;   PIV: IOP, DOR,       Hospira, Cardinal;
                                                        CNAP), RR and SpO2 (the latter two                                EMR: Epic;           DOF; ACM: AR;        CIS: Drager; EMR:
                                                        for his COPD and because of PCA).                                 Middleware:          TC; RTM              Epic; Middleware:
                                                        Alarms to be added.                                               Capsule; Gateway:                         Cerner; Gateway:
                                                         Antibiotics scheduled for 72 hours.                              Philips; Alarm                            Philips
                                                        Vancomycin should be infused over                                 Manager: LiveData
                                                        60 minutes via IV device


Patient-   H-1        Hosp          1    Hosp2 Ward Admitted pt has improved,                    None (start Act)                              XDS.b (Doc Source)   Allscripts-C         Out=XDS-MS               Create good story for                4       Hosp EMR's       Medication
Provider              Discharge          / Med      discharged. Discharge Summary                                                              [XDR variant]        Allscripts-E[xdr]    Discharge (Content       why a pt was in the                          Allscripts-E,    Reconcilliation
Partnering            Summary            Records    generated - sent via XDS.                                                                  [XDS-I Source        Allscripts-P         Creator)                 hospital and would                           Blueware, CPSI,  opportunity (IS07)
                                                    Pt Pickup Images at Med Rec [PDI                                                           variant]             Blueware                                      have needed imaging
                                                                                                                                                                                         Out=[XDS-I Source                                                     Epic, and GE_CIS
                                                    variant]                                                                                                        CPSI[xdr]                                     studies done.
                                                                                                                                                                                         variant]                                                              or ADT selected
                                                                                                                                                                    EMDS                                          -----
                                                                                                                                                                    Epic                 Out=FSA (Content         Need to link XDS-I
                                                                                                                                                                    GE(3)[xdr][(1)xds-   Creator) [variant -      Sources to workflow ie
                                                                                                                                                                    I]                   Pain Scale and           CSH PACS, GE PACS
                                                                                                                                                                    Greenway[xdr]        Braden]                  & OF)
                                                                                                                                                                    Mckesson                                      -----
                                                                                                                                                                    MIE                                           Need to add PDI +
                                                                                                                                                                    NextGen[xdr]                                  MS(disch) variant
                                                                                                                                                                    Sage                                          using Sorna
                                                                                                                                                                                                                  ----
                                                                                                                                                                                                                  No vendors have
                                                                                                                                                                                                                  signed up for FSA.
Patient-   H-1        Hosp          2    PCP Office     Follow up. Discharge summary             XDS.b (Doc Consumer)     Alert[xd-lab]       XDS.b (Doc Source)    Allscripts-E[xdm]    In=XDS-MS                FSA Profile not                     9[6]     Ambul EMR's          Medication
Provider              Discharge                         consumed and viewed that was             [XDR variant]            Allscripts-C        [XDM Variant]         Allscripts-P[xdm]    Discharge (Content       supported by any                             Allscripts-P, GE-    Reconcilliation
Partnering            Summary                           generated from hospital. Document        [XDS-I Viewer variant]   Allscripts-E[xdr]                         Blueware             Consumer),               vendor                                       EHR, Greenway,       opportunity (IS07) -
                                                        and images shown to patient.             [XD-Lab variant]         Allscripts-P                              Capmed[xdm]                                   ---
                                                                                                                                                                                         In=XDS-I images                                                       Mckesson, MIE, &     PCP notices a
                                                        [Consumer XPHR generated (in cast                                 Blueware                                  GE(1)                                         Vendor CSH is XDS-I
                                                                                                                                                                                         (Viewer)                                                              Sage selected;       med prescribed at
                                                        variants that create XPHRs in a                                   CapMed[xd-lab]                            Greenway[xdm]                                 Consumer; needs to
                                                        scene step 3).                                                    CPSI[xdr]                                 McKesson[xdm]        In=XD-Lab Content        support XDS-MS                               Capmed and NMC       hospital that the
                                                                                                                          EMDS                                      MIE[xdm]             Consumer                 Content Consumer &                           as PHR's not         patient has not
                                                                                                                          Epic                                      NMC[xdm]             In=FSA (Content          XPHR Content Creator                         considered at all;   been taking - adds
                                                                                                                          GE(5)[xds-I(3)][xd-                       Phreesia             Consumer) [variant       ---                                          outbound             prescription
                                                                                                                          lab]                                      Sage[xdm]            - Pain Scale and         Need NextGen to be an                        constrained
                                                                                                                          Greenway[xdr]                                                  Braden]                  XPHR Content Creator
                                                                                                                          Mckesson                                                       Out=XPHR                 to benefit from them
                                                                                                                          MIE                                                            Summary (Content         being an XDS-I
                                                                                                                          NextGen[xds-                                                                            Consumer
                                                                                                                                                                                         Creator)
                                                                                                                          I][xdr][xd-lab]                                                                         ---
                                                                                                                          Sage                                                                                    eMDS needs to
                                                                                                                          SAIC[xd-lab]                                                                            support XPHR Content
                                                                                                                          Wellogic                                                                                Creator to be used
Emergncy E-2          Hosp          2a   PCP Office     Immunization registry variant.                                                        IC (Doc Source)       GE_EMR               Data that might be       Mckesson is only                    4(1)     EMR Mckesson
Care                  Discharge                         PCP discovers that this child is                                                                            Greenway             appropriate to be        vendor that supports                         only option
                      Summary                           behind on his immunizations (what                                                                           Mckesson             reported to a            both inbound /
                                                        one?). Needed Immunizations                                                                                 MIE                  immunization             outbound requirements
                                                        completed and data sent to                                                                                                       registry for teenager.   and IC
                                                        immunization registry                                                                                                            ---                      ----
                                                        -----                                                                                                                                                     Need to add IC to
                                                        PCP notes that DTaP was given in                                                                                                                          another ACT that has
                                                        ER. Notes that the patient is going                                                                                                                       includes items that
                                                        to college, plans to live in dormitory,                                                                                                                   additional 3 vendors
                                                        has not had a meningococcal                                                                                                                               also support
                                                        vaccine and discusses risk, benefits
                                                        and indications for the vaccine in this
                                                        patient. The patient decides to have
                                                        the vaccine and it‘s updated in the
                                                        patient‘s record.
Emergncy E-2          Hosp          2b   State Health   Immunization registry variant           IC (Doc Consumer)         SWPartners           IC (C72)             SWPartners to        XDS Doc Source (IC       Need to identify which              5(1)     SWPartners
Care                  Discharge          Agency         Immunization registry content                                                                               UWA                  Content) would need      vendor(s) would prefer                       selected; GE
                      Summary                           updated for the pt                                                                                                               to go to SWPartners      to serve as a State                          potential also
                                                                                                                                                                                         which would              Health Agency Actor
                                                                                                                                                                                         translate into a HL7     that could accept an IC
                                                                                                                                                                                         v2 msg                   Doc




        Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                                        8/17
                                                                                                                                                                                                                                                                           259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme       ACT# Act                Sce Setting       Story / Clinical Discussion              Profile / Actor -   Potential      Profile / Actor -   Potential      Clinical         Comments /                    02/11   Showings   Showings Expl       HITSP Related
                                    ne                                                         Inbound             Vendors        Outbound            Vendors        Considerations & Variants                                                             Comments
                                                                                                                                                                     Content Needed

