Microsoft PowerPoint - 2A Sengstack

7/18/2016

UseCases:

WhatAreThey?

HowtoDevelopThem

AndMethodstoTestThem

PatriciaSengstack,DNP,RN‐BC,CPHIMS

ChiefNursingInformaticsOfficer

BonSecoursHealthSystem,Inc.

patricia_sengst[email protected]

SethCarlson,MS,CPHIMS

ClinicalArchitect

NationalInstitutesofHealth

[email protected]

Objectives

• Define and describe a Use Case in the healthcare

information technology field

• State the importance of a collaborative approach

in the development of Use Cases

• Define the various types of testing and discuss

their importance (unit, functional, integration,

regression, performance, user acceptance)

“Use Case” Defined

• Behaviorally related sequence of steps (a

scenario), both automated and manual for the

purpose of completing a single business task.

• Use Cases describe the system functions from

the perspective of end users

• Technique to better understand and document a

system’s requirements

Source: Whitten, Bentley & Dittman (2000). Systems Analysis and Design Methods (5

ed.). McGraw-Hill

Irwin. Boston.

System (Functional) Requirements

• A functional requirement is a function or feature

that must be included in an information system

to satisfy the business need and be acceptable to

the end users

• Can be put into 3 categories:

▫ Must have

▫ Would like to have

▫ Bells and whistles

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Example Requirements - An Infection

Control System shall:

• Identify culture results indicating that a particular

antibiotic would be resistant in a patient in real

time.

▫ Include patient unit, room number, name, account

number and organism.

• Identify drug-bug mismatches and opportunities to

streamline or discontinue antimicrobial therapy

• Automate creation of National Healthcare Safety

Network reports that are formatted for export to

Microsoft Excel and/or upload to NHSN

Examples in Healthcare

More Examples: ONC’s Interoperability Task Force 6/23 -

five broadly applicable use cases for health IT

1.Transitions of Care: Automated query from ER physician in one state to the

patient’s PCP EHR record where the patient is regularly seen and have it

imported directly to the ER physician’s EHR.

2.Shared Care Plans: All health professionals sharing care for a cancer patient

have access to care plan developed by the oncologist.

3.Patient-Initiated Data: A diabetic patient’s caregiver gathers notes and lab

results from her PCP and Endocrinologist and submits the patient’s glucometer

readings to both doctors.

4.Clinical Information Transparency for Patients/PCP: Hospital

discharge of high-risk patient to post-acute care with appropriate involvement

of PCP. The patient is able to access and review their health information, view

costs for medications and pharmacies; in addition to payer coverage.

5.Quality Improvement: Allow persons in quality management and health

care organizations (such as ACOs) the ability to interchange and review clinical

quality data for a patient or a population.

Benefits of Use Cases

• Provides the perspective of the desired system

functionality from the end user’s viewpoint

• Ensures end user involvement

• Creates an effective tool for validating

requirements

• Supplies an effective communication tool for all

parties involved in analysis, development and

testing

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Actors and Their Roles for $400

• Terminology for Use Cases can be confusing.

• Actors – anything that needs to interact with the

system to exchange information during the course of

the scenario

• An actor initiates the Use Case for the purpose of

completing a task

• An “actor” represents a role fulfilled by an end user

interacting with the system – not an individual

person

• In Use Cases we create, who is our primary actor?

The Nurse!

Time as an Actor

• Remember - An actor initiates the Use Case for the

purpose of completing a task

• Time can be a trigger to initiate a task

• Examples:

▫ A billing system for a credit card company may

automatically generate bills at midnight on the 5

day

of the month

▫ A lab system may automatically generate a list of

morning labs for the phlebotomist daily at 5am

• “Temporal Event” – is a system event that is

triggered by time. An actor of a temporal event is

time.

Naming Use Cases

• Use Cases are typically named using the name of

the event or input preceded by an action verb

• Examples

▫ Submit blood transfusion order

▫ Administer blood transfusion using bar code

scanner

▫ Generate list of morning labs to be drawn by

phlebotomist

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Documenting the Use Case

• Step by step description starting with the actor

initiating the use case and going through to the end

of the event

• Include:

▫ Use Case name

▫ Actors

▫ Any references (requirements)

▫ Course of events – each step spelled out individually

▫ Alternate course of events – if applicable

▫ Pre-condition

▫ Post condition

Use Case Example

• Use Case name: Administer blood transfusion using bar code

scanner

• Actor: Nurse

• Any references (requirements): See requirements

document

• Course of events – each step spelled out individually:

• Alternate course of events (if applicable): May include

steps if barcode technology not working or steps if

patient experiences reaction

• Pre-condition: Patient’s condition warrants

administration of PRBCs

• Post condition: Blood administered, patient stable, H &

H drawn for follow-up

Step by step course of events

• Actor – triggers initiation of use case: Nurse

sends message to blood bank to deliver PRBCs

back to nursing unit

• Blood bank receives message, delivers blood to

nursing unit

• Nurse takes blood to patient’s bedside with

another RN

• Nurse scans patient armband, nurses badge and

unit of PRBC, etc…..

Use Case Documentation

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Use Case Documentation (cont’d)

Source: Whitten, Bentley & Dittman (2000). Systems Analysis and Design Methods (5

ed.). McGraw-Hill Irwin. Boston.

