Table 2-A (2.1)— General Display Requirements (1)

The following table contains general display functional requirements:

ID

Description

Scope

1.1

Divide display into three parts: Header, Body, and Footer.

• Header provides Sirona banner and tab menu.

• Navigation tabs for this area of Sirona include

Log In provides interface for requesting account, requesting new password, and logging into created account.

About provides introductory information on Sirona applications.

Medical News provides access to current news on health and wellness topics.

• Body provides area for user input of information and application activity. Body's center pane title changes according to option selected in navigation menu.

• Footer provides for Sirona site navigation.

• Navigation Footer provides access to information displayed in navigation tabs, as well as Support/Help, Legal/Security, and Contact Us.

1.2

Provide for full- screen enlargement and subsequent reduction.

• Full Screen bar on upper right of screen provides varying screen sizes.

1.3

Provide for capability of printing information.

• Print icon upper right of body of screen provides access to this functionality.

1.4

Provide current date.

• Appears in upper right corner of screen.

1.5

Provide for means of logging out.

• Becomes operational after user has logged in.

• Log Out button appears in upper right corner of screen.

1.6

Provide account name.

• Name of logged-in user appears in upper right corner of screen.

1.7

Provide search function.

• Appears below date and account name in header.

• Search box is identified by magnifying glass icon.

• Appears only at General Education level, before user has logged in.

• Search request can produce relevant supporting pages, such as searching on word patient. Result gives list of links containing any top level pages (ones listed at bottom as links) with patient as relevant topic or tag for that page.

1.8

Provide visual indication when a task is in progress.

Sun-shaped pulsating wait icon resides on upper left of screen, to left of component name, such as Inbox or Diagnostic Guide.

Table 2-A (2.1)— General Display Requirements (2)

ID

Description

Scope

1.9

Provide means of scrolling through displays of data.

• Horizontal slider at bottom of center pane provides means of navigating data in Medical Records options that require it, such as Immunizations or Results.

• Slider function provides a 'mouse-over' text box to indicate to what location user is scrolling.

1.10

Provide different color schemes for areas of product functionality.

• Templates are used to define major Sirona modules, such as PMR and EMR. Widgets define modules governed by templates, such as Patient Portal and Provider Portal.

• Color of bright sky blue defines Sirona Home, Log In, Site Navigation and Patient Portal area, being the major educational functionality for the patient.

• Color of bright aqua defines Provider Portal, including Desktop, EMR, Resource Capacity Simulator, and CDS Workbench interfaces. These applications are available only to authenticated provider users.

Table 2-B (2.2.4) — Log In Tab Requirements

The following table provides the functional requirements for account access:

ID

Description

Scope

1.9

Log in by specifying user name and password.

• All users, whether provider or patient, log in on same Home Log In page.

• Log In button is provided for users. Once users specify user name

and password, they can either click the Log In button or press Return.

1.10

Log in using Common

Access Card (CAC).

• Provide account access using DoD CAC authentication.

1.11

Reset password and e-mail temporary system-generated password to user.

• Request New Password on the Home Log In page provides this functionality.

• Users must enter their full email address used to sign into their account, and click Submit.

1.12

Request online access to specified application, Patient Portal or Provider Portal.

• Users enter first and last name, email address, username, and policy number.

• Policy number is ID associated with chosen health care facility.

• Request Account button on Home Log In Page allows user to send request to medical facility.

1.13

Add user accounts to system, specifying primary care manager (PCM) for each user.

• Once user sends request, System Administrator schedules time to meet with user in person and then manually creates account.

• To ensure HIPAA security and privacy regulations, user must appear in person to complete enrollment process.

• When account is created, System Administrator notifies user of completion of account creation at user's personal email address.

1.14

Grant appropriate ac- cess level to each user.

• System Administrator specifies roles and access level at time of manual account creation.

Table 2-C (2.5.10) — Navigation Footer Requirements

The following table provides the functional requirements for the display and content of the Feature Tour and General Layer functions:

ID

Description

Scope

1.15

Provide general information about Sirona applications and their functionality.

• About tab provides general application information.

1.16

Provide health management informa- tion and medical news on Home page.

• Medical News tab provides various health care-related topics.

1.17

Provide access to online help, help desk contact phone numbers, and user feedback interface.

• Support/Help provides FAQs, help, and feedback options.