Patient-   H-1        Hosp          3    Home           XPHR Variant. Pt XPHR is updated XDS.b (Doc Consumer) Allscripts-C        None (end of Act)                  In=XPHR          Need to confirm how                     16[3]    PHR's Capmed,
Provider              Discharge                         and results can be viewed at home. [XDM Variant]      Allscripts-E[xdm]                                      Summary (Content GE_HIE will perform in                           NMC, GE_HIE and
Partnering            Summary                           XDM + PDI Variant?                                    Allscripts-P[xdm]                                      Consumer)        this step as a PHR                               Epic_phr (xdm
                                                                                                              Blueware                                                                      equivalent?                                variant only)
                                                                                                              CapMed[xdm]
                                                                                                                                                                                                                                       selected
                                                                                                              Epic
                                                                                                              Epic_phr[xdm
                                                                                                              only]
                                                                                                              GE(5)
                                                                                                              Greenway[xdm]
                                                                                                              Mckesson[xdm]
                                                                                                              MIE[xdm]
                                                                                                              NextGen[xdm]
                                                                                                              NMC[xdm]
                                                                                                              Phreesia
                                                                                                              Sage[xdm]
                                                                                                              SAIC
Patient-   H-1        Hosp          4    Infrastructure Wizard of OZ explains
Provider              Discharge
Partnering            Summary



Emergncy E-1          Emer          1    Identity     Federal Bridge recognized                                                   C19, TP20 Identities SAFE Biopharma - Out=DSG             HISPC AUT-1, AUT-                  1       SAFE Biopharma
Care                  Response           Management   healthcare digital identities are                                                                identities described                 3, AUT-5, DAT-1,
                      w Privacy          Service      provided to healthcare professionals                                                             are used in                          DAT-3, DAT-4, DAT-
                      Mgmt               Provider     and emergency responder staff in                                                                 Greenway (DSG
                                                                                                                                                                                            6, DAT-7, DAT-10,
                                                      accordance with regulatory agency                                                                only)
                                                                                                                                                                                            SYS-1, SYS-12, POL-
                                                      provisions. These high assurance
                                                      credentials enable accountability for                                                                                                 2, POL-8 (identities)
                                                      authentication to health information
                                                      resources and enable a trusted
                                                      signature.
                                                      Providers and their regulated
                                                      professions (structural roles) are
                                                      managed by an Identity Service
                                                      Provider. Identities are issued to
                                                      providers leveraging digital
                                                      certificates which are used for role-
                                                      based access control for the HIE.
Emergncy E-1          Emer          2    911 call     The patient was involved in a            XDS.b (Doc Consumer) GE HIE                            GE HIE         In=XPHR          2 XPHR Summaries..1                      1       A 2nd instance of
Care                  Response           center       building collapse due to an              BPPC, C19, TP20                                                       Summary (Content sensitive and 1 non-                             2 systems need to
                      w Privacy                       earthquake. He is unconscious, but                                                                             Consumer)        sensitive.. would need                           be setup to serve
                      Mgmt                            his wallet is used for identification.                                                                                           to be created as part of
                                                                                                                                                                                                                                       as the 911 Call
                                                      The 911 dispatcher authenticates to                                                                                              registration event
                                                                                                                                                                                                                                       Center
                                                      the HIE Portal, and locates the                                                                                                   or via P-1 (HISPC
                                                      patient‘s PHR. The 911 operator                                                                                                  AUT-1, AUT-3, AUT-5,
                                                      sees only the documents marked for                                                                                               DAT-1, DAT-3, DAT-4,
                                                      Emergency Responders in                                                                                                          DAT-6, DAT-7, DAT-
                                                      accordance with HIE role-based                                                                                                   10, SYS-1, SYS-12,
                                                      access control policy. The 911                                                                                                   POL-2, POL-8,
                                                      operator looks up bed availability                                                                                               Metadata identifiers of
                                                      and advises the EMS..                                                                                                            source, Sensitivity,
Emergncy E-1          Emer          2+   EMS at       On scene, the EMT also                   XDS.b (Doc Consumer) GE HIE        XDS.b (Doc Source) GE HIE          In=XPHR           HISPC AUT-1, AUT-3,                     1       A 2nd instance of
Care                  Response           disaster     authenticates to the HIE Portal, and     BPPC, C19, TP20                    RFD (Form Filler)                  Summary (Content AUT-5, DAT-1, DAT-3,                             2 systems need to
                      w Privacy          scene        retrieves available HIE documents,                                                                             Consumer)         DAT-4, DAT-6, DAT-7,                            be setup to serve
                      Mgmt                            but is not authorized to see the                                                                                                 DAT-10, SYS-1, SYS-
                                                                                                                                                                     Out=XPHR / MS                                                     as the EMS
                                                      documents that are marked                                                                                                        12, POL-2, POL-8,
                                                                                                                                                                     (Content Creator)
                                                      Restricted in accordance with HIE                                                                                                Metadata identifiers of
                                                      role-based access control policy.                                                                                                source, Sensitivity,
                                                      The EMT can see that there is a                                                                                RFD Notes:        BPPC)
                                                      Normal document that is accessible,                                                                            Outcome will serve
                                                      and a Restricted document that                                                                                 as the Form
                                                      would require the EMT to use ‗break                                                                            Manager to GE
                                                      glass‘ procedures. The EMT                                                                                     HIE. GE_HIE will
                                                      determines he has reason to use                                                                                complete form with
                                                      ‗break glass‘ and accesses the                                                                                 data at the scene
                                                      document. The EMT publishes
                                                                                                                                                                     of the accident.
                                                      scene/transport data to the HIE. The
                                                      scene/transport data is available to                                                                           [This data will also
                                                      the Emergency Department staff.                                                                                be used to source
                                                      -----                                                                                                          the XPHR / MS
                                                      I‘m not sure what type of scenario to                                                                          (=C32) document]
                                                      use here because I don‘t know what                                                                             ----
                                                      would be consider restricted—HIV
                                                      status, psychiatric history or more
                                                      mundane health information like
                                                      medications. Depending on what is
                                                      restricted I could come up with more
                                                      details.




        Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                            9/17
                                                                                                                                                                                                                                                                                                 259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme       ACT# Act                Sce Setting        Story / Clinical Discussion               Profile / Actor -    Potential         Profile / Actor -     Potential        Clinical         Comments /                      02/11    Showings        Showings Expl           HITSP Related
                                    ne                                                           Inbound              Vendors           Outbound              Vendors          Considerations & Variants                                                                         Comments
                                                                                                                                                                               Content Needed

