OSCAR

Health Tracker Module

Business Requirement Document

Version 2.1

Author: Alek Mirkin, Rosemary Mohammed

Document Revision History

Version	Date	Changed By	Change
1.0	06/21/2013	Rosemary Mohammed	Initial Draft – List of Business Requirement
1.1	06/24/2013	Alek Mirkin, Rosemary Mohammed	Refinement to list of Business Requirement
1.2	06/26/2013	Rosemary Mohammed	Added the Acceptance Criteria to the BRD
1.3	06/28/2013	Alek Mirkin, Rosemary Mohammed	More refinement to BR & Acceptance Criteria
1.4	07/1/2013	Alek Mirkin, Rosemary Mohammed	Updated and Refined the list of BR including OMD requirements
1.1	07/3/2013	Rosemary Mohammed	Added Project Overview, References and OMD Acceptance Criteria
1.5	07/5/2013	Rosemary Mohammed	Developed the project network diagram of the project timeline - Appendix A
1.6	07/8/2013	Alek Mirkin, Rosemary Mohammed	Refined the Project Overview & OMD Requirement
1.7	07/9/2013	Rosemary Mohammed	Final Draft – Added Document Revision History, Executive Summary, Business Model and Requirement Approach
1.8	07/10/2013	Alek Mirkin, Rosemary Mohammed	Added User Interface Solution to Business Requirement and more formatting of BRD
1.9	07/11/2013	Alek Mirkin, Rosemary Mohammed	More refinement on BRD Final Draft
2.0	07/14/2013	Alek Mirkin, Rosemary Mohammed	Updated Functional Requirement for R7 & R8
2.1	07/25/2013	Alek Mirkin, Rosemary Mohammed	Updated R7, R8 & R22

1. Overview

Introduction

The purpose of the Business Requirements Document (BRD) is to lay the foundation for the design and development of a technical solution. The BRD describes the high-level business process and also outlines the business needs that will be fulfilled by the successful completion of the project and also takes this one step further and identifies actual technical or system requirements for the solution.

The foundation for a successful project is built upon the quality and thoroughness of requirements gathering. The BRD establishes key requirements, objectives, and goals that drive all other subsequent lifecycle phases. It describes the business problem to be solved in terms of verifiable and traceable characteristics and constraints. In addition to key program level requirements, the BRD also captures operational concepts and program level interfaces. This document should be continuously referenced during the project lifecycle phases to ensure that the deliverables from the project meet the approved requirements.

Glossary

OMD – OntarioMD;

Demographic Record – A Patient’s personal data like Name, Date of Birth, Age, Sex, Health Insurance No. etc.;

Disease Flow-sheet - A form that gathers all the important data or measurements regarding a patient's disease condition

Executive Summary

Health Tracker is a module in OSCAR designed to assist Clinicians view, access and manage all the measurements and chronic disease indicators of a Patient within the same window or screen. This will meet the need of clinicians and OMD requirement for disease tracking and reporting.

The purpose of this document includes the Health Tracker Module accessibility, functionality, user interface including the bugs and design-based issues identified during user testing and the OMD specified requirements. However, some of the OMD requirements will not be configured in the first release of Health Tracker. These has been listed towards the end of the BR table. They are mainly technical ability for clinicians to change or modify a specific patient or their clinic’s treatment targets, interval, measurements and configure the view and display of patient information.

This BRD captures the screen layout of the disease flow-sheets menu bar and information deck with a list of the required disease acronyms and their meaning. It covers a detailed description of requirement that enables the provider navigate the bars and buttons within the Health Tracker screen to access patient’s demography, medication, allergies, reminders and alerts as populated from other modules in OSCAR. The measurement input entry, display and graph plotting to show measurement trend is also captured in this document to efficiently support providers in disease management and decision making.

Project Overview

The key stakeholders for the Health Tracker development & testing project are Stone Church Family Health Centre and McMaster Family Practice. The main functions that will be performed by the system is to create and provide a centralized hub for chronic disease management by clinicians with one user interface screen per patient.

Health Tracker Module in OSCAR will eliminate the need to open separate window pop up for different flow-sheets for the same patient or common patient diagnosis. The plan would be to replace the current implementation of chronic disease management listed under the Measurements section located in the eChart encounter screen.

