Use Cases Demonstrating the Utilization of Direct in Four ... · Use Cases Demonstrating the...
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December 2013
Use Cases Demonstrating the Utilization of Direct in Four States:
Alabama, Florida, Illinois, Rhode Island
Appendices
Prepared for
Office of the National Coordinator for Health Information Technology U.S. Department of Health and Human Services
300 C Street, SW Washington, DC 20201
Prepared by
Gloria J. Deckard, Ph.D. Monica Chiarini Tremblay Ph.D.
Debra VanderMeer Florida International University
Michael Shapiro RTI International
230 W. Monroe St, Suite 2100 Chicago, IL 60606
RTI Project Number 0212050.007.000.006
_________________________________ RTI International is a trade name of Research Triangle Institute.
RTI Project Number 0212050.007.000.006
Use Cases Demonstrating the Utilization of Direct in Four States:
Alabama, Florida, Illinois, Rhode Island
Appendices
December 2013
Prepared for
Office of the National Coordinator for Health Information Technology U.S. Department of Health and Human Services
300 C Street, SW Washington, DC 20201
Prepared by
Gloria J. Deckard, Ph.D. Monica Chiarini Tremblay Ph.D.
Debra VanderMeer Florida International University
Michael Shapiro RTI International
230 W. Monroe St, Suite 2100 Chicago, IL 60606
iii
Contents
Appendix Page
Appendix A: Guideline for Use Case Development A-1
Appendix B: Activity Models B-1
B.1 Overview of Activity Modeling .................................................................. B-1
B.2 Alabama Activity Models .......................................................................... B-2 B.2.1 Dyad 1: Eastern Alabama .............................................................. B-2 B.2.2 Dyad 2: Southern Alabama .......................................................... B-12
B.3 Florida Activity Models .......................................................................... B-14 B.3.1 Dyad 1: Central Florida ............................................................... B-14 B.3.2 Dyad 2: Southwest Florida ........................................................... B-21
B.4 Illinois Activity Models ........................................................................... B-26 B.4.1 Dyad 1: Illinois Behavioral Assessment .......................................... B-26 B.4.2 Dyad 2: Illinois Methadone Services .............................................. B-31
B.5 Rhode Island Activity Models .................................................................. B-38 B.5.1 Dyad 1: Rhode Island Integrated Care ........................................... B-38 B.5.2 Dyad 2: Rhode Island Community Behavioral Services ..................... B-46
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Exhibits
Number Page
B-1. Example Activity Model ................................................................................ B-1 B-2. Review of Eastern Alabama, Scenario 1 .......................................................... B-2 B-3. Eastern Alabama Scenario 1 Pre-Direct Initiate Referral .................................... B-3 B-4. Eastern Alabama Scenario 1 with-Direct Initiate Referral ................................... B-4 B-5. Eastern Alabama Scenario 1 Pre-Direct Receive Referral ................................... B-5 B-6. Eastern Alabama Scenario 1 With-Direct Receive Referral ................................. B-6 B-7. Eastern Alabama Scenario 1 Pre-Direct Monitor Followup .................................. B-7 B-8. Eastern Alabama Scenario 1 With-Direct Monitor Followup ................................ B-8 B-9. Review of Eastern Alabama Interaction, Scenario 2 .......................................... B-9 B-10. Eastern Alabama Scenario 2, Pre-Direct ....................................................... B-10 B-11. Eastern Alabama Scenario 2, With Direct ...................................................... B-11 B-12. Review of Southern Alabama Interaction ...................................................... B-12 B-13. Southern Alabama Interaction, Pre-Direct ..................................................... B-13 B-14. Review of Central Florida Interaction ............................................................ B-14 B-15. Central Florida Pre-Direct Initiate Referral ..................................................... B-15 B-16. Central Florida Direct-Enabled Initiate Referral .............................................. B-16 B-17. Central Florida Pre-Direct Receive Referral, Treat Patient, and Provide
Treatment Record ..................................................................................... B-17 B-18. Central Florida Direct-Enabled Receive Referral, Treat Patient, and Provide
Treatment Record ..................................................................................... B-18 B-19. Central Florida Pre-Direct Receive Treatment Record ...................................... B-19 B-20. Central Florida Direct-Enabled Receive Treatment Record ............................... B-20 B-21. Review of Southwest Florida Interaction ....................................................... B-21 B-22. Southwest Florida Pre-Direct Initiate Referral ................................................ B-22 B-23. Southwest Florida Direct-Enabled Initiate Referral .......................................... B-23 B-24. Southwest Florida Pre-Direct Receive Referral ............................................... B-24 B-25. Southwest Florida Direct-Enabled Receive Referral ......................................... B-25 B-26. Review of Illinois behavioral Assessment ...................................................... B-26 B-27. Illinois Behavioral Assessment Pre-Direct Initiate Referral ............................... B-27 B-28. Illinois Behavioral Assessment with-Direct Initiate referral .............................. B-28 B-29. Illinois Behavioral Assessment Pre-Direct Receive Referral .............................. B-29 B-30. Illinois Behavioral Assessment with-Direct Receive Referral ............................. B-30 B-31. Illinois Behavioral Assessment, Receive Discharge Notice for Pre-Direct and