Emergncy E-1          Emer          3   ED             The on-scene data is available to the XDS.b (Doc Consumer)     Alert              XDS.b (Doc Source)   Allscripts-E     In=XDS-SD              Since EDES is not                     6(2)          Outbound
Care                  Response                         Emergency Room staff along with       BPPC                     Allscripts(BPPC)                        Blueware[EDES]   (Content               supported by any                                   constrained
                      w Privacy                        the clinical history; The patient is                           Blueware                                CapMed           Consumer)              vendors this year…no                               --
                      Mgmt                             treated and a Emergency                                        CapMed(BPPC)                            Epic[EDES]       In=XDS-MS              output summary wil be                              Using Blueware,
                                                       Depertment Encounter Summary is                                CPSI                                    GE(1)                                   created
                                                                                                                                                                               (Content                                                                  Epic, and GE
                                                       published; Bed availability data is                            EMDS(no xds-sd)                         Greenway
                                                       updated;                                                       Epic                                    McKesson         Consumer)                                                                 only Blueware and
                                                                                                                      GE(5),                                  Sage             ----                                                                      EPIC showings to
                                                                                                                      GE(1)(BPPC)                                              Out=EDES                                                                  reflect the full IS04
                                                                                                                      Greenway(BPPC)                                           (Content Creator)                                                         support by the
                                                                                                                      Healthvision(xds-                                        [variant to support                                                       generation of the
                                                                                                                      sd only)                                                 IS04 req]                                                                 EDES
                                                                                                                      HIS(xds-sd only)
                                                                                                                      ITH-
                                                                                                                      ICOSERVE(xds-sd
                                                                                                                      only)
                                                                                                                      Mckesson(BPPC)
                                                                                                                      MIE
                                                                                                                      NextGen
                                                                                                                      NMC
                                                                                                                      Orionhealth(xds-sd
                                                                                                                      only)
                                                                                                                      Sage(BPPC)
                                                                                                                      SAIC (no xds-sd)
                                                                                                                      Wellogic
Emergncy E-1                        4   Public Health The EMT data required has been             RFD (Form Manager)   Outcome                                                                         Need to identify when                   1
Care                                                  described in a form which is valued                                                                                                             EMT data needs to be
                                                      at the scene of the accident. This                                                                                                              reported to Public Hlth
                                                      step shows the Form Manager role                                                                                                                agency (check w Steve
                                                      in providing and receiving the                                                                                                                  Hufnagel, Mike
                                                      completed form.                                                                                                                                 Glickman)

Patient     P-1       Privacy       1   PCP Office     Create a consent and stored in the        BPPC (Content       Healthvision                                              Out=XDS.SD or just                                       Lori to review
Consent               Consent                          regisitry.                                Creator)                                                                      a CDA with a pointer                                     and tweak for
                      Setup &                                                                    XDS Document Source                                                           to the policy                                              the latest
                      Use                                                                                                                                                                                                                state of the
                                                                                                                                                                                                                                         HITSP and
                                                                                                                                                                                                                                          IHE work.
Patient     P-1       Privacy       2   Home           The pt enters family and social           tbd                                    XDM Creator           Epic, NMC        Out=XPHR
Consent               Consent                          history in PHR. The pt needs to go                                                                                      (Content Creator)
                      Setup &                          her physician for routine screening.
                      Use
Patient     P-1       Privacy       3   PCP Office     She see's her family physician.           XDM Importer         Sage              XDS Document          Sage             In=XPHR (Content
Consent               Consent                          Found in Heart Failure. Referred to                                              Source (with                           Consumer)
                      Setup &                          ER Physician has discovered that                                                 Sensitive setting)
                      Use                              the woman is HIV positive and wants
                                                       the information "blinded' to others.
Patient     P-1       Privacy       4   Ambulance On scene, the EMT also                         BPPC (Content        GE-OTHER_HIE
Consent               Consent                          authenticates to the HIE Portal, and      Consumer)
                      Setup &                          retrieves available HIE documents,        XDS Doc Consumer
                      Use                              but is not authorized to see the
                                                       documents that are marked
                                                       Restricted in accordance with HIE
                                                       role-based access control policy.
                                                       The EMT can see that there is a
                                                       Normal document that is accessible,
                                                       and a Restricted document that
                                                       would require the EMT to use ‗break
                                                       glass‘ procedures. The EMT
                                                       determines he has reason to use
                                                       ‗break glass‘ and accesses the
                                                       document. The EMT publishes
                                                       scene/transport data to the HIE. The
                                                       scene/transport data is available to
                                                       the Emergency Department staff.
Patient     P-1       Privacy       5   Hosp1 ER       In ER, Records Reviewed. ED               BPPC (Content        CIS_GE_CENTRI
Consent               Consent                          physician sees that the woman has         Consumer)            CTY_ENTERPRIS
                      Setup &                          "blinded" documents and needs to          XDS Doc Consumer     E
                      Use                              override that blinding. He has the
                                                       authorization to see these
                                                       documents. He will override the
                                                       "blinding" restriction, incl entry of a
                                                       reason for override.
                                                       [V
Patient     P-1       Privacy       6   Infrastructure Go to ARR to show two different           ATNA ARR             IBM, Axolotyl
Consent               Consent                          reporting scenarios in the security
                      Setup &                          audit log.
                      Use
Patient     P-1       Privacy       7   PCP Office     The patient is relocating to another      BPPC (Content       Greenway
Consent               Consent           (other         state and doesn't want the data at        Creator)
                      Setup &           location)      the old HIE to be seen. The pt            XDS Document Source
                      Use                              revokes the consent document all-
                                                       together and updates their consent
                                                       in the document repository to that
                                                       effect.




        Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                                 10/17
                                                                                                                                                                                                                                                                           259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme        ACT# Act                Sce Setting       Story / Clinical Discussion           Profile / Actor -     Potential       Profile / Actor -    Potential         Clinical         Comments /                   02/11   Showings   Showings Expl   HITSP Related
                                     ne                                                      Inbound               Vendors         Outbound             Vendors           Considerations & Variants                                                        Comments
                                                                                                                                                                          Content Needed

Infra        P-2       Identity      1   Identity       Federal Bridge recognized                                  SafeBioPharma
Services               and Audit         Management     healthcare digital identities are
                                         Service        provided to healthcare professionals
                                         Provider       and emergency responder staff in
                                                        accordance with regulatory agency
                                                        provisions. These high assurance
                                                        credentials enable accountability for
                                                        authentication to health information
                                                        resources and enable a trusted
                                                        signature.
                                                        Providers and their regulated
                                                        professions (structural roles) are
                                                        managed by an Identity Service
                                                        Provider. Identities are issued to
                                                        providers leveraging digital
                                                        certificates which are used for role-
                                                        based access control for the HIE.
Infra        P-2       Identity      2   Infrastructure 1) How the Security Officer could get ATNA ARR             IBM, Axolytl
Services               and Audit         - Audit        security alerts generated from the
                                         Repository     audit logs.
                                                        a. Too many login failures – may
                                                        indicate a hack attack
                                                        b. Use of ―Break-Glass‖ – may
                                                        indicate someone inappropriate use
                                                        c. Unusual traffic from a one source
                                                        d. audit record used to support
                                                        security policy
Infra        P-2       Identity      3   Infrastructure 2) How the Privacy Officer can use ATNA ARR                IBM, Axolytl
Services               and Audit         - Audit        the logs
                                         Repository     a. how the audit logs can help
                                                        resolve a patient complaint that a
                                                        neighbor, who is an employee of the
                                                        hospital, may have inappropriately
                                                        accessed the patient records.
                                                        b. how the audit log can be used to
                                                        assist
                                                        c. audit record used to support
                                                        privacy policy
                                                        3) How the use of federated identity
                                                        gives better fidelity to the audit logs,
                                                        allowing us to see direct user
                                                        accesses where this had to be
                                                        indirectly before XUA.
                                                        a. Show how some audit logs from
                                                        XDS Registry Actors don‘t have a
                                                        user identity because the D