• Preferences capability allows user to configure portal experience.

1.18

Provide access to legal and security information.

• This data includes Terms of Service, Copyright and Privacy policies, and security information.

1.19

Access and display public contact information.

• Contact Us option provides this capability.

• Contains public contact information for medical facility's public facilitators, patient representatives, legal department, and portal administrative help and support teams, including street addresses, phone numbers, and email addresses.

Table 3-A (3.1.1) — Patient Application Menu Requirements

The following table describes the functional requirements for displaying Application Menu options in the left-hand application navigation area of the portal user interface:

ID

Description

Scope

1.20

Provide application navigation menu that allows user to choose options.

• Organizer provides options to compose email and display and manage messages in Inbox, Sent, Drafts, and Archive folders via Messages function.

• Archive allows users to view messages that they have archived. From this location, users can un-archive (send message back to inbox).

• Messages includes option to request and receive health care summaries from outside organizations via Nationwide Health Information Network button.

• Additional Organizer options provide for scheduling appointments, viewing contacts in address book, and displaying personal information.

• Medical Records provides options to access specific areas of patient's medical record.

1.21

Collapse or expand

Application Menu.

• Toggle triangle to left of name.

Table 3-B (3.2.4.1) — Message Display Requirements (1)

The following tables describe the functional requirements for the display of messages and Messages Inbox functions.

ID

Description

Scope

1.22

Show all message types, or categories.

• Default view shows all messages and their types (such as Email, Alert, and NwHIN Document).

1.23

Provide date that mes- sage was sent.

• Date column provides this information.

1.24

Provide time that mes- sage was sent.

• Time column provides this information.

1.25

Provide subject of message.

• Message column provides this information.

1.26

Provide name of sender of message.

• From column provides this information.

• Name can be person or system.

• In case of email message, sender's address is not shown.

1.27

Provide type of message.

• Differentiates message sent.

• Types include Alert, Task, Mail, and NHIN Document.

1.28

Provide status information.

• Message in bold is unread.

• Message in normal font is read.

• Highlighted message indicates current message shown in Message

Display panel.

• Star or asterisk indicates important. User specifies importance in column labeled with star.

• For message of Message type, status is read/unread.

1.29

Provide priority of message.

• Priority column provides this information.

• Values include Normal, HIGH, and Critical.

1.30

Provide task progress information.

• Task column provides this information.

• Dynamically shows progress toward message task completion.

• For any message without associated task request, column displays no task progress percentage.

1.31

Provide panel for displaying message.

• Message Display panel shows text of actual message.

1.32

Sort on any column.

• User can sort using Microsoft Windows functions. Inbox messages have priority value for sorting.

• By default, inbox messages are sorted by date in reverse chronological order.

Table 3-B (3.2.4.1) — Message Display Requirements (2)

ID

Description

Scope

1.33

Display messages according to selected filter category.

• All Messages category drop-down menu provides access to function.

• Filtering locates all message types that fit selected categories.

• Unified Collaboration Portal supports complex filtering of multiple categories at one time.

• Category function is available at all times.

1.34

Display unread messages in bold.

• Read messages display in normal type.

1.36

Control display of functions.

• When patient first opens Messages Inbox, first message is selected.

• Type of message selected determines what functions are available to user.

• When user is in compose mode, composition toolbar, and Send, Save

Draft, Discard, and Print functions are available.

• Attach is out of scope for this version of Sirona.

1.55

Display locations where messages reside.

• Location drop-down menu provides this functionality.

• Location drop-down menu is right of navigation option title, such as

Messages.

• Locations include Inbox, Sent, Drafts, and Archive.

1.59

Display warning popup when user tries to archive or delete message with incomplete tasks.

• Archiving or deletion can be completed on user request.

1.63

Provide display refresh function.

• Reload icon in toolbar above Messages lists allows user to reload messages to determine whether new messages have been received.

Table 3-C (3.2.4.2) — Requirements for Actions User Performs on Message (1)

The following table describes the functional requirements for actions that the user can perform on messages:

ID

Description

Scope

1.38

Compose mail message.

• Compose button provides functionality that is available at all times.

• Includes extensive composition toolbar that allows user to specify font, type size, character formatting such as italics, and margin justification, among other functions.

• Trashcan icon on composition toolbar allows user to clear all text in message.

1.39

Search for text in any message.