With-Direct .............................................................................................. B-31 B-32. Review of Illinois Methadone Services interaction ........................................... B-31
v
B-33. Illinois Methadone Services Pre-Direct Initiate Referral ................................... B-32B-34. Illinois Methadone Services with Direct Initiate Referral .................................. B-33B-35. Illinois Methadone Services Pre-Direct Receive Referral .................................. B-34 B-36. Illinois Methadone Services with-Direct Receive Referral ................................. B-35 B-37. Illinois Methadone Services Pre-Direct Receive Treatment Record ..................... B-36 B-38. Illinois Methadone Services With-Direct Receive Treatment Record ................... B-37 B-39. Review of Rhode Island Integrated Care, Scenario 1 ...................................... B-38 B-40. Rhode Island Integrated care, Scenario 1, Pre-Direct Initiate Referral ............... B-39 B-41. Rhode Island Integrated Care, Scenario 1, Post-Direct Initiate Referral ............. B-40 B-42. Rhode Island Integrated Care, Scenario 1, Pre-Direct Receive Referral .............. B-41 B-43. Rhode Island Integrated Care, Scenario 1, With-Direct Receive Referral ............ B-42 B-44. Review of Rhode Island Integrated Care, Scenario 2 ...................................... B-43 B-45. Rhode Island Integrated Care Scenario 2, Pre-Direct ...................................... B-44 B-46. Rhode Island Integrated Care Scenario 2, With-Direct .................................... B-45 B-47. Review of Rhode Island Community Behavioral Services, Scenario 1 ................. B-46 B-48. Rhode Island Community Behavioral Services, Scenario 1, Pre-Direct ............... B-47 B-49. Rhode Island Community Behavioral services Scenario 2, With-Direct ............... B-48 B-50. Review of Rhode Island Community Behavioral Services, scenario 2 ................. B-49 B-51. Rhode Island Community Behavioral Services Scenario 2, Pre-Direct ................ B-50 B-52. Rhode Island Community Behavioral Services Scenario 2, With-Direct .............. B-51
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A-1
APPENDIX A: GUIDELINE FOR USE CASE DEVELOPMENT
Pre-Observation Discussion: To diagram the workflow and illustrate the impact of Direct adoption, we spoke with contacts at each location before our observations were conducted. We elicited the following information to prepare our initial workflow diagrams:
1. Length of time using Direct
2. Reasons for adoption
3. Number of individuals using Direct in location
4. Primary user of Direct in location to identify individuals to observe
5. Integration of Direct with EHR
6. Integration of Direct with any other IT systems within location
7. Adoption process
a. Internal
b. External
8. Current uses of Direct (what would be observed)
9. Workflow for exchange of protected health information prior to adoption of Direct
Observation: Prior to the observation, we detailed the individual steps (workflow) for the exchange of protected health information as discussed in the pre-observation phone conference. At the observation we would:
1. Share the UML diagram representing of pre-Direct workflow to assure accuracy.
2. Discuss changes in the workflow diagram following the adoption of Direct.
3. Discuss any other impacts created by the adoption of Direct.
4. Observe use of Direct.
Post-Observation Discussion: To verify that the UML diagram accurately reflected the use of Direct as observed, we emailed a copy of the diagrams to each location and conducted a post-observation phone conference with our contact at each location.
State Health Policy Consortium: FIU Direct Use Case
A-2
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B-1
APPENDIX B: ACTIVITY MODELS
B.1 Overview of Activity Modeling
We describe the details of interaction among the people and systems in each Use Case scenario in the form of UML Activity Models. UML is a graphical modeling language in which each graphical element has a specific meaning. Exhibit B-1 provides an overview of the elements of UML Activity Models here. Subsequent exhibits present detailed Activity Models for the observation Use Cases.
Exhibit B-1. Example Activity Model
State Health Policy Consortium: FIU Direct Use Case
B-2
Exhibit B-1 depicts a simple scenario in which patient calls a medical practice for an appointment. Here, each separate vertical column or “swimlane” represents a participant in the process. Each swimlane is labeled with the role and the words denoting whether a person or the system executes the role. Swimlanes that are contiguous reside with a single organization. Rounded-corner boxes represent activities in the workflow process. Each activity resides within a swimlane, which indicates that the swimlane’s owner is responsible for performing the activity. The solid black dot indicates the start of the workflow process, and the black dot with the circle around it indicates the end. Arrows between activities indicate the precedence ordering of activities. These arrows do not carry data for communication purposes; rather, communication between participants is explicitly represented in the activities. The diamond indicates conditional logic, where multiple options are available, and each outgoing arrow indicates which option is selected by following it. A rectangular box with arrows leading away from it or into it (not pictured in this example) indicates the beginning or end of parallel processing, respectively.