Comm         B-1       Biosurveill 1     PCP           Pt presents to the PCP Office with                          Any             XDS-MS/EDR           Allscripts_E_2,   Infrastructure &      Need CDC guidelines C39                    IS02
Health                 ance                            GI symptoms. PCP submits EMR                                                (C48), PIX/PDQ       Greenway_3,       Registry/Repository   for ILI; rudimentary
                       Monitoring                      summary of visit to HIE using XDS-                                          (TP22, T23), XDS.b   NextGen_3,                              patient demographics
                       &                               MS. Takes samples and sends to lab                                          (TP13)               GE_EHR2                                 (no PHI); HISPC AUT-
                       Detection                       for analysis.                                                                                                                            6, DAT-2, DAT-10,
                                                                                                                                                                                                DAT-11, DAT-12, SYS-
                                                                                                                                                                                                5 (verify - AUT-1, AUT-
                                                                                                                                                                                                3, AUT-5, DAT-1, DAT-
                                                                                                                                                                                                3, DAT-4, DAT-6, DAT-
                                                                                                                                                                                                7, DAT-10, SYS-1,
                                                                                                                                                                                                SYS-12, POL-8)
Comm         B-1       Biosurveill 2     Public Health Lab analyzes sample and sends         PIX/PDQ (TP22, T23)   IBM_Bridge      XD*Lab(C37),       IBM_Bridge                                HISPC AUT-6, DAT-
Health                 ance              LAB           results to Infrastructure using XD-                                         PIX/PDQ (TP22,                                               2, DAT-10, DAT-11,
                       Monitoring                      Lab                                                                         T23); XDS.b (TP13)                                           DAT-12, SYS-5
                       &                                                                                                                                                                        (verify - AUT-1, AUT-
                       Detection
                                                                                                                                                                                                3, AUT-5, DAT-1,
                                                                                                                                                                                                DAT-3, DAT-4, DAT-
                                                                                                                                                                                                6, DAT-7, DAT-10,
                                                                                                                                                                                                SYS-1, SYS-12, POL-
                                                                                                                                                                                                8)                                         IS02




         Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                          11/17
                                                                                                                                                                                                                                                                                   259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme        ACT# Act                Sce Setting          Story / Clinical Discussion              Profile / Actor -   Potential           Profile / Actor -   Potential              Clinical         Comments /             02/11    Showings    Showings Expl   HITSP Related
                                     ne                                                            Inbound             Vendors             Outbound            Vendors                Considerations & Variants                                                    Comments
                                                                                                                                                                                      Content Needed

Comm         B-1       Biosurveill 3     State PH /    Population-level View: State PH      XDS-MS, XD-Lab             UWA/SAIC            Summarized          UWA/SAIC                               Need to verify docs-                         IS02, IS11
Health                 ance              HIE (WA)      retrieves population-based data from                                                minimum data set,                                          for-docs standards
                       Monitoring        –Surveillance HIE. Enters data into state-level                                                   NHIN gateway                                               interface. C39
                       &                               surveillance system that                                                                                                                       transform to C48 -
                       Detection                       simultaneously makes this data
                                                                                                                                                                                                      Regenstrief. PWP
                                                       available to state and local PH. The
                                                       system shows a rise in GI illness.                                                                                                             (T64)+T63/C82
                                                                                                                                                                                                      alerting
                                                                                                                                                                                                      (EDXL/CAP/HAN),
                                                                                                                                                                                                      Email, FAX; (NOTE
                                                                                                                                                                                                      for FUTURE: Test
                                                                                                                                                                                                      NAV and XDS-SD to
                                                                                                                                                                                                      support PHIN
                                                                                                                                                                                                      enhancement with
                                                                                                                                                                                                      patient-specific
                                                                                                                                                                                                      notification); HISPC
                                                                                                                                                                                                      AUT-6, DAT-2, DAT-
                                                                                                                                                                                                      10, DAT-11, DAT-12,
                                                                                                                                                                                                      SYS-5 (verify - AUT-
                                                                                                                                                                                                      1, AUT- 3, AUT-5,
                                                                                                                                                                                                      DAT-1, DAT-3, DAT-
                                                                                                                                                                                                      4, DAT-6, DAT-7,
                                                                                                                                                                                                      DAT-10, SYS-1, SYS-
                                                                                                                                                                                                      12, POL-8)
Comm         B-1       Biosurveill 4     Local PH         Provider engagement/Decision             PWP                 Regenstrief        T81 Knowledge        Regenstrief (to 5c),                   HISPC AUT-6, DAT-
Health                 ance              (Marion          support: Local PH reviews data,                              (variant to 5c),   Source               CDC/JohnsHopkin                        2, DAT-10, DAT-11,
                       Monitoring        County, IN) --   notes increase in GI illness and                             CDC/JohnsHopkin                         s (to 5a), UWA (to                     DAT-12, SYS-5
                       &                 Risk             modifies the Knowledge Base by                               s (variant to 5a),                      5b)                                    (verify - AUT-1, AUT-
                       Detection         Communicati      adding an alert for a specific patient                       UWA (variant to
                                                                                                                                                                                                      3, AUT-5, DAT-1,
                                         on / Alerting    population. A broadcast message is                           5b)
                                                          sent to providers.                                                                                                                          DAT-3, DAT-4, DAT-
                                                                                                                                                                                                      6, DAT-7, DAT-10,
                                                                                                                                                                                                      SYS-1, SYS-12, POL-
                                                                                                                                                                                                      8)
Comm         B-1       Biosurveill 5a    PCP              New pt comes into physician office       T81 Knowledge       Regenstrief,                                                                                                   IS02, IS11
Health                 ance                               with diarrhea. Context data from         Consumer            GE_EHR2
                       Monitoring                         EMR is sent to Public Health to
                       &                                  check for alerts using T81. PH
                       Detection                          returns Alert containing
                                                          assessment/tx guidelines generated
                                                          using T81.
Comm         B-1       Biosurveill 5b    PCP              New pt comes into physician office       RFD                 Allscripts_E_2                                                                                                 IS02
Health                 ance                               with diarrhea. Context data from                             Greenway_3
                       Monitoring                         EMR is sent to Public Health to
                       &                                  check for alerts using RFD. PH
                       Detection                          returns Alert containing
                                                          assessment/tx guidelines is
                                                          generated using RFD.
                                                          OPTIONAL ADDITION: Clinician
                                                          clicks link on alert to report disease
                                                          using RFD. Morbidity form is
                                                          retrieved from PH server and
                                                          populated with EMR data. Clinician
                                                          adds additional info and submits to
                                                          PH using RFD.
Comm         B-1       Biosurveill 5c    PCP              Alert is received through EMR using      T63                 NextGen, Vangent,                                                                                              IS11
Health                 ance                               Regenstrief ‗s Docs-for-Docs. Alert is                       GE_EHR2
                       Monitoring                         displayed through EMR as a pt-
                       &                                  specific alert or inbox message.
                       Detection
Comm         B-1       Biosurveill 6     CDC (UWA)        Receives Biosurveillance aggregated Summarized minimum       FHA or federally-
Health                 ance                               data from State PH through NHIN     data set, NHIN gateway   branded table
                       Monitoring                         gateway. Data is displayed using                             [CDC/SAIC/UWA
                       &                                  Distrbute tool                                               station]
                       Detection




         Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                  12/17
                                                                                                                                                                                                                                                                                               259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme        ACT# Act                Sce Setting      Story / Clinical Discussion          Profile / Actor -         Potential         Profile / Actor -     Potential           Clinical         Comments /                      02/11   Showings   Showings Expl       HITSP Related
                                     ne                                                    Inbound                   Vendors           Outbound              Vendors             Considerations & Variants                                                               Comments
                                                                                                                                                                                 Content Needed

