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(New page: Back to Conceptual BF Document Eve Everywoman, a 27-year-old female, as an inpatient at Good Health Hospital and is attended by Dr. Patricia Primary. Dr. Primary checked Eve into t...)
 
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Back to [[Conceptual BF Document]]
 
Back to [[Conceptual BF Document]]
  
  Eve Everywoman, a 27-year-old female, as an inpatient at Good Health Hospital and is
+
  A 24-year old female, Eve Everywoman, presents at Community Urgent Care with
  attended by Dr. Patricia Primary. Dr. Primary checked Eve into the hospital yesterday
+
  severe headaches, numbness and tingling. Dr. Harold Hippocrates examines the
  when Eve lost consciousness during a routine exam in the Doctor’s office.  Eve reports
+
  patient and learns that she is employed in the Manufacturing Industry where
  a history of Anemia and recent, excessive tiredness.  Dr. Primary enters a request to
+
  she is exposed to Lead based products.  Dr Hippocrates wants to rule out Lead
check the iron levels in Eve’s blood into her care system.  Dr. Primary’s care system
+
  poisoning.
then sends the test requests to the Good Health Hospital’s Laboratory serviceA few
 
minutes later, Dr. Primary determines to add a CBC (twice a day for the next 3 days) to
 
  the prior ordered iron level test.  Dr. Primary updates the request and Dr. Primary’s
 
care system send the updated request to the lab system.
 
 
   
 
   
  The laboratory service collects the appropriate specimens (2) on the first day and
+
Dr. Harold Hippocrates places the order for a STAT Lead Level test. The order
  enters the results into the lab which communicates them to Dr. Primary’s care system.
+
fulfillment request is sent from the Clinical Information System to the
   
+
  Laboratory.
  Dr. Primary determines on the second day, to hold all future testing and collection of
+
 
  blood for the CBC tests.
+
  The laboratory system receives the order fulfillment request and determines that
 +
  it meets its requirements. It immediately responds with a promise to the clinical
 +
  information system.
 
   
 
   
  Dr. Primary determines to discharge Eve on the third day (since the original CBC order)
+
  Eve Everywoman goes to the laboratory one week later.  Rita Receptionist finds the
  so the order is canceled (aborted).
+
order for a Lead Level.  The system assigns the accession number and prints the
==Business Process==
+
  specimen label.  Boris Bleeder collects the specimen in a tan top (EDTA) tube.
The business processes shown in the storyboard above are meant to show the primary business triggers for information exchanges between care sites and laboratory testing services.
+
He enters the collection date/time (0700 on December 24, 2003) and specimen type
==Storyboard Objects==
+
into the laboratory system.  He delivers the specimen to be processed.  The
This storyboard illustrates additional request object states:
+
laboratory system sends a status message indicating “Specimen in Lab” process
[[Image:ClinicalRequestSTM.PNG]]
+
step of its promise to the clinical information system.
 +
The clinical information system receives the promise status message from the
 +
laboratory system.  It updates the process step of its order to “Specimen in
 +
Lab” and responds to the laboratory system with an order status response message.
  
Though each of the two new states is relatively simple in concept, they add a few more state transitions to/from those states. Note that all request states are just that, requestedThere are a number of reasons for a place to request cancellation of an order. However, the laboratory does not always honor the request to cancel the request; whether it does so depends on a combination of whether the specimen has already been collected, the expense of the testing process, and how the laboratory is paid.
+
Bill Beaker performs the test and determines that the level is within OSHA
 +
guidelines.  He releases them for final reporting and faxes the report to
 +
Dr. Hippocrates in accordance with STAT protocol.
 +
  Chemistry Observation/Test Name: Lead Level
 +
Result Value/Flag: 30 ug/dL
 +
Normal Range: 40 ug/dL
 +
  Date/Time of Observation: December 24, 2003  0900
  
 +
The laboratory system sends the final result to the clinical information system.
 +
The clinical information system determines that the result meets its requirements
 +
for confirming it.  It sends a message to the laboratory system indicating that
 +
it has confirmed the final result.  The clinical information system sets its
 +
order status to complete.
 +
Dr Hippocrates reviews the result on December 27, 2003 and questions the result
 +
because it does not appear to correlate with his diagnosis.  He calls the
 +
laboratory and asks for the test to be performed again on the initial specimen.
  