B.2 Alabama Activity Models
B.2.1 Dyad 1: Eastern Alabama
In this section, we provide detailed Activity Models for the Eastern Alabama Dyad. This dyad has two scenarios; we present each in turn. Scenario 1 describes the interaction between a Case Management Agency that helps Medicare clients navigate the health care system and the State Department of Public Health, where some of the Case Managers are employed. Exhibit B-2 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-2. Review of Eastern Alabama, Scenario 1
We present our Activity Models for this Use Case scenario for these steps. Specifically, Exhibit B-3 and Exhibit B-4 depict the details for Step A for the pre-Direct and Direct-enabled cases, respectively; Exhibit B-5 and Exhibit B-6 show the details for Step B for the pre-Direct and Direct-enabled cases, respectively; and Exhibit B-7 and Exhibit B-8 show the details for Step C for the pre-Direct and Direct-enabled cases, respectively.
Step A: Location 1 sends
follow-up case referrals to Location 2
Step B: Location 2 receives follow-up referral,
follows up with client, and records
activity in statewide system
Step C: Location 1 audits follow-up cases in
the statewide system, and sends
out audit reports for incomplete follow-
up cases
B-3
Appendix B
— A
ctivity Models
Exhibit B-3. Eastern Alabama Scenario 1 Pre-Direct Initiate Referral
State Medicaid Staff
Case Management System Staff (Person)
Case Management Staff (System)
Case Management Agency Email (System) Case Management Agency Quality Manager (Person) State Dept. of Public Health Case
Manager (Person)
Compile monthly report
of Medicaid activity
Provide data to Case
Management system staf for
Upload data to Case Management
system
Run report
Store data
Log in Case Management system
Run report for list of clients with chronic conditions
Note unusual/missing activity for
followup
Determine which case management is responsible for
client’s case
Send internal email with instructions for followup on
client
Call clinician
Wait a few hours
Tell clinician about client followup needs
Receive client followup
information
Transmit email
YesNo
Clinician is within agency?
No YesReach clinician?
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ealth Policy Consortium
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B-4
Exhibit B-4. Eastern Alabama Scenario 1 with-Direct Initiate Referral
State Medicaid Staff Case Management System Staff (Person) Case Management Staff (System)
Compile monthly report of
Medicaid activity
Provide data to Case
Management system staf for
Upload data to Remedy system
Run report
Store data
Case Management Agency Quality Manager (Person)
Log in Case Management system
Run report for list of clients with chronic conditions
Note unusual/missing activity for followup
Determine which case management is responsible for client’s case
Log in to DirectSend internal email with instructions for followup on
client
Yes
No
Clinician is within agency?
Case Management Agency Email (System)
Transmit email
Create email with instructions for followup on client; include copy to
supervisor
Send email
Send non-Direct email to notify of new Direct
message; include copy to supervisor
Transmit email
Direct (System)
Transmit email
Appendix B — Activity Models
B-5
Exhibit B-5. Eastern Alabama Scenario 1 Pre-Direct Receive Referral
B-6
State H
ealth Policy Consortium
: FIU D
irect Use C
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Exhibit B-6. Eastern Alabama Scenario 1 With-Direct Receive Referral
B-7
Appendix B
— A
ctivity Models
Exhibit B-7. Eastern Alabama Scenario 1 Pre-Direct Monitor Followup
Case Management Agency Quality Manager (Person)
Log in to Case Management system
Load client record in Case Management System
Look for follow-up records in client case
record
Determine which case manager is responsible for client’s case
Call case manager
Send internal email asking
about any problems in
following up with client
YesNo
Clinician is within agency?
Case Management Agency Email (System)
Transmit email
Drop off audit paper copy to case management
supervisor
Ask clinician about any problems in following
up with client
Case Management System (System)
Return client record
State Dept. of Public Health Case Manager (Person)
State Dept. of Public Health Case Mgt. Supervisor (Person)
Discuss any problems in following up with
client
Receive audit report
For each client needing follow-up
Yes
No
Followup complete?
Wait a few hours
Reach a case manager?
Yes
No
B-8
State H
ealth Policy Consortium
: FIU D
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Exhibit B-8. Eastern Alabama Scenario 1 With-Direct Monitor Followup
Case Management Agency Quality Manager (Person)
Determine which case manager is responsible for client’s case
Log in to Direct
Send internal email asking
about any problems in
following up with client
YesNo
Clinician is within agency?
Case Management Agency Email (System)
Transmit email
Send Direct email with followup questions for
case manager
Send Direct email with audit results
to supervisor
Transmit email
Direct (System)
Transmit email
Case Management System (System)
Return client record
Log in to Case Management System
Load client record in Case Management System
Look for follow-up records in client case
record
for each client needing follow-up
Yes
No
Followup complete?