Comm         PH-1      Public     1      PCP (in      An 18 month old patient is seen     QED (Querier)              GE_EHR2          XDS.b (Doc             (GE - only vendor   Need XDS Registry      NOTE: This is                        1       Only GE used here   Pre-populate with
Health                 Health            State #1)    by the PCP. The practitioner        QED (Data Source)          -----            Source), BPPC          that can do         that supports XCA      published to Affinity                        since it can do     birth-18 months
                       Immunizati                     queries the state immunization                                 IBM (Clin Data   IC (Content Creator)   QED..must be in     ----------------       Domain 1 with BPPC                           QED and source      immunizations;
                       ons                            information system to identify                                 Source)                                 this step)          Out=XDS-MS IC          sensitivity marking for                      IC                  variant to
                                                                                                                                                             Greenway
                                                      current immunization status, and                               SWPartners (Clin                                            (Doc Source)           policy set-up. Check                                             implement vaccine
                                                                                                                                                             Mckesson
                                                      the child is immunized in                                      Data Source)                                                Out=IC (Content        with Epic for a                                                  forcast from public
                                                      accordance with the                                                                                                        Creator)               possible V2.3.1                                                  health
                                                      recommended immunization                                                                                                   ------------           transform to IC via
                                                      schedule for a child of 18 months.                                                                                         IC can be done as      SW Partners
                                                      The provider submits the                                                                                                   XDS doc or IC          Gateway. HISPC
                                                      immunization record to the state‘s                                                                                         Message. When IC       AUT-1, AUT- 3, AUT-
                                                      HIE. The HIE, on behalf of the                                                                                             message,               5, DAT-1, DAT-3,
                                                      clinician, transforms and transmits                                                                                        SWPartners will        DAT-4, DAT-6, DAT-
                                                      the clinical content to the                                                                                                translate and          7, DAT-10, SYS-1,
                                                       HL7 2.3.1 message required by                                                                                             provide XDS doc.       SYS-12, POL-8
                                                      the state Immunization
                                                      Information System. The provider
                                                      publishes an immmunization
                                                      summary to the local HIE (via the
                                                      Service Gateway). where it is
                                                      registered for access to
                                                      authorized care providers.


Comm         PH-1      Public     2      PCP (in       The child's parents move to another XDS.b (Doc Consumer)      GE (doing scene1) XDS.b (Doc Source) GE (doing              Need XDS Registry      NOTE: This is                        1       Only Greenway        variant to
Health                 Health            State #2)     state and bring the child to a new    IC (Content Consumer)   Greenway_3        IC (Content Creator) scene1)              that supports XCA      retrieved from Affinity                      used here since     implement vaccine
                       Immunizati                      Primary Care Physician 3 1/2 years                            -----                                  Greenway_3           ----------             Domain 1 via Affinity                        GE is used in       forcast from public
                       ons                             later (child is now 5). The parents                           SWPartners                                                  In=XDS-MS IC (Doc
                                                                                                                                                                                                        Domain 2, leveraging                         step1               health
                                                       are not able to provide a detailed                                                                                        Consumer)
                                                                                                                                                                                                        XUA at the
                                                       immunization history, but are able to                                                                                     In=IC (Content
                                                       list the previous Primary Care                                                                                            Consumer)              repository, and
                                                       physicians names and cities, from                                                                                         Out=XDS-MS IC          published to Affinity
                                                       both this state and the neighboring                                                                                       (Doc Source)           Domain 2. Policy
                                                       state. The parent indicates that they                                                                                     Out=IC (Content        from Affinity Domain
                                                       think the child is due sometime this                                                                                      Source)                1 must be applied to
                                                       year for a 'booster' shot. The new                                                                                        -----                  identify whether the
                                                       PCP queries the HIE and retrieves                                                                                         Need QED Clincal       organization role and
                                                       the detailed prior immunizations.                                                                                         Data Sources for       ID from Affinity
                                                       The Immunization registry from the                                                                                        Immunization
                                                                                                                                                                                                        Domain 1, and opt-in
                                                       neighboring state is also queried                                                                                         Registry
                                                       using HIE gateways providing a full                                                                                       ------------           consent is sufficient
                                                       history of the child's immunization                                                                                       GET NEW LIST           to authorize
                                                       which the provider reviews with the                                                                                       FROM LORI....**        disclosure of the
                                                       patient's parents. Noting that the                                                                                        Potential              documents. HISPC
                                                       child is due for a DTaP (Diphtheria,                                                                                      immunizatons:          AUT-1, AUT- 3, AUT-
                                                       Tetanus, Pertussis), IPV (Inactivated                                                                                     DTaP( Diphtheria,      5, DAT-1, DAT-3,
                                                       PolioVirus), MMR (Measles, Mumps,                                                                                         Tetanus, Pertussis),   DAT-4, DAT-6, DAT-
                                                       Rubella) and Varicella boosters, the                                                                                      Hepatitis B, IPV       7, DAT-10, SYS-1,
                                                       practitioner immunizes the child and                                                                                      (Inactivated
                                                                                                                                                                                                        SYS-12, POL-8
                                                       . the document is published to the                                                                                        PolioVirus), MMR
                                                       Registry/repository of HIE2 and sent                                                                                      (Measles, Mumps,
                                                       to the state immunization                                                                                                 Rubella) and
                                                       information system.                                                                                                       Varicella boosters.
Comm         PH-1      Public     3      Public Health This service has enabled              IC, C72, C78, QED       SW Partners       IC, C72, C78, QED     SW Partners
Health                 Health            Service       clinicians connected to the HIE to
                       Immunizati        Gateway       provide a single submission of
                       ons
                                                      immunizations for both HIE
                                                      sharing and conformance with
                                                      state immunization reporting
                                                      requirements. This gateway has
                                                      enabled the existing IIS a bridge
                                                      into the HIE to more efficiently
                                                      capture immunization data and
                                                      improve conformance. QED
                                                      discussion




         Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                              13/17
                                                                                                                                                                                                                                                                                                 259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme        ACT# Act                Sce Setting        Story / Clinical Discussion             Profile / Actor -   Potential              Profile / Actor -     Potential          Clinical         Comments /                     02/11   Showings   Showings Expl       HITSP Related
                                     ne                                                         Inbound             Vendors                Outbound              Vendors            Considerations & Variants                                                              Comments
                                                                                                                                                                                    Content Needed

Comm         PH-1      Public     4       School /       Soon after the most recent set of      XDS.b (Doc Consumer) UWA/SAIC [SAFE None                         UWA/SAIC [SAFE e-authentication via HISPC AUT-1, AUT-                                 Can GE HIE - also
Health                 Health             Nurses         immunizations, the child‘s parents     IC (Content Consumer), Biopharma behind                          Biopharma behind Access Control     3, AUT-5, DAT-1,                                  do the VFM?
                       Immunizati         Office         attempt to register the child for      C19, TP20 (XUA at      scenes]                                   scenes]          liteweight -->     DAT-3, DAT-4, DAT-
                       ons                               kindergarten. Soon after they          Repository)                                                                         OASIS New            6, DAT-7, DAT-10,
                                                         arrive at the school, they realize                                                                                         Direction            SYS-1, SYS-12, POL-
                                                         that they do not have an up-to-                                                                                                                 8
                                                         date copy of the child‘s
                                                         immunization history (a
                                                         requirement for registration). The
                                                         school nurse/public health nurse
                                                         is able to use mobile identity
                                                         credentials to look up the child‘s
                                                         records by providing the name,
                                                         gender, and date of birth. The
                                                         nurse is then able to view a list of
                                                         the patient‘s immunizations
                                                         registered with the HIE.
                                                          A message containing each
                                                         immunization record for the child
                                                         is sent to a Web Service called
                                                         the Vaccine Forecast Manager
                                                         (VFM), This service returns a
                                                         forecast including dates and
                                                         immunizations for the child. Using
                                                         this information, the nurse is able
                                                         to confirm that the child is indeed
                                                         up-to-date on immunizations and
                                                         is therefore registered for school.
                                                         The parents are provided a copy
Comm         PH-1      Public     5       Infrastructure The infrastructure surrounding the     XCA, XUA, TP20,     IBM_CLIN_DATA_
Health                 Health                            secure information exchange is         ATNA                SOURCE
                       Immunizati                        reviewed. Interstate policy                                (also speak to the
                       ons                                                                                          other infra services
                                                         assertion is described and the
                                                                                                                    of reg & gatway)
                                                         implementation of that policy
                                                         through the interoperability
                                                         profiles and specifications is
                                                         described. Securing HIE nodes
                                                         and Audit repository support is
                                                         also covered.

