# [use case documents from the health care domain]

**Category:** [Technical (archive)](https://discourse.openehr.org/c/technical-archive/156)
**Created:** 2003-11-17 12:40 UTC
**Views:** 11
**Replies:** 7
**URL:** https://discourse.openehr.org/t/use-case-documents-from-the-health-care-domain/14455

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## Post #1 by @thomas.beale

Forwarded from Arild Faxvaag &lt;arild\.faxvaag@medisin\.ntnu\.no&gt;

Dear all\.
Has someone tried to establish a collection of use case documents with descriptions of information\-related tasks by health care workers?

Would you developers consider it useful if such a collection existed?

kindly regards

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## Post #2 by @Luca_Romoli

Hi Thomas, Hi Arild,
my name is Luca Romoli and since september I&#39;m working at an OpenSource
Project called CARE2x \(http://www.care2x.com\) which is a Hospital and Health
Care Integrated Information System \.\.\. one week ago I also subscribed to
this project\.
My scope in the care project is to provide basic documentation to present,
sell, deploy and maintain such similar environment; so I work on power
points&#39; doc, gantts&#39; charts, excels&#39; sheets\.
The greatest lack I found, not considering basic documentation, in the most
health care OSS is real data\. So what I&#39;m also trying to do is collecting
real information, form hospital, internet and nationals&#39; health care
association\.
Right now I&#39;m ending up providing few basic doc and after I&#39;ll work harder
on collecting data, so well \.\.\. in a couple of week I&#39;ll be able to help you
and the project in this direction

If you wanna take a look at what I&#39;ve done till now\.\.\.
In care project with the PM and PR board I moderate different topics

http://care2x.org/phpbb/viewforum.php?f=28
For marketing related posts \(Presentations, Business strategies\)

http://care2x.org/phpbb/viewforum.php?f=29
For planning and implementation posts \(NDA, Hw studies, Gantt\)

http://care2x.org/phpbb/viewforum.php?f=30
For financial related posts \(tools and considerations over ROI, TCO, TBO\)

You can also download the documentation I&#39;m preparing right now from my
website

http://www.camocim.com/care.ppt
A Portuguese \(I&#39;ll translate in english soon\) presentation of the
environment

http://www.camocim.com/care_hw.ppt
An English &quot;how\-to&quot; to help implementers to design a care Hw environment

http://www.camocim.com/care_oss.ppt
An Alpha presentation of Open Source Software, ROI and other acronym

http://www.camocim.com/Project_costs.xls
An excel sheet for helping ppl managing project costs

I also set up a project management web environment
http://project.camocim.com
Try User: caredep Password: caredep

Hope you can find this information interesting and we can work together as
soon as possible
Regards

\-\-\-\-\-Messaggio originale\-\-\-\-\-

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## Post #3 by @Bill_Walton1

Arild Faxvaag wrote:

> Has someone tried to establish a collection of use case documents with
> descriptions of information\-related tasks by health care workers?
>
> Would you developers consider it useful if such a collection existed?

It seems to me that question of &quot;context&quot; needs to be addressed before those
task descriptions will have much value\.  I&#39;m thinking that Roles differ from
country to country, and in most cases, by health\-care setting within a
country\.  So just starting here we have a three\-level hierarchy \(Country \-&gt;
Setting \-&gt; Role\)\.  Once that&#39;s established, Responsibilities and Authority
can be mapped\.  Exceptions to Authority would need to be mapped\.  Now we&#39;re
at five levels, perhaps six depending on the approach to mapping exceptions\.

I wouldn&#39;t suggest even attempting to extend this to descriptions of the
tasks\.  Just establishing the taxonomy above would be a huge job; forget
about the effort to maintain it over time\.  Task descriptions would, IMO,
make the maintenance task impossible\.

It seems to me that the value of such a collection would extend \_much\_
further than the development community\.

Best regards,
Bill

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## Post #4 by @Ralph_MacFadden

Luca,

Thanks for the information and please keep us updated. Many people would like a list such as Arild described.

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## Post #5 by @Luca_Romoli

Thx Ralph I’m subscribing right now.

I’m asking you one thing, looking think at the links and the documentation of my past post, which do you think will be the best help I can give to the communities ?

Regards
Luca Romoli

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## Post #6 by @Ralph_MacFadden

Generally, the best help anyone can give is what they knew best. But it depends on the community and what strengths they already have.

In your situation, it looks like your links are particularly useful to hospitals.

A list of medical data entry duties as Arild described is useful to a wider audience, especially health departments, hospital human resource departments, medical staffing businesses, labor unions that include such workers, and government employee unions (since some hospitals are run by states, etc.)