Send non-Direct email to notify of
Direct email
Send non-Direct email with audit
results to supervisor
Transmit email
Transmit email
Appendix B — Activity Models
B-9
Scenario 2 considers the interaction between the Transportation Coordinator at the Case Management Agency and the Case Manager at the State Department of Public Health as they coordinate the transportation of a client to/from medical facilities or the delivery of needed medical equipment. Exhibit B-9 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-9. Review of Eastern Alabama Interaction, Scenario 2
We present our Activity Models for this Use Case scenario for these steps summarized in two activity models. Specifically, Exhibit B-10 and Exhibit B-11 depict the details for the pre-Direct and Direct-enabled cases, respectively.
Step A: Location 2
sends a request for
transportation to Location 1
Step B: Location 1
receives requests and
requests coordination details from Location 2
Step C: Location 1
receives coordination
detail requests and responds to Location 2
Step D: Location 2 provides
transportation as agreed
B-1
0
State H
ealth Policy Consortium
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Exhibit B-10. Eastern Alabama Scenario 2, Pre-Direct
Appendix B
— A
ctivity Models
B-1
1
Exhibit B-11. Eastern Alabama Scenario 2, With Direct
Dept. of Public Health Staff (Person) Direct (System)Dept. of Public Health
Fax (System)Dept. of Public Email Fax
(System)Case Management Agency
Fax (System)Case Management Agency
Email (System)Case Management Agency Transport
Coordinator (Person)
Transport person/item
Log in to Direct
Send Direct email to coordinate pickup/dropoff locations, etc.
Send non-Direct email to notify of
Direct mail
Read email
Receive request
Transmit email
Receive email
Log in to Direct
Transmit email
Receive email
Transmit request
Transmit email
Log in to Direct
Fax request for transport to Case
Management Agency
Send Direct coordination
response
Send non-Direct email to notify of
Direct mail
Transmit email
Client needs transportation or medical item
Sufficient information?
Yes
No
State Health Policy Consortium: FIU Direct Use Case
B-12
B.2.2 Dyad 2: Southern Alabama
In this section, we provide detailed Activity Models for the Southern Alabama Dyad, where a Mental Health Provider manages the treatment and transfer of clients under the care of the State Department of Mental Health. In this specific interaction the Mental Health Provider notifies the State Department of Mental Health about the transfer of a client between facilities or about the client’s discharge. Exhibit B-12 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-12. Review of Southern Alabama Interaction
In this Use Case, only the pre-Direct case is modeled (the participants had not yet fully integrated Direct at the time of observation).
Exhibit B-13 presents the Activity Models for the pre-Direct interaction in this Use Case.
Step A: Location 1 transfers or discharges a
client and notifies Location 2
Step B: Location 2 receives the notification
from Location 1
Appendix B
— A
ctivity Models
B-1
3
Exhibit B-13. Southern Alabama Interaction, Pre-Direct
State Health Policy Consortium: FIU Direct Use Case
B-14
B.3 Florida Activity Models
B.3.1 Dyad 1: Central Florida
In this section, we provide detailed Activity Models for the Central Florida Dyad, in which a Specialist Practice refers a patient to another Specialist Practice for a particular type of specialized surgery. Exhibit B-14 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-14. Review of Central Florida Interaction
Our Activity Models for this Use Case map closely to these steps. Specifically, Exhibit B-15 and Exhibit B-16 depict the details for Step A for the pre-Direct and Direct-enabled cases, respectively; Exhibit B-17 and Exhibit B-18 show the details for Step B for the pre-Direct and Direct-enabled cases, respectively; and Exhibit B-19 and Exhibit B-20 show the details for Step C for the pre-Direct and Direct-enabled cases, respectively.
Step A: Location 1 initiates
referral to Location 2
Step B: Location 2 receives
referral, treats patient, and sends a record of treatment
to Location 1
Step C: Location 1 receives
treatment record
Appendix B
— A
ctivity Models
B-1
5
Exhibit B-15. Central Florida Pre-Direct Initiate Referral
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ealth Policy Consortium
: FIU D
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B-1
6
Exhibit B-16. Central Florida Direct-Enabled Initiate Referral
Appendix B
— A
ctivity Models
B-1
7
Exhibit B-17. Central Florida Pre-Direct Receive Referral, Treat Patient, and Provide Treatment Record
Referring Practice Staff (Person) Administrative Staff (Person)
Walk to referring practice
Create new patient in EMR
Administrative Staff PC (System) EMR (System) Clinical Staff (Person) Reviewing Physician (Person) Treating Physician (Person)
Hold referral documents for
pickup
Pick up referral documents from referring practice
Scan referral documents into EMR (referral, demographics,
pathology, picture)
Give paper referral
documents to reviewing
physician for review
Store new patient record
new patient?