             PH-2      Cancer        1    Pathology     The entry of the tumor diagnosis NA                         NA                     IHE Cancer            Cerner
                       Registry                         at the Pathology Laboratory                                                        pathology pre-profile
                                                        triggers an electronic submission                                                  HL7 2.3.1
                                                        to the Public Health Cancer
                                                        Registry and Hospital Cancer
                                                        Registry using traditional HL7
                                                        messaging as constrained by IHE
                                                        for Pathology.
             PH-2      Cancer        2    Hospital      The Hospital Cancer Registry                                CDC‘s HL7              RFD Form Filler;      ???                                     Verify: In this test, we                                          Is there a Hospital
                       Registry                         receives electronic submission                              Messaging              C76; Use CDC                                                  will be using                                                         RFD NPCR
                                                        through messaging and                                       Workbench,             NPCR WebPlus                                                  Connectathon                                                       WebPlus form in
                                                        processes pathology report for                              Mapper Plus            form; Variant: Form                                           connectivity to                                                        this step?
                                                                                                                                           Archiver; Outcome
                                                        inclusion in the database.                                                                                                                       simulate the
                                                                                                                                           Form Manager
                                                                                                                                                                                                         messaging service
                                                                                                                                                                                                         (PHIN-MS).
             PH-2      Cancer        2a   Hospital      The Hospital Cancer Registry            RFD Form Filler;    CDC's Abstract         RFD Form Filler;      Cerner             Out=RFD Form         Need Trigger/criteria                         Possible clinical
                       Registry                         identifies the case as eligible for     (CRD)               Plus                   CRD; Identify form;   Epic ; Outcome     Filler (TP50)        for identifying clinical                      trials form
                                                        Clinical Trial and submits                                  Connect with           Variant: Form         Form Manager                            trials that are                               submission for
                                                                                                                    caBIG, other           Archiver;
                                                        information to PCP.                                                                                                                              accepting patients                            NHIN tie-in
                                                                                                                    Clinical Trial
                                                                                                                    Entities
             PH-2      Cancer        3    PCP           PCP diagnoses Chronic               RFD Form Filler; C76;   Allscripts             RFD Form Filler       Allscripts         In=RFD Form Filler   Need to add trigger                                               May change to
                       Registry                         Lymphocytic Leukemia (CLL).         (CRD)                   GE                     Variant: Form         GE                 (TP50) w C76 (and    to EMR system.                                                    Childhood
                                                        1. EMR displays question on                                 Greenway               Archiver              Greenway           CRD)                 Need to develop                                                   leukemia for NHIN
                                                                                                                    ---------                                    ---------
                                                        whether patient will access either                                                                                          Out=RFD Form         Form that PCP                                                     Alignment;
                                                                                                                    NextTrials [Form                             NextTrials [Form
                                                        acute care or pathology laboratory                                                                                          Filler (TP50)        completes.                                                        Possible clinical
                                                                                                                    mgr]                                         mgr]
                                                        services.                                                   Outcome [Form                                Outcome [Form                           Need to develop                                                   trials form
                                                        2. PCP replies, "No", triggering a                          mgr]                                         mgr]                                    transmission                                                      submission for
                                                        form for completion.                                        Capmed [Form                                 Capmed [Form                            standard for form to                                              NHIN tie-in
                                                        3. PCP completes form.                                      mgr]                                         mgr]                                    Cancer Registry.
                                                        4. EMR transmits form to Public                             SAIC [Form mgr]                              SAIC [Form mgr]
                                                        Health Cancer Registry.
                       Cancer        3a   PCP           PCP reviews information             RFD Form Filler; CRD    Allscripts             RFD Form Filler       Allscripts                              Need help
                       Registry                         regarding possibile eligibility for                         GE                     Variant: Form         GE                                      determining how
                                                        Clinical Trial and Approves.                                Greenway               Archiver              Greenway                                PCP connects with
                                                                                                                    ---------                                    ---------                               Clinical Trials to
                                                                                                                    NextTrials [Form                             NextTrials [Form
                                                                                                                                                                                                         exchange information
                                                                                                                    mgr]                                         mgr]
                                                                                                                    Outcome [Form                                Outcome [Form                           and to enroll patient
                                                                                                                    mgr]                                         mgr]                                    in Clinical Trial.
                                                                                                                    Capmed [Form                                 Capmed [Form
                                                                                                                    mgr]                                         mgr]
                                                                                                                    SAIC [Form mgr]                              SAIC [Form mgr]




         Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                                14/17
                                                                                                                                                                                                                                                                                            259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme         ACT# Act                Sce Setting         Story / Clinical Discussion              Profile / Actor -      Potential        Profile / Actor -      Potential        Clinical         Comments /                    02/11   Showings   Showings Expl     HITSP Related
                                      ne                                                           Inbound                Vendors          Outbound               Vendors          Considerations & Variants                                                           Comments
                                                                                                                                                                                   Content Needed

              PH-2      Cancer        4    Public Health Public Health State Cancer                                       IHE Cancer       CDC‘s HL7          None                                     Verify: In this test, we                                        Need to work with
                        Registry           Agency        Registry receives electronic                                     pathology pre-   Messaging                                                   will be using                                                   form manager to
                                                          submission through "messaging"                                  profile          Workbench and                                               Connectathon                                                    build NPCR
                                                          and processes pathology report                                  HL7 2.3.1        Mapper Plus; CDC‘s                                          connectivity to                                                 WebPlus form;
                                                                                                                                           Abstract Plus
                                                          for inclusion in the database.                                                                                                               simulate the                                                    DSG - HTML form
                                                                                                                                                                                                       messaging service                                               signing; Possible
                                                                                                                                                                                                       (PHIN-MS).                                                      tie in to NCI/NHIN
                                                                                                                                                                                                                                                                       demonstration
                        Cancer        5    NCI/Clinical   The data in the investigator‘s site                                              Outcome [Form                                               Need help                                                       CDISC input? NCI
                        Registry           Trials         archive (not the EHR) is now                                                     mgr] + NCI player(s)                                        understanding                                                   Input; Signature
                                                          established as the electronic                                                                                                                Cancer Registry's                                               validation?
                                                          source record for the clinical trial                                                                                                         involvement in this
                                                          and the data sent to the form                                                                                                                step.
                                                          receiver is eSource data.