Use Case Diagram

Use Case Templates

(available on the web)

• TechnoSolutions:

http://www.technosolutions.com/use_case_template.html

• TechWhirl: http://techwhirl.com/use-case-template/

• Bridging the Gap: http://www.bridging-the-

gap.com/what-is-a-use-case/

• Product Management Insights:

http://pmblog.accompa.com/2009/10/08/use-case-

template-example-requirements-management-basics/

Testing

• A Use Case is a great collaborative tool for

developers and end users to work through a

system design and build

• Testing throughout the design and build is as

important (if not more) as developing a strong

use case

• Terminology around testing can also be complex

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Phases of Testing

• Unit Testing

• Functional Testing

• Integration Testing

• Regression Testing

• Performance Testing

• User Acceptance Testing

• Production Validation Testing

Use Case Scenario – Specimen

Collection Verification Testing

• Specimen collection verification using bar code

technology

Source: Carlson, S. (2015). Testing in the Healthcare Informatics Environment. In Sengstack & Boicey Mastering Informatics: A Healthcare

Handbook for Success. STTI. Indianapolis, IN

Unit Testing

• Initial testing of an individual software

component

• Performed while a component is being

developed and before it is turned over to the test

team

• Typically performed by the developer who

creates the component

• Includes testing of different low-level logical

pathways within component

Unit Testing - Example

• Unit test of status update to EHR

• Create positive test case that unit xyz has been

transfused to patient. Validate in EHR that

patient shows they have received unit XYZ

• Create negative test case that unit xyz was not

successfully transfused. Validate in EHR that

patient did not receive unit XYZ

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Function Testing

• Testing of system by the test team to ensure that

system meets the functional requirements

• Functional requirements and use cases need to

be defined and documented

• Test scripts written to evaluate if the system

meets the functional requirements

• Each requirement is mapped to a test script

Function Testing - Example

• Requirement = The system shall notify the end

user of an incompatibility of blood type between

patient and unit to be administered

• Create a test patient in system with ABO blood

type A

• Create unit to be transfused with ABO blood

type B

• Attempt to select unit for transfusion. Validate

that system displays alert about ABO type

mismatch

Integration Testing

• “The development of common scenarios that will

exercise the integrated components of the

clinical system”

• Goal is to ensure that the individual components

of the system work together to support the

business process

• Can leverage common use cases for this testing

Source: Garton & McCulloch (2012). Source: Garton & McCulloch (2012). Fundamentals of technology project management (2

ed.) MC Press

Online, LLC. Boise, ID.

Integration Testing - Example

• Physician orders PRBCs to be transfused to

patient

• Transfusion medicine department verifies

crossmatch and issues units

• RN uses barcoding system to identify patient

and issued units

• RN takes vitals and transfuses units to patient

• Vital signs and transfusion report are sent to

EHR to document process

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User Acceptance Testing

• End users perform testing of the system and

identify problems or issues they see with the

functional aspects of the system, or the business

process flow

• Testing is often similar to how the end users

envision using the system once it is deployed

User Acceptance Testing - Example

• Can be similar to the Integration testing

scenarios/use cases, except executed by the end

user

• Can be done by the end users alone, or with

another member of the project team who acts as

an observer and records significant issues,

observations by the end user about the system

Performance Testing

• Technical testing, which involves creating a user

load on the system to validate the components

can withstand anticipated volumes of usage

• Involves testing the application itself, the

underlying database, and any other system

components, and how they perform together as a

whole

Source: Garton & McCulloch (2012). Source: Garton & McCulloch (2012). Fundamentals of technology project management (2

ed.) MC Press

Online, LLC. Boise, ID.

Performance Testing - Example

• Create a script that simulates the Integration test

scenario of ordering units, issuing units, and

then documenting vital signs and the transfusion

• Run this script with 50 concurrent incidences

and monitor memory usage and response time

of the system

• Another example is flushing all of the toilets at

the same time in a football stadium

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Regression Testing

• A standardized set of test scripts which is used to

verify that no functionality that was previously

working is now failing as a result of a change

that was introduced

• Performed after a change has been made to the

system along with testing of the change itself

Source: Garton & McCulloch (2012). Fundamentals of technology project management (2

ed.) MC Press

Online, LLC. Boise, ID.

Regression Testing - Example

• After a change is made to the interface that

sends the issued units from the Transfusion

Medicine system to the Barcoding system,

regression testing would consist of testing

additional functions of the interface, including

issuing different types of units, and canceling the

issuing of units.

Production Validation Testing

• Production Validation testing is performed when

testing a change that has passed testing in a Test

environment and has now been placed into the

Production environment

• Usually means running a similar test case to

what was tested in the Test environment, but

may only mean running a subset of the tests

Production Validation Testing -

Example

• When moving the new Transfusion System to

Production, many test cases have been run in the

Test environment

• In Production, would execute some

representative scenarios and functionality tests,

including issuing a new unit and then

transfusing the unit (on a test patient), and

performing a transfusion with and without vital

signs

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Tying it all Together

• Use cases help document a scenario of system

use from the end user perspective

• Use cases (documented well) reduce the chances

that your IT team builds something that won’t

work or won’t be accepted

• Testing what is built in a system needs to happen

on a number of levels to ensure the system is

working as intended

• Conducting all types of testing are required to

maintain a strong system

Question

• One of the most important benefits of a Use Case

is:

1. It supports the concept of “if it’s not

documented, it’s not done”

2. It ensures the end user’s perspective is included

in the design of a system

3. It requires rigorous testing

4. Actors can configure functional requirements

Question

• Functional requirements that provide the

foundation for a Use Case can be categorized

into 3 categories. Which one does not belong:

1. Would like to have

2. Actor supported

3. Bells and whistles

4. Must have

Question

• Conducting testing to ensure that the individual

components of the system work together to

support the business process (from A to Z)

would be called:

1. Performance testing

2. Regression testing

3. Integration testing

4. Unit testing

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