Yes
No
Store new patient record
Schedule patient
treatment, obtain history,
and medications
Assign patient to physician
Treat patient
Enter treatment details in patient records in EMR
Store treatment details
Export treatment record
Store treatment record as PDF
Print record for review and signature
Print digitally signed record
Walk to referring practice
Deliver treatment record to referring office
Receive treatment record
Physician preference
Review and digitally sign treatment record
Scan signed paper record Store scanned
record
Store digitally signed record
sign paper record
Review and sign paper copy
State Health Policy Consortium: FIU Direct Use Case
B-18
Exhibit B-18. Central Florida Direct-Enabled Receive Referral, Treat Patient, and Provide Treatment Record
B-1
9
Appendix B
— A
ctivity Models
Exhibit B-19. Central Florida Pre-Direct Receive Treatment Record
B-2
0
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ealth Policy Consortium
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Exhibit B-20. Central Florida Direct-Enabled Receive Treatment Record
Appendix B — Activity Models
B-21
B.3.2 Dyad 2: Southwest Florida
In this section, we provide detailed Activity Models for the Southwest Florida Dyad, which considers the interactions between a Children’s Social Services Agency and a School System as children age out of the Agency’s early intervention program and potentially become eligible for an individual education plan in the School System. Exhibit B-21 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-21. Review of Southwest Florida Interaction
The workflow in this scenario requires significant interaction between the communicating parties; thus, rather than separating the steps shown above into separate Activity Models, we have developed Activity Models that represent the points of view of Location 1 and Location 2 for all steps in the interaction. Exhibit B-22 and Exhibit B-23 depict the interaction from Location 1’s point of view for the pre-Direct and Direct-enabled cases, respectively. Exhibit B-24 and Exhibit B-25 show the interaction from Location 2’s point of view for the pre-Direct and Direct-enabled cases, respectively.
Step A: On a monthly basis,
Location 1 provides a list of upcoming transfer cases to
Location 2
Step B: For each transfer
case, Locations 1 and 2 interact until
Location 2 has all needed records to
determine eligibility
Step C: On a quarterly basis,
Locations 1 and 2 interact to audit
complete and pending cases to
ensure full coverage
State Health Policy Consortium: FIU Direct Use Case
B-22
Exhibit B-22. Southwest Florida Pre-Direct Initiate Referral
Appendix B — Activity Models
B-23
Exhibit B-23. Southwest Florida Direct-Enabled Initiate Referral
Children’s Social Services Agency Staff (Person)
Review caseload to identify children eligible for referral to
school system
Children’s Social Services Agency PC (System) Direct (System)
Transmit email
Every month
Compile list of children turning 3 in the next 9
months
Log in to Direct
Create email; attach list
Send email
Prepare exit assessment and referral packet (including relevant test
results); this packet contains PHI and FERPA-protected information
Log in to Direct
Send email
Create list of completed and transfer cases
Log in to Direct
Create email; attach audit list
Send email for audit reconciliation to
ensure all referral cases are complete
Store list to local drive
Store referral documents to local
hard drive
Create email; attach list
Transmit email
Transmit email
State Health Policy Consortium: FIU Direct Use Case
B-24
Exhibit B-24. Southwest Florida Pre-Direct Receive Referral
School Staff (Person)
Receive list of expected children
Early Intervention Staff (Person)
Scan documents in referral packet to local
drive
Upload referral packet documents to IEP software
Hold IEP decision meeting
Meet with social services agency staff to ensure all
referral cases are complete
School Fax (System)
Drop off referral packet
Receive further records
Every monthAs each child approaches 3rd birthday
Check received documents against
checklist for IEP program acceptance
Drop off further records
Wait a few days
Call to remind social services agency staff of needed
documents/reports
Quarterly audit of children transitioning
File complete?
Yes
No
Appendix B — Activity Models
B-25
Exhibit B-25. Southwest Florida Direct-Enabled Receive Referral
School Staff (Person)
Receive list of expected children
Create record IEP in software for each child
Log in to Direct
Direct (System) School PC (System) IEP Tracking (System)
Receive email with expected
children
Receive email with child’s records
Open email; download
attachments
Upload referral documents in IEP
Check received referral documents against
checklist for IEP program acceptance
Store attachments to local drive
Store list of expected children
Create new record
Store referral documents to child’s record
Create email to request missing
documents
Meet with social services agency staff to ensure all
referral cases are complete
Wait a few days
Log in to Direct
Quarterly audit of children transitioning
File complete?Yes
No
Send emailTransmit email
Receive response?
YesNo
Receive email documents
Hold IEP decision meeting
State Health Policy Consortium: FIU Direct Use Case
B-26
B.4 Illinois Activity Models
B.4.1 Dyad 1: Illinois Behavioral Assessment
In this section, we provide detailed Activity Models for the Illinois Behavioral Assessment Dyad, where a Social Service Agency performs assessments of adolescents in crisis, and refers those needing acute care to a Hospital. Here, the interaction involves transmitting the details of the assessment from Clinician in the field to the Hospital. Exhibit B-26 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-26. Review of Illinois behavioral Assessment
Our Activity Models for this Use Case map these steps as follows. Exhibit B-27 depict the details for Steps A, B, and C for the pre-Direct case, while Exhibit B-28 illustrates the corresponding Direct-enabled cases. Exhibit B-29 and Exhibit B-30 show the details for Step D for the pre-Direct and Direct-enabled cases, respectively. Step E is the same for both the pre-Direct and Direct-enabled cases, and is shown in Exhibit B-31.