Comm          PH-2      Drug        1      Identity       Federal Bridge recognized                RFD Form Filler; C76                    RFD Form Filler;       SAFE Biopharma                       Greenway Variant –                    2       EPIC (Hosp) and
Health                  Safety             Management     healthcare digital identities are                                                C76; Use AHRQ                                               add digital signature                         Greenway (ofc)
                        Reporting          Service        provided to clinicians and their staff                                           form; Variant: Form                                         (DSG/C26)
                        (Pt Safety)        Provider       in accordance with regulatory                                                    Archiver; Outcome
                                                          agency provisions. These high                                                    Form Manager
                                                          assurance credentials enable
                                                          accountability for authentication to
                                                          health information resources and
                                                          enable a trusted signature.
                                                           Identities are issued to providers
                                                          leveraging digital certificates which
                                                          are used for signing research
                                                          submissions and case report
                                                          documents.
Comm          PH-2      Drug          2    PCP          Patient presents with (drug         RFD Form Filler; C76          Greenway         RFD Form Filler;       Greenway                             Pfizer/Aster (VAERS)                  1
Health                  Safety                          reaction symptoms). The
                        Reporting                       practitioner reviews the symptom
                                                        onset with the patient and
                                                        determines that the event was
                                                        related to the new medication that
                                                        had been prescribed 3 days
                                                        earlier. The recording of the drug-
                                                        related complication in the EHR,
                                                        triggers a drug safety report. The
                                                        form is pre-populated with data
                                                        already available from the EHR,
                                                        and the practitioner adds
                                                        additional event details, and
                                                        submits the form to the
                                                        manufacturer.
Comm          PH-2      Drug          3    Drug         The electronic form is received by RFD Form Filler; C76           Outcome          RFD Form Manager; Outcome +Pfizer                           For US, submitted to                  1
Health                  Safety             Manufacturer the Drug Manufacturer. The Drug                                                    Form receiver; C76;                                         FDA, for Japan,
                        Reporting                       Manufacturer. The manufacturer                                                     Variant – validates                                         submitted to Japan‘s
                                                        begins case investigation efforts.                                                 signature                                                   Ministry of Health,
                                                                                                                                           (DSG/C26)
                                                        The Drug Manufacturer, through                                                                                                                 Labor and Welfare
                                                        the form manager, forwards a
                                                        copy of the report to the Drug
                                                        Regulatory Authority. Having
                                                        received multiple reports of
                                                        patients with similar


Chronic       Q-1       Quality       1    PCP            A 55year old diabetic patient     None (start of Act)                            XDS.b (Doc Source) Greenway [SVS]       Out=XDS-MS          If Possible: Historical
Care                    Reporting                         presents at a Specialist for                                                     SVS [potential]    ----                 Referral (Content   data available via HIE
                                                          examination and routine                                                                             GE-HIE serves as     Creator) / C38      and contributed to
                                                          bloodwork and urine screening.                                                                      SVS Repository       Out=QED / TP21      information reported
                                                          The blood pressure (PQRI #3),
                                                          confirmation of dilated macular
                                                          examination by an eye care
                                                          professional (PQRI #18),
                                                          indication of macular examination
                                                          findings (PQRI #19).

Chronic       Q-1       Quality       1a   PCP            A 55year old diabetic patient        None (start of Act)                         XDS.b (Doc Source) GE_EHR               Out=XDS-MS          If Possible: Historical
Care                    Reporting                         presents at a Specialist for                                                                                             Referral (Content   data available via HIE
                                                          examination and routine                                                                                                  Creator) / C38      and contributed to
                                                          bloodwork and urine screening.                                                                                           Out=QED / TP21      information reported
                                                          The blood pressure (PQRI #3),                                                                                            Out=XD-Lab (Doc
                                                          confirmation of dilated macular                                                                                          Source)
                                                          examination by an eye care
                                                          professional (PQRI #18),
                                                          indication of macular examination
                                                          findings (PQRI #19) and
                                                          laboratory results are published to
                                                          the HIE so as to share the results
                                                          with those involved in the patient's
                                                          care




          Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                          15/17
                                                                                                                                                                                                                                                                                              259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme         ACT# Act                Sce Setting        Story / Clinical Discussion               Profile / Actor -        Potential          Profile / Actor -     Potential          Clinical         Comments /                  02/11   Showings   Showings Expl   HITSP Related
                                      ne                                                           Inbound                  Vendors            Outbound              Vendors            Considerations & Variants                                                       Comments
                                                                                                                                                                                        Content Needed

Chronic       Q-1       Quality       2   Hospital       The patient presents to the ED      XDS.b (Doc Consumer)           Cerner             RFD (Form Filler)     Cerner             In=XDS-MS           Historical data                                             Epic - stroke is
Care                    Reporting                        with stroke. The diagnosis triggers RFD (Form Filler)              Epic                                     Epic               Referral (Content   available via HIE and                                       most interesting
                                                         the need to generate a quality                                     ------                                   ------             Consumer)           contributed to                                              for inpatient (AHA,
                                                         report as part of the physician‘s                                  NextTrials [Form                         NextTrials [Form   In=XD-Lab           information reported -                                      American stroke
                                                                                                                            mgr]
                                                         participation in a quality                                                                                  mgr]               (Content            Epic only                                                   association - get
                                                                                                                            Outcome [Form
                                                         monitoring program using the                                       mgr]                                     Outcome [Form      Consumer)                                                                       with the
                                                         CMS clinical performance                                           Capmed [Form                             mgr]               -----                                                                           guidelines)
                                                         measures for stroke. The                                           mgr]                                     Capmed [Form       PQRI clinical
                                                         physician retrieves the appropriate                                SAIC [Form mgr]                          mgr]               performance
                                                         form for CMS clinical                                                                                       SAIC [Form mgr]    measures form for
                                                         performance measurement                                                                                                        diabetes
                                                         tracking. Additional data                                                                                                      management.
                                                         elements are entered to complete                                                                                               -----
                                                         the full data set for submission of                                                                                            RFD Form
                                                         performance information.                                                                                                       Manager resource
                                                                                                                                                                                        is required
Chronic       Q-1       Quality       3   Quality        The quality measures are            RFD (Form Receiver) NextTrials [Form None (End of Act)                                                         Outcome has the
Care                    Reporting         Management     collected by the QMO/PSO and                            mgr]                                                                                       PQRI indicator forms
                                          Organization   aggregate analysis is performed.                        Outcome [Form                                                                              and can work with us
                                          (e.g CMS) /    Comparative quality reports are                         mgr]                                                                                       on the stroke forms.
                                          Patient
                                                         prepared and made available for                         Capmed [Form
                                          Safety
                                          Organization   public health monitoring.                               mgr]
                                                         Because the provider was able to                        SAIC [Form mgr]
                                                         view the pre-filled form with
                                                         existing known data elements and
                                                         supplement the available
                                                         information available only in free-
                                                         text areas of the record, the
                                                         performance of the practice is
                                                         now reflective of actual care
                                                         provided.