• Out of scope for this version of Sirona.

1.40

Delete draft message.

• Discard button provides this functionality.

• Once user deletes draft, draft cannot be retrieved.

• Delete function is allowed only from Drafts location.

• No Trash location is available in Patient Portal.

1.41

Forward message.

• Users can forward only Email and NwHIN Document messages.

• Users can forward only to people listed in their address book.

• Forward button is available only when user has selected message to forward.

1.42

Reply to message.

• Patients can reply only to Email messages.

• Reply, Reply All, and Forward options are available in Reply drop- down menu only when Email message has been selected for display.

1.43

Print any message in Inbox.

• Out of scope for this version of Sirona.

1.44

Specify action for

Alert messages.

• Rule metadata determines possible Alert actions.

• Options include Accept, Reject, Hold, Modify, Escalate, and Discard.

1.47

Archive messages.

• Archive button provides access to this function.

• Unarchive option in task drop-down button moves file from Archive to

Inbox.

1.48

Set message as read.

• If user clicks message and maintains focus on message for defined number of seconds or more, system marks message as read (normal type).

Table 3-C — Requirements for Actions User Performs on Message (2)

ID

Description

Scope

1.49

Save draft of message.

• When user performs no edit functions in the compose pane for more than configured number of seconds, system saves draft.

1.54

Allow inclusion of new results to view.

• Access to results may be through link that takes patient to Results page.

1.57

Archive completed task automatically.

• If message contains multiple tasks, archive only after all tasks complete.

• Include archiving action with account registration disclosure message.

1.58

Set message to unread status.

• Out of scope for this version of Sirona.

Table 3-D (3.2.4.3) — Alert Message Requirements

The following table describes the functional requirements for tasks related to alert messages and other alert functions, either performed by the user or by Sirona:

ID

Description

Scope

1.37

Display alert action labels on alert buttons when alert includes action.

• Rule author defines labels independently.

1.44

Specify action against alert messages.

• Rule metadata determines possible alert actions: Accept, Reject, Hold, Modify, Escalate, and Discard.

• Above options are dynamic and controlled by DSA rules once alert is retrieved and is in body of message detail.

1.45

Discard alert message.

• Patient chooses to ignore recommendation.

• Unified Collaboration Portal sends Discard notice to sender of Alert message.

1.46

Reject alert message.

• User reads message and chooses to reject recommendation.

• Unified Collaboration Portal sends Reject notice to sender of Alert message.

1.50

Display alert messages from CDS system.

• Alert messages notify patient of impending required/suggested tasks.

• Alert message can be for information only (FYI), for example, news about trial.

1.51

Associate task(s) with alert message.

• Alert message may have associated task that patient is recommended to perform.

• Examples: Recommendation to get prostate-specific antigen (PSA)

baseline or mammogram.

1.52

Allow inclusion of sur- vey or questionnaire.

• Link can provide access to survey or questionnaire. Once clicked, link takes patient to embedded survey page.

• Can also be embedded Tohu Drools survey.

1.53

Allow request to accept new appointment with health care provider.

• If accepted, entry is inserted into calendar; no redirection to calendar page needed.

• If rejected, no entry.

• If modified, patient is redirected to calendar and allowed to select different date on calendar. If patient selects new open appointment from calendar, alert task is updated appropriately.

1.56

Display alert message and any embedded tasks.

• Display Message Display panel when user selects alert.

Table 3-E (3.2.4.4) Document Request and Retrieval Requirements

The following table describes the functional requirements for the request and retrieval of NwHIN and other documents:

ID

Description

Scope

1.35

Request NwHIN

documents on demand.

• User clicks Request NwHIN Documents button to request all available NwHIN documents at any time. Button displays Processing Request while request is sent and processed.

• Sirona broadcasts request to all NwHIN-affiliated institutions and automatically submits document requests to any facility with new data not previously downloaded. No refined Document Search capability

is necessary.

• Only documents that were not included in last request and retrieval are consolidated in new NwHIN Document message that is sent to Patient Inbox.

• Refresh icon allows user to reload Messages list to find new NwHIN documents. If request results in no new documents, system displays message indicating that request was successful and no new documentation is available.

• Patients can view provider-requested NwHIN documents when accessing Patient Inbox in Patient Portal.