Step A: Location 1
verifies bed
availability with
Location 2 to verify
availability of a bed
Step B: Location 2
verifies availability
Step C: Location 1
sends assessment
to Location 2
Step D: Location 2
treats adolescent
Step E: Location 1 provides follow-up
care
Appendix B
— A
ctivity Models
B-2
7
Exhibit B-27. Illinois Behavioral Assessment Pre-Direct Initiate Referral
Reporting Person
Request for adolescent psychiatric assessment
Assessing Clinician (Person)
Go to site to assess
Assess adolescent
Call hospital to verify bed availability
Suggest other help
requires hospitalization
Yes
No
Keep calling other hospitals
Provide case basics verbally
available?No
Yes
Fax available nearby?
Rewrite assessment for transport with
adolescent
Fax assessment to hospital
No Yes
Fax assessment to hospital
Social Services Agency Fax (System)
Transmit assessment
Local Fax (System)
Transmit assessment to hospital
Transporting Person (Person)
Transport handwritten assessment
with adolescent
Hospital Fax (System)
Receive assessment
Hospital Staff (Person)
Receive adolescent
and handwritten assessment
Receive assessment
Wait for official
assessment
Begin treating adolescent
State Health Policy Consortium: FIU Direct Use Case
B-28
Exhibit B-28. Illinois Behavioral Assessment with-Direct Initiate referral
Reporting Person
Request for adolescent psychiatric assessment
Social Service Agency Clinician (Person)
Go to site to assess
Assess adolescent
Call hospital to verify bed availability
Suggest other help
requires hospitalization
Yes
No
Keep calling other
hospitals
Provide case basics verbally
available?No
Yes
Social Services Agency EHR (System)
Social Service Agency Shared Storage (System) Direct (System)
Log in to VPN
Enter assessment
into EHR
Export assessment as PDF to shared
storage
Log in to Direct
Create email; attach assessment
Send emailTransmit
Store assessment
Export assessment
Store assessment
Appendix B — Activity Models
B-29
Exhibit B-29. Illinois Behavioral Assessment Pre-Direct Receive Referral
State Health Policy Consortium: FIU Direct Use Case
B-30
Exhibit B-30. Illinois Behavioral Assessment with-Direct Receive Referral
Appendix B — Activity Models
B-31
Exhibit B-31. Illinois Behavioral Assessment, Receive Discharge Notice for Pre-Direct and With-Direct
B.4.2 Dyad 2: Illinois Methadone Services
In this section, we provide detailed Activity Models for the Illinois Behavioral Assessment Dyad, in which a Methadone Clinic refers new clients (at start of treatment) and ongoing clients (on an annual basis) to a Community Health Center for a physical checkup. Exhibit B-32 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-32. Review of Illinois Methadone Services interaction
Our Activity Models for this Use Case map closely to these steps. Specifically, Exhibit B-33 and Exhibit B-34 depict the details for Step A for the pre-Direct and Direct-enabled cases, respectively; Exhibit B-35 and Exhibit B-36 show the details for Step B for the pre-Direct and Direct-enabled cases, respectively; and Exhibit B-37 and Exhibit B-38 show the details for Step C for the pre-Direct and Direct-enabled cases, respectively.
Step A: Location 1 refers client for physical
checkup
Step B: Location 2 performs
physical checkup
Step C: Location 1 receives results of physical
checkup from Location 2
State Health Policy Consortium: FIU Direct Use Case
B-32
Exhibit B-33. Illinois Methadone Services Pre-Direct Initiate Referral
Appendix B — Activity Models
B-33
Exhibit B-34. Illinois Methadone Services with Direct Initiate Referral
Clinician (Person)
Process new patient
Perform quarterly
case review
Make appointment for physical
Yes No
Needs annual physical?
Create referral sheet
Admin staff (Person) Scanner (System) Shared Storage (System) Direct (System)
Transmit email
Give referral sheet to
admin staff
Scan referral to PDF on shared
storageScan document Scan document
Log in to Direct
Create email
Attach documents to email
Send email
State Health Policy Consortium: FIU Direct Use Case
B-34
Exhibit B-35. Illinois Methadone Services Pre-Direct Receive Referral
Patient (Person)
Give referral paperwork to
admin staff
Admin Staff (Person) Practice Fax (System) Clinician (Person)
Create new patient file (episodic charts)
Give referral to Clinician
Perform physical
Create clearance document (confirmation
of physical, clearance for treatment, initial
dose amount)
Write up initial record of physical
Wait for lab results
Finalize report of physical
Hold final report for clinic staff pickup
Fax for clearance
Transmit clearance to clinic
For new clients
Appendix B — Activity Models
B-35
Exhibit B-36. Illinois Methadone Services with-Direct Receive Referral
State H
ealth Policy Consortium
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B-3
6
Exhibit B-37. Illinois Methadone Services Pre-Direct Receive Treatment Record
Practice Admin Staff (Person)
Fax initial clearance to
clinic
Hold full record for clinic pickup
Practice Fax (System)
Transmit initial clearance
Clinic Fax (System)
Receive initial clearance
Admin Staff (Person)
Give clearance document to
clinician
Each Thursday, drive to practice
with another admin staff member
Another Admin Staff (Person)
Go into practice to pick up
records
Clinicial (Person)
Review clearance document
Begin dosage regimen for
patient
Wait in car
Drive back to clinic Return to car
Give records to clinician
Wait for full record
Review record and modify
dosage regimen as needed
Appendix B — Activity Models
B-37
Exhibit B-38. Illinois Methadone Services With-Direct Receive Treatment Record
Direct (System)
Transmit main med record
Admin Staff (Person) Clinician (Person)
Log in to Direct
Open mail, print attachments
Review lab results, change treatments
if needed
day of appointment
Transmit lab records
day after appointment
Place paper med record in patient file
Give record to clinician
Log in to Direct
Open mail, print attachments
Place paper med record in patient file
Give record to clinician
Review med record, change treatment if
needed
State Health Policy Consortium: FIU Direct Use Case
B-38
B.5 Rhode Island Activity Models
B.5.1 Dyad 1: Rhode Island Integrated Care
In this section, we provide detailed Activity Models for the Rhode Island Integrated Care Dyad. There are two scenarios for this dyad. We present each in turn.
