Consolidated User Story 1: Chronic Diseases (cancer, occupational health)

1. Consolidated User Story 1: Chronic Diseases (cancer, occupational health) User Story Names: • Chronic Diseases, Outpatient Flow • Patient, Provider/Physician, Laboratory, PH agency • 1. Patient comes to Physician with symptoms of a disease or for a check up • 2. Physician provides clinical examination and assesses medical history. • 3. Physician orders lab (clinical or pathology) and any diagnostic tests. Office staff takes samples and sends them to Laboratory. Any diagnostic tests are performed. • Laboratory performs ordered tests on received specimens. • TRIGGER: reportable condition identified/diagnosed • 5. Laboratory send results to Physician and PH agency for reportable conditions • Physician re-examines clinical findings/diagnostic results and lab results • TRIGGER: reportable condition identified/diagnosed • 7. Physician sends report to a PH agency for reportable conditions • 8. Electronic report validated by PH agency/information system • 9. Electronic confirmation/acknowledgement was sent from PH agency to Provider Actors: Flow of Events: Pre-condition EHR System Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type Varies, prefer real-time

2. Consolidated User Story 2: Chronic Diseases (Quality, NCHS, NE CVD) User Story Names: Chronic Diseases Patient, Provider/specific healthcare facility, PH agency 1. Patient comes to a specific healthcare facility TRIGGER: Patient admitted to specific healthcare facility 2. Physician orders tests, counsels and or treats patient 3. Providers/data entry clerks add lab results to the orders, medications, imaging results, history of some of these results, based on the diagnosis code TRIGGER: Patient is discharged from specific healthcare facility 4. (a) (from specific healthcare facility) and preferred Billing personnel sends discharge claim record to PHAgency or (b) (from clearing house) 1. Billing personnel sends discharge claim record to clearing house 2. Clearing House personnel sends discharge claim records to PHAgency 5. Electronic message was validated by PH agency/information system 6. Electronic confirmation/acknowledgementwas sent from PH agency to Provider/facility Actors: Flow of Events: Pre-condition EHR System Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type Admit – 5 days after admit and 24 hours after billing code Discharge – preferred quarterly (accepted monthly or 24 hours)

3. Consolidated User Story 3: Chronic Diseases (MI genetic counseling) User Story Names: • Chronic Diseases • Patient, Provider/specific healthcare facility, PH agency • Patient comes to a genetic counselor • Patient undergoes genetic counseling for BRCA gene, Lynch syndrome, or for cardiac death in the young • Counselor may request physician to order genetic testing • Counselor may receive genetic test results • Counselor may have follow up visit with patient to discuss results • TRIGGER: Counseling process is completed • 6. Counselor send report to PHAgency • 7. Electronic message was validated by PH agency/information system • 8. Electronic confirmation/acknowledgementwas sent from PH agency to Provider/facility Actors: Flow of Events: Pre-condition EHR System Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type varies