• Providers can view patient-requested NwHIN documents when accessing Communications Module in EMR Medical Records in the Provider Portal.

1.60

Provide means of browsing local disk for document and uploading it.

• Browse button provides this functionality.

• Out of Scope for this version of Sirona.

1.61

Provide drag and drop function for document retrieval.

• Viewer has place where patient can drag document from his or her computer and then click to upload it.

• Out of Scope for this version of Sirona.

1.62

Provide ability for pa- tients to initiate request for all available medical documentation.

• Request NwHIN Documents button provides this functionality.

1.64

Send received document to rule engine for analysis.

• Sirona performs this function.

Table 3-F (3.2.2.1) — Calendar Requirements

The following table provides the functional requirements for displaying the calendar:

ID

Description

Scope

1.65

Provide calendar module for patients to view and monitor health events and appointments.

• Calendar module supports today, month, week, and specific day.

1.66

Display all past and pending appointments of patient within selected view.

• Medical Calendars area can display all past and pending medical appointments for patient.

• Personal Calendars area provides patient's personal calendars, such as home or work.

• Reminders for appointments appear only as alert messages in inbox.

1.67

Display all open education classes within selected view.

• Individual education and support calendars appear under

Medical Calendars.

1.68

Display details of education class, when requested.

• Provide mouse-over tool tip.

Out of scope for this version of Sirona.

1.69

Display details of appointments.

• Calendar provides this information in date box.

• Medical Calendar checkboxes are available for patient's PCM

and other facilities depending on patient need.

• If system administrator has configured patient for specific calendar, that calendar appears as option in Medical Calendars. For example, with proper configuration, if PCM makes referral

to specialist, rule engine sees order and displays subspecialty clinic checkbox, which allows patient to access available times to book appointment with specialist.

• Medical Calendars area provides checkboxes for common public access clinics, such as mammogram clinics and other routine diagnostic and preventative clinics.

1.70

Cancel pending appointment.

• Out of scope for this version of Sirona.

1.71

Reschedule pending appointment.

• Out of scope for this version of Sirona.

1.72

View all open specialty clinic appointments, select appoint- ment, associate it with open consult order list, and book appointment.

• Out of scope for this version of Sirona.

1.73

View all open appointments of patient's primary care man- ager, select appointment, and book it.

• Out of scope for this version of Sirona.

Table 3-G (3.2.3.1) — Contacts Requirements

The following table describes the functional requirements for the Medical Address Book:

ID

Description

Scope

1.74

Provide patient access to medical contacts maintained in address book.

• Organizer > Contacts provides complete medical contact information for patient.

• Clicking Compose Email > To field displays only names of health care providers, without email addresses.

1.75

Provide at least one entry in medical address book: patient's primary care manager.

• PCM is automatically added to Contacts list.

• If patient changes PCM and previous provider remains in medical facility, previous health care provider's name remains in address book, and name of new PCM is automatically added to Contacts list.

• Name of any health care provider seen within last two years appears in Contacts list.

• Name of any medical professional with whom patient has booked appointment appears in Contacts list. If patient cancels appointment, health care provider's name is removed from Contacts list.

1.76

Add names of relevant health care providers automatically to address book when appointment or consult requested.

1.77

Disallow patient additions, deletions,

or changes to contacts in address book.

1.78

Store contacts in the address book for

two years.

• If user has had no appointments with contact for two years, PMR

automatically deletes contact from address book.

1.79

Hide email addresses of health care providers.

Table 3-H (3.2.4.1) — Personal Info Requirements

The following table provides the functional requirements for displaying the Personal Info data:

ID

Description

Scope

1.80

Allow patients to view their demographic data and contact information.

• Organizer > Personal Info in Application Menu provides this functionality.

1.81

Provide database of personal information on patient.

• Medical facility serving patient gathers demographic information from patient and relevant others, per HIPAA privacy regulations.

1.82

Provide list of persons patient has submitted for family, legal, and emergency contacts.

• Display in upper pane.

1.83

Provide appropriate column fields to depict demographic information.

• Upper pane lists data on age, gender, date of birth, whether person is next of kin, relationship to patient, whether HIPAA release is on file, designated emergency contact, power of attorney (POA), and health care POA.

• If applicable, Available indicates that document exists; user clicks

Available to retrieve document.

1.84

Provide tabs in lower pane for additional related information for person selected in upper pane.