Note that the repeating request is actually broken into individual requests, each of which is processed separately and each go through the same request/fulfillment pattern (therefore the result object state machine doesn’t change as a function of these request object states).
+
Corrected Result
 +
Bill Beaker re-runs the Lead Level on the initial specimen.  The result is 110 ug/dL.
 +
  Just to confirm, he performs QA on the instrument. He analyzes the specimen again
 +
due to the large discrepancy between the initial reported result and the new result.
 +
  The result this time is 112 ug/dL.  He averages the two results and reports out
 +
111 ug/dL.  He reviews the result and reports it out as corrected.
 +
Chemistry Observation/Test Name: Lead Level
 +
Result Value/Flag: 111 HH
 +
Normal Range: 40 ug/dL
 +
Date/Time of Observation: December 27, 2003  1200
 +
 +
He notifies Dr. Stan Slide, Laboratory Pathologist of the discrepancy.  The
 +
laboratory system sends the corrected result to the clinical information system.
 +
 +
The clinical information system determines that the corrected result meet its
 +
requirements for confirming it.  It sends a message to the laboratory system
 +
indicating that it has confirmed the corrected result. The clinical information
 +
system updates its order status to reflect the corrected order completion date.
 +
 +
Bill Beaker initiates the panic value protocol which includes releasing the
 +
corrected result with note attached indicating that Dr. Hippocrates was notified
 +
on December 27, 2003 at 1200.  The information is sent to the appropriate
 +
regulatory agencies governing Lead testing.
 +
==Business Process==
 +
This business process doesn’t introduce new objects, just new states for those objects and a few new transitions.  The new states are ‘corrected’ for one or more Reporting objects and a new Fulfillment status ‘specimen received’. Diagrams will follow with these two additions, later in this document along with succeeding additions.
  
 
Back to [[Conceptual BF Document#Storyboards and Discussion]]
 
Back to [[Conceptual BF Document#Storyboards and Discussion]]

Revision as of 22:26, 16 September 2010

Back to Conceptual BF Document

A 24-year old female, Eve Everywoman, presents at Community Urgent Care with
severe headaches, numbness and tingling.  Dr. Harold Hippocrates examines the
patient and learns that she is employed in the Manufacturing Industry where
she is exposed to Lead based products.  Dr Hippocrates wants to rule out Lead
poisoning.

Dr. Harold Hippocrates places the order for a STAT Lead Level test.  The order
fulfillment request is sent from the Clinical Information System to the
Laboratory.
The laboratory system receives the order fulfillment request and determines that
it meets its requirements.  It immediately responds with a promise to the clinical
information system.

Eve Everywoman goes to the laboratory one week later.  Rita Receptionist finds the
order for a Lead Level.  The system assigns the accession number and prints the
specimen label.  Boris Bleeder collects the specimen in a tan top (EDTA) tube.
He enters the collection date/time (0700 on December 24, 2003) and specimen type
into the laboratory system.  He delivers the specimen to be processed.  The
laboratory system sends a status message indicating “Specimen in Lab” process
step of its promise to the clinical information system.
The clinical information system receives the promise status message from the
laboratory system.  It updates the process step of its order to “Specimen in
Lab” and responds to the laboratory system with an order status response message.
Bill Beaker performs the test and determines that the level is within OSHA
guidelines.   He releases them for final reporting and faxes the report to
Dr. Hippocrates in accordance with STAT protocol.
Chemistry Observation/Test Name: Lead Level 
Result Value/Flag: 30 ug/dL
Normal Range: 40 ug/dL
Date/Time of Observation: December 24, 2003  0900
The laboratory system sends the final result to the clinical information system.
The clinical information system determines that the result meets its requirements
for confirming it.  It sends a message to the laboratory system indicating that
it has confirmed the final result.  The clinical information system sets its
order status to complete.
Dr Hippocrates reviews the result on December 27, 2003 and questions the result
because it does not appear to correlate with his diagnosis.  He calls the
laboratory and asks for the test to be performed again on the initial specimen.
Corrected Result
Bill Beaker re-runs the Lead Level on the initial specimen.  The result is 110 ug/dL.
 Just to confirm, he performs QA on the instrument. He analyzes the specimen again
due to the large discrepancy between the initial reported result and the new result.
 The result this time is 112 ug/dL.  He averages the two results and reports out
111 ug/dL.  He reviews the result and reports it out as corrected.
Chemistry Observation/Test Name: Lead Level 
Result Value/Flag: 111 HH
Normal Range: 40 ug/dL
Date/Time of Observation: December 27, 2003  1200

He notifies Dr. Stan Slide, Laboratory Pathologist of the discrepancy.  The
laboratory system sends the corrected result to the clinical information system.

The clinical information system determines that the corrected result meet its
requirements for confirming it.  It sends a message to the laboratory system
indicating that it has confirmed the corrected result. The clinical information
system updates its order status to reflect the corrected order completion date.

Bill Beaker initiates the panic value protocol which includes releasing the
corrected result with note attached indicating that Dr. Hippocrates was notified
on December 27, 2003 at 1200.  The information is sent to the appropriate
regulatory agencies governing Lead testing.

Business Process

This business process doesn’t introduce new objects, just new states for those objects and a few new transitions. The new states are ‘corrected’ for one or more Reporting objects and a new Fulfillment status ‘specimen received’. Diagrams will follow with these two additions, later in this document along with succeeding additions.

Back to Conceptual BF Document#Storyboards and Discussion