So the best help you can provide a community depends on the community.

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## Post #7 by @thomas.beale

Luca Romoli wrote:

> Hi Thomas, Hi Arild,
> my name is Luca Romoli and since september I&#39;m working at an OpenSource
> Project called CARE2x \(http://www.care2x.com\) which is a Hospital and Health
> Care Integrated Information System \.\.\. one week ago I also subscribed to
> this project\.
>

I finally got around to looking at the care2x website \- it&#39;s great \(I want one\!\)\. My main question is: is interoperability achieved by having all applications talk to the one back\-end database, and if so, is there a published UML model or schema which describes care2x&#39;s interface? If there was, we could surely work toward making a bridge to it from openEHR, which would open up some data highways in both directions\. What is your philosophy with respect to standards and interoperability?

\- thomas beale

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## Post #8 by @thomas.beale

Bill Walton wrote:

> It seems to me that question of &quot;context&quot; needs to be addressed before those
> task descriptions will have much value\.  I&#39;m thinking that Roles differ from
> country to country, and in most cases, by health\-care setting within a
> country\.  So just starting here we have a three\-level hierarchy \(Country \-&gt;
> Setting \-&gt; Role\)\.  Once that&#39;s established, Responsibilities and Authority
> can be mapped\.  Exceptions to Authority would need to be mapped\.  Now we&#39;re
> at five levels, perhaps six depending on the approach to mapping exceptions\.
>
> I wouldn&#39;t suggest even attempting to extend this to descriptions of the
> tasks\.  Just establishing the taxonomy above would be a huge job; forget
> about the effort to maintain it over time\.  Task descriptions would, IMO,
> make the maintenance task impossible\.
>

I think that may be a little over\-pessimistic \- at least for the kinds of tasks I have in mind to describe\. The kind of thing I would suggest documenting would be:

\- a simple chain of events: GP visit; request for test; test result; diagnosis or other evaluation; therapy or other action/advice;

\- the management of any patient with the typical pattern of recurrent visits, monitoring of progress, education, occasional crisis episode, e\.g\. an asthma patient\. This is bread and butter for doctors, but very interesting \(and not trivial\) to get right in the EHR, if we are to accurately represent not only what happens at each visit, but to string the visits together with links which document the causality and other relatedness of the items, so as to tell any carer who looks at it the &quot;story of the patient&quot; \(something which Mike Mair, a NZ opthalmologist is always reminding us we should be concentrating on\)\.

\- scenarios to do with creation of fine\-grained information by multiple clinicians in an ICU e\.g\. during a re\-animation situation; when / what parts of this info hits the EHR?

\- decision by clinicians/tools on what pieces of detailed episodic EPR to move up to shared EHR

\- scenarios to do with management of patient in home care with automatic monitoring and controlling of devices \(e\.g\. pill dispenser\)

\- medication management, from prescription to completion, for complex \(but common\) cases, e\.g\. chemotherapy; multi\-drug aged patients

\- scenarios where the patient is interacting with the EHR, e\.g\. adding data of weight, blood sugar etc, maybe adjusting their own dosage of a drug;

\- attestation scenarios; e\.g\. a junior doctor commits a note about a patient to their EHR; it needs to be attested legally by a senior person before being completely legal, but in between time, it is clinically useful and \_usable\_ info whcih should be in the EHR;

\- and so on\.

What I believe the clinical part of this community needs to think about is: how can we codify what we do in such a way as to tell us how to design certain aspects of the EHR? We hope that most of the answers will be in the form of archetypes, templates, terminology, guidelines \- i\.e\. knowledge resources; but we know that some tings will affect the concrete models of the EHR whcih we need to get right as best as possible in order to support all possible scenarios\.

A lot of the design features of openEHR are in response to having thought carefully about specific scenarios and then generalising to categories of scenarios \(i\.e\. by induction, if you will\)\. The UML models might look simple, but they are not accidental\.

> It seems to me that the value of such a collection would extend \_much\_
> further than the development community\.
>

one kind of additional value it would have is that scenario descriptions \(as with all requirements\) are the basis of test cases \- you use them to test systems\. So if your hospital is threatening to buy some expensive system, you can provide a large repository of test cases you believe it should satisfy as a means of vetting it\.

\- thomas beale

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**Canonical:** https://discourse.openehr.org/t/use-case-documents-from-the-health-care-domain/14455
**Original content:** https://discourse.openehr.org/t/use-case-documents-from-the-health-care-domain/14455