• Addresses tab includes contact addresses for person highlighted in list.

Type of address includes Home, Work, Vacation.

Indicates whether address is active; also indicates whether it is preferred.

• Telcom tab includes phone numbers. Type includes Home, Work, Cell.

Indicates whether phone number is active, preferred, or both.

• EmailAddress tab provides email address information. Indicates whether address is active, preferred, or both.

1.85

Provide photo in lower pane of person selected in upper pane, if available.

Table 3-I (3.3.1.1) — General Requirements

The following table provides the general functional requirements for displaying Patient Medical Record information:

ID

Description

Scope

1.86

Allow authenticated patients to view only

their own health records.

• Patients access this information under Medical Records option.

1.87

Disallow deletion, addition, or edition of information from or to patient medical record.

1.88

Provide major sections of medical record.

• Include Admissions, Allergies, Documentation, Immunizations, Medications, Problems, Results, and Vital Signs.

• Adhere to standards documented in Healthcare Information Technology Standards Panel CDA Content Modules Component, Version 1.1, July 2008.

1.89

Provide capability for user to list selectively entries based on status.

• Drop-down Status menu in upper left corner of center pane provides this capability. Status depends on medical record section, and might be Preliminary, Completed, Draft, and so on.

• Option of all on drop-down Status menu allows user to view all list entries, instead of limiting status attribute to specific status.

• Functional requirement applies to all sections of medical record, including Allergies, Documentation, Immunizations, Medications, Problems, Results, and Vital Signs.

• Out of scope for this version of Sirona.

1.90

Highlight sections of medical record that require close monitoring.

• Not applicable to Patient Portal.

1.91

Provide display screens that organize data into upper and lower panes.

1.92

Provide means of selecting row or item.

• Row selection determines what information appears in lower pane of medical record screen.

• Clicking row selects it.

1.93

Provide means of printing medical record data.

• Print button provides this functionality.

1.94

Display dates in

YYYY-MM-DD format.

• This version of Sirona also supports other date formats.

Table 3-J (3.3.2.1) — Admissions Requirements

The following table describes the functional requirements for displaying the Admissions Module for the patient:

ID

Description

Scope

1.95

Provide reverse chronological list of hospital admissions.

• Upper pane provides this information.

• Row fields include data on history of admissions, sorted from most current down.

1.96

Provide appropriate column fields to depict admission information.

• Fields include Date of admission Date of discharge Admitting doctor Discharge doctor Follow-up doctor Diagnosis 1

Diagnosis 2

Status, such as final

Data source, such as Indian Health Service (IHS)

1.97

Provide detail and summary information.

• Detail and Summary Description tabs in lower pane provide this information, which is narrative.

Table 3-K (3.3.3.1) — Allergies Requirements

The following table describes the functional requirements for displaying the Allergies medical record of the authenticated patient:

ID

Description

Scope

1.98

Provide reverse chronological list of allergies.

• Upper pane provides this information.

• Row fields include name of allergies sorted from most current down.

1.99

Provide appropriate column fields to depict allergy information.

• Fields include

Name of allergen, such penicillin or peanuts

Type, such as medication, chemical, pollen, or food

Severity, such as mild or severe

Age on onset

Status, such as active, resolved, or inactive

1.100

Provide detailed and summary data relevant to item selected in upper pane.

• Lower pane contains information available through Detail and

Summary Information tabs.

• Diagnoses, Treatment, and Literature tabs provide information from

Educational Content Service.

1.101

Provide appropriate delineation of data in lower pane, per selected row in upper pane.

• Column titles for Detail include

Report date Onset date Resolution date Allergen name

Reaction, such as shortness of breath or rash

Severity

Recorder, health care professional's name

1.102

Provide summary, diagnosis, and treat- ment information.

• Summary Information, Diagnoses, and Treatment tabs in lower pane provide information from Educational Content Service, which is primarily narrative and dependent on site license at medical facility.

1.103

Provide for Allergies education of user.

• Literature tab in lower pane provides further educational information, dependent on Educational Content Service license of medical facility.

Table 3-L (3.3.4.1) — Documentation Requirements

The following table describes the functional requirements for displaying the Documentation Module for the patient:

ID

Description

Scope

1.104

Provide means of selecting inpatient or outpatient documentation.

• Out of scope for this version of Sirona.

