Track 2. Use Cases & Planning
Scoped use cases are critical to success. A use case plan serves to document agreed scope, steps, schedules, and resources needed to deliver solutions successfully.
What is a use case?
A "use case" in this context is a project that requires electronic collection, storage, sharing, and/or use of standardized data within a new, well-scoped workflow relative to current practice. Implementation and adoption of the use case should enable measurable improvements in the health ecosystem, including more effective, faster, and/or less expensive patient care.
A specific use case provides the framework for all that comes next. Thus, a compelling use case is critical for success. A use case attracts the subset of the larger community who care deeply about the objectives and can drive work and allows standards development work to focus on the data elements needed to execute new systems and workflows.
A prototypical use case is the Radiation Therapy Treatment Data Case Study. This project replaced inefficient sharing of PDF documents from a radiation therapy services to oncologists, leveraging an mCODE-based FHIR exchange of structure radiation treatment summary data. Its deployment in real-world systems has improved information quality and reduced clinical burden.
CodeX Use Case Development Guidelines
CodeX created Use Case Development Guidelines as a framework for successful use case work via three Stages: Discovery, Planning, and Execution.
Below are key learnings around the CodeX use case discovery and planning stages. The CodeX "execution" experience will be referenced in the Implementation & Testing and Adoption & Value sections of this website.
Use Case Discovery:
Identifying and Prioritizing Potential Specialty Projects
Use case discovery, in CodeX, generally starts with champions who engage and gain commitment from potential participants. Together, they identify and prioritize use cases projects, based in part on the factors below.
New specialties should review CodeX oncology use cases to identify parallel use cases (e.g., for clinical trials, registry reporting, quality measurement, prior authorization, and others that cut across specialties) which could jump start their own specialty use cases. Modeling new specialty work after existing work can streamline development and ensure compatibility with prior efforts, thus improving implementer, health system, and patient experiences.
For the CodeX Program Management Office to assess the readiness of a use case to go into the CodeX Discovery Stage, the following information is requested:
- High-level version of concept - stakeholders do not need to be in complete agreement and alignment
- List of organizations and individuals committed to lead the Discovery discussions and alignment
- List of other specific organizations across stakeholder groups that could be candidates for working the concept through Discovery, Planning, and Execution
By the end of the Discovery stage, and before moving into the Planning stage, a CodeX use case project has the following attributes:
- Based on a thorough landscape analysis, the proposed approach is unique and/or advances the field
- The potential to substantially improve patient care and research within and/or across specialties
- Shares the vision of collecting patient data once and reusing the data for multiple uses
- Believed to be viable (some risk is natural and acceptable)
- Leverages clinically based FHIR Implementation Guides for automated collection and exchange of a minimal set of clinical data
- Leverages resources and open FHIR-based API-based data exchange
- Leverages government supported frameworks, including USCDI and the US Core FHIR IG.
- Leverages foundational IGs such as mCODE
- May develop supplemental data elements/IGs to address specific use case needs
- Driven by the community, with leadership from champions, representatives from all necessary stakeholders, and committed resources
- Expedites use case project work based on Agile project plans, with short phases, quick results
- Pilot workflows and systems during the Execution in real-world settings that demonstrate the “art of the possible” and can be adopted and scaled
Other considerations that MITRE has found useful to determining readiness to proceed:
- A new specialty should consider starting with one or two less ambitious use cases, based on simpler new workflows that share a minimal set of standardized data. This raises the probability of success at speed and can help a new community collaborate to become a functional team.
- Ask the right questions:
- What is driving the need for the use case? Is the need related to clinical workflow improvements, research improvements, new regulatory requirements, cost or burden reduction, and/or other factors?
- Who are the target actors? (e.g., patients, physicians, nurses, researchers, payors, regulators, and others).
- Develop use case scenarios:
- Write scenarios such that the widest group of potential participants can review and understand.
- Create example personas for roles in the proposed workflow.
- Cite clinical sources and other prior work
Use Case Planning:
From Starting Work to Providing Value in the Ecosystem
Once the community has prioritized a use case, the next step is to develop a plan. Here are considerations that CodeX documents in their Use Case Development Guidelines:
- Problem. Why are current solutions inadequate?
- Solution. What new systems and workflows are planned? Identify which roles/actors and standardized data are needed for each component of the solution.
- Impact. Where will the health ecosystem be substantially improved with the envisioned solution?
- Champions. Which organizations and people are committed to lead? Which others are needed and where does engaging them stand?
- Resources.
- Which organizations and people are committed to participate actively? Which others are needed and where does engaging them stand?
- Are there additional personnel, facilities, and/or financial resources required to succeed, that are not committed yet?
- Think about the types of resources needed over the entire project, through planning, development, implementation, testing, and adoption.
- Describe the options and plans for attaining necessary resource. It can be difficult to estimate resource needs accurately, especially in the early phases of a use case. Note that use case scope and schedule can be adjusted to the availability of resources.
Provided on this site is a Role and Resource Planning spreadsheet template (download) which can help define resource requirements and fulfillment.
- Break the plan into phases. Each phase might be 3-9 months. Phase themes, stories, workflows, objectives, and development (FHIR IGs, software) will vary.
- One pattern that is common in CodeX is a first phase starting with exchanging synthetic data for a minimal set of data elements, progressing to a phase with de-identified data, and finally a phase with real-world patient data. Later phases include strategies for measuring use case value and driving real-world adoption. Participation, realism, and results all become more ambitious with each new phase.
- Specify measures of success for each phase, out to at least a year or two.
- Note risks and other issues within the plan that require additional alignment within the use case team.