Infra         I-1       Infrastruct   1   Patient ID   Presents: why patient id                    PIX (Manager);                              PIX (Manager);
Services                ure               Mgmt         management is necessary, how it             PDQ (Service Provider)                      PDQ (Service
                                                       participates in XDS, Relationship                                                       Provider)
                                                       between Patient Identity Source, PIX
                                                       Manager and Document Registry,
                                                       consideration when deploying a
                                                       patient id management system:
                                                       security, privacy, backup, demograp
Infra         I-1       Infrastruct   2   XDS          Presents: how the Document                  XDS (Provide and                            XDS (Provide and                         XDS-MS, XDS-I;
Services                ure               Repository   Repository participates in XDS.             Register Doc)                               Register Doc)                            XDS-SD; XD-Lab
                                                       Considerations when deploying a             XDS (Retrieve Doc)                          XDS (Retrieve Doc)
                                                       Document Repository: security,
                                                       privacy, backup, auditing, how many
                                                       are needed,
Infra         I-1       Infrastruct   3   XDS Registry Presents: how the Document                  XDS (Provide and                            XDS (Provide and
Services                ure                            Registry participates in XDS.               Register Doc)                               Register Doc)
                                                       Considerations when deploying a             XDS (Query Reg)                             XDS (Query Reg)
                                                       Document Registry: security,                [XCA variant]                               [XCA variant]
                                                       privacy, backup, XDS Affinity
                                                       Domain specified metadata values,
                                                       terminology, auditing. Which patient
                                                       identifier field is used in an ADT
Infra         I-1       Infrastruct   4   XCA          Present: what a community is, how           XCA (Init and Resp)                         XCA (Init and Resp)
Services                ure               Gateway      community sharing is supported by
                                                       Initiating and Responding Gateways,
                                                       How Initiating and Responding
                                                       Gateways interact with XDS actors
                                                       (registry, repository, consumer), how
                                                       gateways support security across
                                                       communities
Infra         I-1       Infrastruct   5   Privacy      Pt consent management requires a            BPPC                                        BPPC                                     Need to review
Services                ure               Consent      Consent Repository to be deployed                                                                                                HITSP TP20
                                          Repository   in conjunction with an XDS                                                                                                       specifications
                                                       Registry/Repository in an HIE.                                                                                                   regarding caccess
                                                                                                                                                                                        control
                                                                                                                                                                                        administration.

Comm          R-1       Clinical      1   Clinical       A clinical study or disease registry                                                  RFD (Form
Health                  Research          Research       participant has arrived for a visit and                            ----               Manager)
                                          Sponsorr       the clinician has documented                                       NextTrials [Form
                                                         assessments and procedures in the                                  mgr]
                                                         patient‘s chart in the electronic                                  Outcome [Form
                                                         health record (EHR) system (the                                    mgr]
                                                         Form Filler). The research                                         Capmed [Form
                                                         coordinator or clinician initiates the                             mgr]
                                                         RFD transaction to retrieve the
                                                         appropriate data capture form. The
                                                         form is pre-populated with the
                                                         relevant data from the EHR and
                                                         displayed within the EHR user
                                                         interface, The user reviews and
                                                         verifies the data in the form,
                                                         completes the form and submits the
                                                         data to the form receiver and, in the
                                                         case of a clinical study, to the
                                                         archiver.



          Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                            16/17
                                                                                                                                                                                                                                                                                            259e758f-4b58-4434-aa35-e316f6d7ab33.xls-Prelim Story 2009



Theme        ACT# Act                Sce Setting            Story / Clinical Discussion                Profile / Actor -      Potential             Profile / Actor -   Potential             Clinical         Comments /                02/11   Showings   Showings Expl   HITSP Related
                                     ne                                                                Inbound                Vendors               Outbound            Vendors               Considerations & Variants                                                     Comments
                                                                                                                                                                                              Content Needed

Comm         R-1       Clinical      1+   PCP               A clinical study or disease registry       RFD (Form Filler)      Cerner, Epic,         RFD (Form Filler)                                         DSG Variant for Greenway
Health                 Research                             participant has arrived for a visit and                           Allscripts,
                                                            the clinician has documented                                      Greenway
                                                            assessments and procedures in the                                 ----
                                                            patient‘s chart in the electronic                                 NextTrials [Form
                                                            health record (EHR) system (the                                   mgr]
                                                            Form Filler). The research                                        Outcome [Form
                                                            coordinator or clinician initiates the                            mgr]
                                                            RFD transaction to retrieve the                                   Capmed [Form
                                                            appropriate data capture form. The                                mgr]
                                                            form is pre-populated with the
                                                            relevant data from the EHR and
                                                            displayed within the EHR user
                                                            interface, The user reviews and
                                                            verifies the data in the form,
                                                            completes the form and submits the
                                                            data to the form receiver and, in the
                                                            case of a clinical study, to the
                                                            archiver.
Comm         R-1       Clinical      2    Clinical          When the usercoordinator selects           RFD ( Forms Archive,   NextTrials [Form      RFD ( Forms
Health                 Research           Research          the submit button on the form, the         Form Manager)          mgr]                  Archive, Form
                                          Sponsor           EHR system submits the completed                                  Outcome [Form         Manager)
                                                            form to the Clintrial eClinical data                              mgr]
                                                            management system responsible for
                                                                                                                              Capmed [Form
                                                            aggregating study or registry data
                                                            from multiple sites (Form Receiver).                              mgr]
                                                            hosted by the Form Receiver and
                                                            For the clinical study use case, the
                                                            form simultaneously submits it to the
                                                            site‘s clinical study/trial data archive
                                                            (the Form Archiver).
Comm         R-1       Clinical      3    Clinical          The data in the investigator‘s site        RFD (Form Archiver     NextTrials
Health                 Research           Research          archive (not the EHR) is now                                      Outcome
                                          Sponsor           established as the electronic source
                                                            record for the study and the data
                                                            sent to the form receiver is eSource
                                                            data. Documentation of lab
                                                            procedures is included in this initial
                                                            data submission and the record is
                                                            then updated when lab results
                                                            become available.

                                          Eligibility and   CAQH CORE Operating
                                          Authorization     Rules…HITSP AF constructs
                                          Eligibility and   CAQH CORE Operating
                                          Authorization     Rules…HITSP AF constructs

                                          Medication HITSP Constructs?
                                          Management
                                          Medication HITSP Constructs?
                                          Management

Comm         R-2       Drug          1    Manufacturer The manufacturer or regulatory          RFD ( Form Manager)            NextTrials            RFD ( Form          NextTrials
Health                 Safety             / regulatory agency has established an electronic                                   Outcome               Manager)            Outcome
                       Reporting          agency       form for drug safety reporting. The                                    Capmed /PDS                               Capmed /PDS
                       (Pharma)                        electronic form will be used to collect                                Cerner Discovere                          Cerner Discovere
                                                       adverse drug event data from the
                                                       clinician through their own EHRs.
                                                       The form is also configured to
                                                       enable pre-population of the form by
                                                       leveraging routine clinical content
                                                       that the EHR may generate as part
                                                       of their clinical care information
                                                       exchanges.
Comm         R-2       Drug          2    Care         In the normal course of patient care RFD (Form Filler)                 Cerner, Allscripts,   RFD (Form Filler)   Cerner, Allscripts,
Health                 Safety             Provider     a clinician suspects that the patient                                  Greenway                                  Greenway
                       Reporting                       suffers from an adverse reaction to a
                       (Pharma)                        commercially marketed drug. The
                                                       clinician pulls up a drug safety
                                                       reporting form, pre-populated as
                                                       appropriate, completes the form, and
                                                       submits to a drug safety
                                                       intermediary.
Comm         R-2       Drug          3    Drug Safety The intermediary, a drug safety          RFD (Form Reciever)            NextTrials
Health                 Safety             Registry     registry, reviews and codes the                                        Outcome
                       Reporting                       event, and forwards to the                                             Capmed /PDS
                       (Pharma)                        manufacturer of record and to the                                      Cerner Discovere
                                                       regulatory authority.




         Copyright IHE HIMSS 2008-2009                                                                                                                                                                                                                                                                                                           17/17

								
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