Reference/Inputs

1	Alek Mirkin, Health Tracker BRD Consultations and contends of document	June – July 2013
2	Alek Mirkin, OSCAR Module BRD Template	June 2013
3	Rachel Aubie, BRD: Enhancement to Diabetes Module	June 2013
4	Darryl Hui, Health Tracker Training Guide	May 2013
5	Madeline Dal Molin, ORN Video script on Health Tracker	June 2013
6	Rachel Aubie, Health Tracker User Interface Improvement BRD	June 2013

2. Business model

The current OSCAR EMR used in the clinics do not have Health Tracker Module turned on in the production environment. However a Chronic Disease Management (CDM) Indicator form exist in OSCAR that allows providers access the reminder, allergies and medication information. It also allows adding and editing of measurement and comments of the patient’s CDM form.

Disease flow-sheets also exist in the current system, however the problem faced is that for a specific patient, different flow-sheet screens pop-up for each registered disease. With the Health Tracker module, providers can navigate efficiently and effectively through the menu bar of disease flow-sheets during patient’s consultation with inputs automatically populated into the note section of the eChart module.

The Diabetes and CKD flow-sheets in health tracker will better support the providers with screening, management and referral of patients than the current system. It also has a new renal information tab with “next steps” feature that will generate recommendation based on patient’s measurements and values taken and follows the Canadian Society of Nephrology (CSN) guidelines. It also has resources of web links to view clinical information for improved decision & support.

3. Requirements Definition

Approach

The requirements were obtained from meetings that were held with key stakeholders in McMaster including the clinicians and their service provider.

The OSCAR EMR Project Operation Manager then met with the Business Analyst and Quality Analyst teams assigning Alek Mirkin as project lead to collate all health tracker related documentations and develop a standard BRD, Use and Test cases documentation for Health Tracker Module of OSCAR EMR. Rosemary Mohammed and Darryl Hui present in the meeting were assigned to his team.

The project team then met with Madeline Dal Molin and Rachel Aubie to discuss the scope to ensure there was no overlapping in the BRD for Health Tracker Module and the BRD of the individual flow-sheets within Health Tracker Module. The user interface and bug fixes requirement were also communicated in this meeting and incorporated into this document.

Business Requirements

The business requirements listed below will enhance the usability and effective management of chronic diseases within OSCAR EMR via the Health Tracker Module. The Business Requirement ID i.e. R7, R23 in red color are requirements that do not currently exist but must be incorporated in future release.