Scenario 1 considers the case of a Primary Care Practice referring a patient to a Behavioral Health Provider. Exhibit B-39 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-39. Review of Rhode Island Integrated Care, Scenario 1
We present our Activity Models for this Use Case scenario for these steps. Specifically, Exhibit B-40 and Exhibit B-41 depict the details for Step A for the pre-Direct and Direct-enabled cases, respectively, while Exhibit B-42 and Exhibit B-43 show the details for Step B for the pre-Direct and Direct-enabled cases, respectively.
Step A: Location 1 makes referral appointment for patient
at Location 2
Step B: Location 2 receives referral, and
treats client
Appendix B — Activity Models
B-39
Exhibit B-40. Rhode Island Integrated care, Scenario 1, Pre-Direct Initiate Referral
Physician (Person) EMR (System)
Create referral in EHR
Store referral and print to
central printer
Admin Staff (Person)
Match printout to patient at counter
Fax (System)
Transmit referral
Patient needs referral to behavioral provider
Make appointment
Fax referral
Create EMR reminder to
follow up every two days until patient keeps appointment
Store reminder
Call referral practice to
check
After two days, remind
physician
Cancel reminder
Remove reminder from EMR
Patient kept appointment
No
Yes
for critical referrrals
At the end of patient visit
State H
ealth Policy Consortium
: FIU D
irect Use C
ase
B-4
0 Exhibit B-41. Rhode Island Integrated Care, Scenario 1, Post-Direct Initiate Referral
Physician (Person) EMR (System)
Create referral in EHR
Store referral and print to
central printer
Admin Staff (Person)
Match printout to patient at counter
DIRECT (System)
Transmit referral
Patient needs referral to behavioral provider
Make appointmentCreate EMR reminder to
follow up every two days until patient keeps appointment
Store reminder
Call referral practice to
check
After two days, remind
physician
Cancel reminder
Remove reminder from EMR
Patient kept appointment
No
Yes
for critical referrrals
At the end of patient visit
Admin PC (System)
Scan referral, demographics, insurance info
Move from shared folder to
local folder
Log in to Direct
Attach documents to Direct email
and send
Appendix B — Activity Models
B-41
Exhibit B-42. Rhode Island Integrated Care, Scenario 1, Pre-Direct Receive Referral
Fax (System)
Receive referral
Admin Staff (Person) Intake Staff (Person) Clinician (Person)
Check for client in Master Client Index
Place paper referral fax in clinician’s box
Interview client
Treat client
Add clinical notes to client treatment
record
existing client record?
Place paper referral fax in clinician’s box
No
Yes
State Health Policy Consortium: FIU Direct Use Case
B-42
Exhibit B-43. Rhode Island Integrated Care, Scenario 1, With-Direct Receive Referral
Scenario 2 considers the interaction for a Primary Care Practice receiving automated admission, transfer, and discharge notifications from a Hospital. Exhibit B-44 provides a review of the interaction steps in the Use Case scenario.
Direct (System)
Transmit referral email
Admin Staff (Person) Intake Staff (Person) Clinician (Person)
Log in to Direct
Check for client in Master Client
IndexInterview client
Treat client
Add clinical notes to client treatment
record
existing client record?
Pass record to appropriate
clinicianNo
Yes
Open mail and send acknowledgement
Print email and attachments
Appendix B — Activity Models
B-43
Exhibit B-44. Review of Rhode Island Integrated Care, Scenario 2
We present our Activity Models for this Use Case scenario for these steps; Exhibit B-45 depicts the details for the pre-Direct case, while Exhibit B-46 shows the details for the Direct-enabled case.