• Only outpatient information is in scope for this version of Sirona.

1.105

Provide capability for user to view selectively list entries based on status.

• Drop-down Status menu in upper left corner of center pane provides this capability. Status depends on medical record domain, and might be Preliminary, Completed, Draft, and so on.

• Option of All on drop-down Status menu allows user to view all list entries, instead of limiting status attribute to specific status.

• Out of scope for this version of Sirona.

1.106

Provide appropriate tabs to allow access to specific areas of interest in outpatient documentation.

• Upper pane provides outpatient tabs in these areas: Clinic Note, Consults, Directives, Telcon, Letters, and Other.

• Other includes miscellaneous documents, such as hand written notes, logs, and other forms.

• Only Clinic Note is in scope for this version of Sirona.

1.107

Provide appropriate column fields to depict outpatient documenta- tion information.

• Columns of information vary according to tab selected and include these examples:

For Clinic Note - Date, Description, Provider Name, Specialty, Document Type, Status, Source.

For Directives - Date, Description, Expiration Date, Status, Source.

1.108

Provide appropriate tabs to allow user to access specific areas of interest in inpatient documentation.

• Upper pane provides columns of information in these areas: Admission, Progress, Procedure, Nursing, Discharge, and Other.

• Inpatient documentation is out of scope for this version of Sirona.

1.109

Provide appropriate column fields to depict inpatient documenta- tion information.

• Upper pane provides columns of information in these areas, among others, depending on selected tab: Date, Description, Provider Name, Specialty, Role, Status, Source.

• Inpatient documentation is out of scope for this version of Sirona.

1.110

Provide in lower pane summary information or actual text of document selected in upper pane.

Table 3-M (3.3.5.1) — Immunizations Requirements

The following table describes the functional requirements for displaying the Immunizations Module for the patient:

ID

Description

Scope

1.111

Provide chronological list of Immunizations administered.

• Upper pane provides this information without tabs.

• Column fields include name of immunization sorted and dates each was administered in forward chronological order.

1.112

Provide details relevant to item selected in upper pane.

• Lower pane contains specific information on vaccines for each

date administered, including vaccine name, dosage, dose number, reaction, date to re-administer, lot number, route and site of administration.

• Other relevant tab in lower pane is Diseases, which describes diseases for which immunization is intended.

1.113

Provide background and disease information.

• Background and Disease tabs in lower pane provide this Educational

Content Service information, which is narrative.

1.114

Provide for further Immunizations education of user.

• Podcasts and Videos tabs provide further educational information.

Table 3-N (3.4.6.1) — Medications Requirements

The following table contains functional requirements for displaying the Medications Module for the patient:

ID

Description

Scope

1.115

Provide appropriate lists of medications prescribed to patient.

• Upper pane contains rows of information for each medication prescribed.

• Column fields include content for following data: Order date

Medication name

Signature of prescribing health care professional

Formulation, such as tablet or capsule

Unit, such as mg or ml. Dosage

Route of administration (by mouth, intravenously, topically, and so on) Site, anatomic location where medication is administered

Frequency

Duration, such as Indefinite or number of days

Quantity in numerical form

Refills allowed and number of refills filled, in format <number of refills filled/number of refills allowed>

Prescriber

Order expiration date

Indication, that is, condition that medication addresses

Source medical facility

1.116

Provide dispensation and description details and other relevant information.

• Lower pane provides these tabs: Dispensations, Description, Instructions, Indications, Side-Effects, Potential Interactions, and Images.

1.117

Provide appropriate delineation of data in lower pane, per selected row in

upper pane.

• For Dispensations, columns contain following data on medications: Fill date and time

Dispense date and time Name of drug dispensed Manufacturer Dispensation amount Expiration date Dispensation location Pharmacist

• Description, Instructions, Indications, Side-Effects, Potential Interactions, and Images tabs provide Educational Content Service data in narrative and images.

Table 3-O (3.4.7.1) — Problems Requirements

The following table contains functional requirements for displaying the Problems Module for the selected patient::

ID

Description

Scope

1.118

Provide capability of filtering lists of data based on status of problem.

• Drop-down Status menu in upper left corner of center pane provides this capability.

• Status of problem might be Active, Resolved, Remission, or Rule

Out, among others.

• Option of All on drop-down menu allows user to view all problem records.

• Out of scope for this version of Sirona.

