User Stories

Status of these User Stories

These User Stories have reached consensus in the Implementation Group at the May 6th Face to Face meeting
User Story Workgroup Endorsement
User Story Implementation Group Endorsements
User Story Other Endorsements
May 6th Face to Face meeting consensus vote

Overview and Context

Patient engagement stories should conform to the overall framework provided by the National Health Information Network Workgroup. In particular, the Direct Project is intended to solve simple direct secure electronic transport supporting health information exchange currently being handled via paper or portal communication following existing trust models.
 
  These use cases have common patterns, including:
 

• Pre-existing information transfer patterns via fax, courier, mail or clipboard, or in some cases, via portal
• Push transactions where patient identity is known and consent and legal authorization exists for the information transfer

See Design Principles and Story Process for more detail.

User stories are subject to the Core Terminology. Please note that the term "EHR" used in these user stories is used as defined there (and expressly includes the use of lightweight EHR module).

Stories

	Story	Priority
1	Primary care provider refers patient to specialist including summary care record	1
2	Primary care provider refers patient to hospital including summary care record	1
3	Specialist sends summary care information back to referring provider	1
4	Hospital sends discharge information to referring provider	1
5	Laboratory sends lab results to ordering provider	1
6	Transaction sender receives delivery receipt	1
7	Provider sends patient health information to the patient	1
8	Hospital sends patient health information to the patient	1
9	Provider sends a clinical summary of an office visit to the patient	1
10	Hospital sends a clinical summary at discharge to the patient	1
11	Provider sends reminder for preventive or follow-up care to the patient	1
12	Primary care provider sends patient immunization data to public health	1
13	Provider or hospital reports quality measures to CMS	2
14	Provider or hospital reports quality measures to State	2
15	Laboratory reports test results for some specific conditions to public health	2
16	Hospital or provider send chief complaint data to public health	2
17	Provider or hospital sends update to regional or national quality registry	2
18	Pharmacist sends medication therapy management consult to primary care provider	2
19	A patient-designated caregiver monitors and coordinates care among 3 domains	2
20	A Provider EHR orders a test	2
21	A patient sends a message to the provider	2
22	Transaction sender receives read receipt	3
23	State public health agency reports public health data to Centers for Disease Control	3

All user stories in this primary table are intended to be supported by the specifications we are development, but we have put primary emphasis and focus on Priority 1 stories. In addition, we are requesting clear policy guidance on the primary 1 stories. Stories of lower priority may have additional policy considerations and may not be a focus of initial implementation work.

Priority

Priority Level	Meaning	Criteria
1	Earliest implementation and earliest request for policy guidance	Maps to Meaningful Use requirements and not currently easy to fulfill or required to deliver story that is a Must
2	Potential for earlier implementation, may have additional policy concerns or considerations	High value story
3	Potential for later implementation, may have additional policy concerns or considrations	Medium value story

Mapping of Stories to Meaningful Use Criteria

Core Meaningful Use Criteria

NOTE: Only criteria that are facilitated by the Direct Project are listed.

Criterion	Story	Comments
For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request	Provider sends a clinical summary of an office visit to the patient Hospital sends a clinical summary at discharge to the patient
On request, provide patients with an electronic copy of their health information (including diagnostic-test results, problem list, medication lists, medication allergies, and for hospitals, discharge summary and procedures)	Provider sends patient health information to the patient Hospital sends patient health information to the patient
Implement capability to electronically exchange key clinical information among providers and patient-authorized entities		Direct + CCD or CCR

Menu Set Meaningful Use Criteria

Criterion	Story	Comments
Incorporate clinical laboratory test results into EHRs as structured data	[Laboratory sends lab results to ordering provider]]
Provide summary of care record for patients referred or transitioned to another provider or setting	Primary care provider refers patient to specialist including summary care record Primary care provider refers patient to hospital including summary care record Specialist sends summary care information back to referring provider Hospital sends discharge information to referring provider
Submit electronic immunization data to immunization registries or immunization information systems	Primary care provider sends patient immunization data to public health
Submit electronic syndromic surveillance data to public health agencies	Hospital or provider send chief complaint data to public health
Submit electronic data on reportable laboratory results to public health agencies	[Laboratory reports test results for some specific conditions to public health]]
Send reminders to patients (per patient preference) for preventive and follow-up care	Provider sends reminder for preventive or follow-up care to the patient
Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies)	[Provider sends patient health information to the patient]] Hospital sends patient health information to the patient

Out of Scope Stories

The following proposed stories have been deemed out of scope

Story	Out of Scope Justification
Patient arrives in doctor's office, critical information missing	Covered in current NHIN Specifications
Patient arrives in Emergency Department	Covered in current NHIN Specifications