ID	Priority	Requirements Statement	Acceptance Criteria
Accessibility
R1		Access Health Tracker module from the eChart module	Health Tracker module is opened from eChart encounter environment under the measurement section
R1.1		Access the disease flow-sheets from Health Tracker main screen	View disease flow-sheet (components) from the top menu bar on the Health Tracker module. Color Blue indicates the disease flow-sheet currently selected/active. Navigation bar split into two sections a) Registered disease are presented: Top menu from left to right before the rule bar and optional button “More”. b) Non-Registered disease are presented: On the second line navigation tab. c) When the “More” button is selected and a warning message appears that means, patient is not registered for the disease with an options to add disease code (this moves the flow-sheet from non-registered i.e. left-side of the rule bar to registered i.e. right-side of the rule bar) or make entry via the disease register. d) A disease flow-sheet opens a listing of measurements with data from existing measurements in condition when a menu tab is selected e) A disease flow-sheet opens a listing of measurements for new data input when a menu tab is selected
User Interface
R2		Demographic information of the patient appear on the top main bar of the Health Tracker	Patient’s demographic record presents a) Last name, First name b) Date of Birth (YYYY-MM-DD) & Age c) Sex (M/F) d) Health Information Number (HIN)
R3		Navigation bar of flow-sheets accessible from main menu of Health Tracker	Presented patient`s actual measurement in the disease flow-sheet selected from the menu tab. a) “INRFLOW” tab opens the International Normalised Ratio flow-sheet b) “HYPERTENSION” tab opens Hypertension flow-sheet c) “DIAB” opens the Diabetics flow-sheet d) “ASTH” opens the Asthma flow-sheet e) “M8” opens the Chronic Obstructive Pulmonary flow-sheet f) “CHF” opens the Chronic Heart Failure flow-sheet g) “CKD” opens the Chronic Kidney Disease flow-sheet h) “HIV” opens the Human Immunodeficiency Virus flow-sheet
R4		Under the navigation button of the flow-sheets have indicators of active disease with options to expand all or collapse all and add overdue (DIAB and CKD flow-sheets only has “Add renal” indicator)	Fields are organized according to layout requirements and clickable buttons a) “Expand All” button expanded all the measurement to open the value and comment fields for the new data measured to be added. b) The button label changed from “Expand All” into “Collapse All” immediately clicked. When “Collapse All” is selected, it collapses all the opened entry fields. c) “Add Overdue” expanded all the OVERDUE measurements ONLY (these appear in RED text) to open the value and comment fields for the new data measured to be added. When the “Add Overdue” button is re-selected it collapses the Overdue opened entry fields.
			d) “Add Renal” expanded the Renal measurements only which are Alb, eGFR & ACE-I to open their value and comment fields for the new renal data measured to be added. When the “Add Renal” button is re-selected it collapses the opened renal data entry fields.
R5		A list of measurements for the selected disease flow-sheet to allow entry of new values, comments and graphical display of data trend	When a disease flow-sheet is opened, existing data and charts appears under the appropriate fields on screen, fields are organized according to layout requirements
R6		Information deck available from the Health Tracker screen and allow access to Medication, Allergies, Reminder and Warning. (Renal for DIAB and CKD flow-sheets)	a) Patient`s existing data appears in the appropriate fields on the screen when the respective functions are selected. b) The Information deck remains static as user scrolls down the screen.
Functionality
R7		Ability to remain on main screen of health tracker after an error message appears – Do Not Exist	Functionality allows warning message to appear on the same Health Tracker screen
R8		Navigate to Top Menu button present at the bottom of the screen to scroll to the top main menu screen of health tracker – Exist, needs improvement	Navigate button at the bottom of the screen appear, to get users back to top menu
R9		Function of Health Tracker allow edit, add and delete of measurement values and comments	Function present correct information and delete function erase selected data
R10		Analyse inputted measurement to determine if the level.	Level presented on screen from “LOW” to “HIGH” Level
R11		Function of calendar control data input	Record and present the measurement date on the screen
R12		Can request data by selecting on Calendar, required date	Calendar selected date is presented sorted on screen
R13		For ACE-I measurement, must select a radial button option (Yes, No or N/A) for comment added to save data	Comment is presented when a radial button is selected
R14		Graph tool for visual display of measurement trend	Displays a graph measurements with more than one data input
R15		Measurement data entered in Health Tracker get populated on the note section of eChart module	Presented the measurement on note section
R16		Provide magnified view of graph for easy analyses	Presented a magnified view of the graph on selecting the graph icon
R17		Navigate through an information deck to display medications, allergies and reminders recorded in the health tracker from eChart module	Populate existing patient data to appear under the appropriate deck on screen a) Medication - access list of medication prescribed to patient b) Allergies – access list of patient’s allergies
R18		Function of Renal being added to the “DIAB” and “CKD” flow sheets with a Next Steps lists of any renal procedural requirements for the specified patient	Renal function is available as next steps appears when “DIAB” or “CKD” flow sheets are selected
R19		Provide resources containing relevant information and links to Renal procedures under the Renal deck	Renal procedures open when link is selected
R20		Provide “Next Step” option	Presented some generated recommendations based on if ACE-I OR ARB has been taken and values of eEGFR and ACR following the Canadian Society of Nephrology (CSN) guidelines
R21		Provide link to access MyOSCAR for registered patients	Patients must be registered in MyOSCAR to have the MyOSCAR link in the top menu
OMD Business Requirements
R22		Adding visual indicator that the page is loading (i.e. when switching between flow-sheets)	“Loading…” message appears integrated within the top menu bar of the flowsheet selected
R23		Ability to change targets/intervals for a single patient and overall for a provider/clinic – Do Not Exist	Health Tracker section in the Admin Module allow changes to targets/intervals for patients and the clinic
R24		Ability to change which measurements/ preventions appear on the flow-sheet for a single patient and overall for a provider/clinic – Do Not Exist	Health Tracker section in the Admin Module allow changes to measurements that appears on the flow-sheet
R25		Ability to print flow-sheets – Do Not Exist	Print option allows the preview and print of selected flow-sheet. – Exist in current version
R26		Ability to view entries from a specified date-range selection input by a user – Do Not Exist	Health Tracker section in the Report Module allow report of specified date range to be viewed
R27		Ability to view X amount of entries set by the provider (i.e. only show the last 3) – Do Not Exist	Presents a view of the amount of entries set by the provider for preview or printing – Exist in current version
R28		Ability to select which elements display (for printing) – Do Not Exist	Displays and Prints only the measurement value for checked or selected elements – Exist in current version

OSCAR Business Support

OSCAR Health Tracker Module - BRD