LRI+-+Use+Case+Diagram+&+Scenario+SWG+Working+Page

include component="page" wikiName="siframework" page="LRI Header" **Activity Diagram**

This version of the activity diagram was an result of the 4/13 SWG meeting.

Base Flow
//Previous Versions of Activity Diagrams As a Result of SWG Meetings//
 * **Step #** || **Actor** || **Role** || **Event/Description** || **Inputs** || **Outputs** ||
 * 1 || Laboratory || Results Sender || Laboratory Information System Sends Releasable Laboratory Test Results || Test Results Report || Sent Test Results Report ||
 * 2 || Provider || Results Receiver, Order Placer || Ambulatory Electronic Health Record System Receives Test Results and, if available, associates with a patient and lab order. || Sent Test Results Report || Received Test Results Report and Test Results Associated with Patient Record & if available the Order ||
 * 3 || Provider || Results Receiver, Order Placer || Accesses & Views Test Results in Ambulatory Electronic Health Record System || Received Test Results Report and Test Results Associated with Patient Record & if available the Order || Displayed Test Results ||
 * **Version #** || **File Name** ||
 * .01 || [|ONC_LRI_ActivityDiagramScenario1_WithAltFlows_DRAFT_v01.jpg] ||
 * .02 || [|ONC_LRI_ActivityDiagramScenario1_WithAltFlows_DRAFT_v02.jpg] ||
 * .03 || [|ONC_LRI_ActivityDiagramScenario1_WithAltFlows_DRAFT_v03.jpg] ||
 * .04 || [|ONC_LRI_ActivityDiagramScenario1_WithAltFlows_DRAFT_v04.jpg] ||
 * .05 || [|ONC_LRI_ActivityDiagramScenario1_WithAltFlows_DRAFT_v05.jpg] ||
 * .06 || [|ONC_LRI_ActivityDiagramScenario1_WithAltFlows_DRAFT_v06.jpg] ||
 * .07 || [|ONC_LRI_ActivityDiagramScenario1_DRAFT_v07.jpg] ||

Revised Actors & Roles Table
This table is a result of the 4/13 SWG meeting.
 * **Actor** || **System** || **Role(s)** ||
 * Provider || Electronic Health Record System || Order Placer, Results Receiver ||
 * Laboratory || Laboratory Information System || Results Sender, ||

**The italicized text below is from the 4/6 SWG meeting. The proposed changes outlined below are no longer valid as of April 11, 2011.**

//The “Lab Results Interface Use Case Diagrams & Scenario” sub-workgroup stumbled across an interesting challenge during their 2011-04-06 conference call. Here are the pieces of the puzzle://
 * 1) //Assumption: The sub-workgroup’s charge is that the process of placing a Laboratory Order is out-of-scope. That is, from the laboratory’s perspective, we (the lab) simply receive a request for us to perform some kind of lab test on a specimen. We don’t care how the Lab Order was created.//
 * 2) //After receiving a request to perform a lab test, we fulfill that request by performing a lab test.//
 * 3) //However, sometimes trouble occurs and we must perform the test again. It seems that this action (namely, to perform the test again) can arise from three different “requestors”, namely://
 * //The **lab** -- when we notice something that is troublesome and decide to re-perform the test so as to correct the results (based on the original Order).//
 * //The **lab** -- when we notice something that is troublesome and decide to re-perform the test so as to amend the results (based on the original Order)//
 * //The **"Order Placer"** -- when the physician who ordered the test notices something that is troublesome and requests that the lab repeat the lab test (based on the original Order).//

//Thus, it seems that there are four (legitimate, but distinct) modes for beginning a lab test://
 * 1) //Perform,//
 * 2) //Correct,//
 * 3) //Amend, or//
 * 4) //Repeat//

//If this is true, then each of these four modes needs to be captured in our flow diagram. Consequently, each of these four modes needs to be characterized in terms of who initiates each workflow.//

//Challenges of using “Order Placer” as the sole moniker//
 * //Does the Ordering Physician initiate all four workflows? No. The lab (itself) initiates some of those workflows.//
 * //Additionally, from the lab’s perspective, we (the lab) perform “tests”; we don’t perform “orders”.//
 * //As a result, if we attempt to use the moniker “Order Placer” to name the actor who requests lab tests, then we misrepresent the fact that the lab can also play the role as a legitimate actor who can request lab tests.//

//Therefore, the sub-workgroup wonders whether it might be better (from the lab’s perspective) to name the actor who can request lab tests as “Test Requestor” (instead of “Order Placer”).//

//Note: If this moniker (namely, “Test Requestor”) is chosen, the sub-workgroup believes that the other nuances of complex lab workflow will not be adversely affected. That is, the Preliminary Testing workflow and the Reflex Testing workflow will not be adversely affected by naming the instigating actor “Test Requestor” instead of “Order Placer”.//

//Does this seem reasonable? If the SWG comes to agreement the actors and roles table would be updated as follows;//
 * //Actor// || //System// || //Role(s)// ||
 * //Provider// || //Electronic Health Record System// || //Test Requester (previously Order Placer), Results Receiver// ||
 * //Laboratory// || //Laboratory Information System// || //Test Receiver (previously Order Receiver), Test Fulfiller (previously Order Fulfiller), Results Sender// ||

Pre-Conditions

 * An order has been generated by an Ordering Provider for the original or repeated laboratory tests to be produced.
 * The Laboratory receives an order (electronic, paper, etc.) or a request to re-run (repeat) a test, or determines a need to re-run a test for possible correction, or determines that reflex testing is required or to amend a test result based on erroneous information.
 * Laboratory has entered manually or through interface pertinent (or corrected) data from an order into the Laboratory Information System.
 * Laboratory has received the order-related specimen.
 * Laboratory has entered pertinent data from/about the specimen into the Laboratory Information System
 * Laboratory has performed the ordered tests on received specimens and/or incorporated calculated and reference data to produce the results referenced.
 * The lab result message contains both the appropriate patient information and the originating order information to associate the lab results to the correct patient and original order.
 * Laboratory information system is capable of and ready to send lab results electronically and in standardized structured format. (SYSTEM REQUIREMENT)
 * EHR system is in place and capable of receiving lab results electronically and in standardized structured format. (SYSTEM REQUIREMENT?)
 * The laboratory result is verified ready for release

Triggers
Laboratory has incorporated calculated and reference data to produce the results referenced. || When incorrect information, such as age or gender, is provided to the Laboratory which was used to calculate normal ranges, abnormal flags or calculations and the test result itself is a correct value, an amended result based on the correct information is issued || The laboratory result is verified ready for release.
 * **Triggering Event** || **Specific Pre-Conditions** || **Description** ||
 * A preliminary test result is verified and ready for release || Laboratory has performed the ordered tests on received specimens to produce the results referenced. ||  ||
 * A final test result is verified and ready for release || Laboratory has performed the ordered tests on received specimens to produce the results referenced. ||  ||
 * A corrected test result is verified and ready for release || Laboratory has performed the ordered tests on received specimens to produce the results referenced. || The Laboratory has produced a corrected result that replaces a final result ||
 * An amended test result is verified and read for release || Laboratory has entered manually or through interface or corrected data from an order into the Laboratory Information System.

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