Step A: Admit, transfer, or discharge event occurs for a patient in the Hospital
Step B: Practice follows up on patient
status
State H
ealth Policy Consortium
: FIU D
irect Use C
ase
B-4
4
Exhibit B-45. Rhode Island Integrated Care Scenario 2, Pre-Direct
Hospital Staff (Person)
Admit Patient
Hospital Fax (System) Provider Fax (System) Provider Admin Staff (Person)
Deliver notice of admission
Fax treatment records
Deliver treatment record
Add treatment to patient record
Remove from follow list
Receive treatment record
Fax notice of admission to primary care provider
Maintain treatment
records
Receive notice of admission
Add patient to “follow list”
Every day, call hospital for
status
Every day, call hospital for
treatment record
Discharged
No
Yes
Received
No
Yes
Follow up with patient regularly until followup is complete
Appendix B
— A
ctivity Models
B-4
5
Exhibit B-46. Rhode Island Integrated Care Scenario 2, With-Direct
Hospital EHR (System)
Generate admission alert
Hospital Staff (Person)
Admit patient
Hospital Fax System
Transfer patient
Direct (System)
Transmit referral email
Provider Admin Staff (Person)
Log in to Direct
Provider Fax (System)
Deliver alert
Provider EHR (System)
Open and print email
Provider Clinical Staff (Person) Clinical Staff PC (System)
Discharge patient
Fax treatment record
Generate admission alert
Generate admission alert
Deliver treatment record
Note activity in patient chart
Shred printout
Move email to “Current Care”
folder
Store record
Log in to Direct
Open email from “Current Care”
folder
Review treatment activity record
Store attachments to local storage
Add PDF attachments to patient medical
record
Store attachments
Store attachments
Add treatment record to patient record
Follow up with patient regularly until followup is complete
Remove from follow list
Receive treatment record
State Health Policy Consortium: FIU Direct Use Case
B-46
B.5.2 Dyad 2: Rhode Island Community Behavioral Services
In this section, we provide detailed Activity Models for the Rhode Island Community Behavioral Services Dyad. There are two scenarios for this dyad. We present each in turn.
Scenario 1 considers the intake process for incoming referrals. Exhibit B-47 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-47. Review of Rhode Island Community Behavioral Services, Scenario 1
We present our Activity Models for this Use Case scenario for these steps. Specifically, Exhibit B-48 and Exhibit B-49 depict the details for the pre-Direct and Direct-enabled cases, respectively.
Step A: Staff collect information for
referral, and assigns to clinician
Step B: Clinician receives referral
documents
Appendix B
— A
ctivity Models
B-4
7
Exhibit B-48. Rhode Island Community Behavioral Services, Scenario 1, Pre-Direct
Client (Person)
Request appointment
Referring Physician (Person)
Refer patient
Intaker (Person)
Type administrative (insurance, etc.) info
into document
Type referral clinical info into
document
Select clinician based on client
need, geography, workloads
Print documentNo
send digitally?
Direct referral to clinician
Not direct referral
Yes
Fax document to clinician
Place in clinician inbox
Forgot to password protect
Forget to password
protectPassword protect
document
Remember to password protect
Create new email, attach
referral document
Upload document to shared cloud
storage
Share document with clinician
Transmit document Receive document
Clinician (Person)
Pick up document
Corporate Email Corporate Cloud Storage
Transmit emailOpen email and download documents
Enter passwordStore referral document in
original format
Notify of new shared document
Receive referral documents
Download document
Enter password
Read document
Yes
No
Hold for clinician
Via fax
via email
via shared storage
Password?
No
Yes
Fax (System)
Request appointment
State H
ealth Policy Consortium
: FIU D
irect Use C
ase
B-4
8
Exhibit B-49. Rhode Island Community Behavioral services Scenario 2, With-Direct
Client (Person)
Request appointment
Referring Physician (Person)
Refer patient
Coordinator (Person)
Type referral clinical info
into document
Clinician (Person)
Received direct external referral
Direct (System)
Type administrative (insurance, etc.)
info into documents
Select clinician based on client
need, geography, workloads
Log in to Direct
Create email, attach document
Transmit email
Notify of new emailLog in to Direct
Open email and attachment
Read document
Direct referral to clinician
Not direct referral
Send email
Appendix B — Activity Models
B-49
Scenario 2 considers the communication of counseling notes between a Clinician and Supervisor. Exhibit B-50 provides a review of the interaction steps in the Use Case scenario.
Exhibit B-50. Review of Rhode Island Community Behavioral Services, scenario 2
We present our Activity Models for this Use Case scenario for these steps. Specifically, Exhibit B-51 and Exhibit B-52 depict the details for the pre-Direct and Direct-enabled cases, respectively.
Step A: Clinician counsels client, documents
notes, and sends to Supervisor
Step B: Supervisor receives notes for
feedback and supervision
B-5
0
State H
ealth Policy Consortium
: FIU D
irect Use C
ase
Exhibit B-51. Rhode Island Community Behavioral Services Scenario 2, Pre-Direct
Appendix B
— A
ctivity Models
B-5
1
Exhibit B-52. Rhode Island Community Behavioral Services Scenario 2, With-Direct