1.119

Provide appropriate tabs for delineation of problem types.

• Upper pane includes tabs All, Concerns, Complaints, Problems, and

Diagnoses.

• All shows all records in list array without filtering by state or type.

1.120

Provide appropriate data fields in upper pane.

• Column fields include

Last recorded date of problem

Description of problem

Date of onset

Status of problem, such as Active, Resolved, Remission, Rule Out

Source of information

1.121

Provide further information in lower pane.

• Tabs include Detail, Summary Information, Diagnosis, and Treatment.

1.122

Provide column fields for detail information on item selected in upper pane.

• Detail data fields include

Date observed Name of problem Name of provider

Status, such as Active, Resolved, Remission, Rule Out

Source of information, such as patient, EMR, or medical facility.

• Other tabs contain narrative information on treatment, diagnosis, and so on.

1.123

Provide access to educational information on conditions, complaints, diseases, and diagnoses.

• Summary Information, Diagnosis, Treatment, Literature, Podcasts, and Videos tabs in lower pane provide access to Educational Content Service information.

Table 3-P (3.4.8.1) — Results Requirements

The following table contains functional requirements for displaying the Results Module for the selected patient::

ID

Description

Scope

1.124

Provide appropriate delineation of Results data.

• Upper pane provides tabs accessing following types of information: All, Micro, Cytology, Pathology, Imaging, Surgical, and Procedures.

• All shows all records in list array without filtering by state or type.

1.125

Provide fields of data defining upper pane tab information.

• Column fields depend on test type, and might include these for blood panel

Effective date

Name of provider ordering test

Accession ID Type of test Specimen Type

Source of information, such as VA or medical facility Status of result, such as Complete or Preliminary Date and time results became available

1.126

Provide supporting information and details.

• Lower pane provides this information, accessed via tabs.

• Results tab information and fields depend on test run. For blood panel example, fields might include

Test name

Result

Interpretation of code Unit, such as percentage High value

Low value

1.127

Provide access to educational information.

• Description, Images, Summary Information, Indication, Risk-Benefits, Literature, Podcasts, and Videos tabs in lower pane provide Educational Content Service information in narrative and images.

Table 3-Q (3.4.9.1) — Vital Signs Requirements

The following table describes the functional requirements for displaying the Vital Signs Module for the selected patient:

ID

Description

Scope

1.128

Provide data on vital signs over time.

• Upper pane provides this information, with most current data to the far right.

• Left panel of upper pane lists relevant vital signs, such as diastolic heart pressure, heart rate, height, and so on.

1.129

Provide means of navigating vital signs data.

• Arrow buttons above upper pane provide navigation to previous or next page or column.

• Beginning and end buttons are also provided to navigate to beginning and end of listing.

• Dynamic paging mechanism is available only if number of data columns exceeds viewable columns.

1.130

Provide graphical representation of selected vital sign data.

• Lower pane provides graphical representation.

Table 4-A (4.1.1) — Provider Portal Navigation Menu Requirements

The following table describes the functional requirements related to the Application Menu options in the left-hand application navigation area of the portal user interface and tab navigation:

ID

Description

Scope

1.133

Provide tabs distinguishing types

of functionality provider can perform.

• Navigation tabs Desktop and Patient Records distinguish between types of tasks provider performs in Provider Portal.

• Desktop tab provides access to tasks that allow provider to view, change, and manage his or her own personal messages inbox, calendar, address book, and personal information.

• Patient Records tab provides access to patient medical records, and allows provider to view records and messages associated

with selected patient and adjust schedules for patient appointments. Title of this tab changes to include patient name once provider selects patient; for example: Patient: Jane Doe.

Table 4-B (4.2.4.1) — Messages Display Requirements (1)

The following table describe the functional requirements for the display of messages and Desktop Inbox functions.

ID

Description

Scope

1.134

Display personal inbox when provider logs into Sirona.

• Desktop tab default display is Desktop Inbox.

1.135

Provide tab to access personal provider inbox during simulations.

• Desktop tab provides this access.

1.136

Show all message types, or categories.

• Default view shows all messages and their types (Mail, Alerts, NwHIN Docs).

1.137

Provide date that message was sent.

• Date column shows date that message was sent.

1.138

Provide time that message was sent.

• Time column provides this information.

1.139

Provide subject of message..

• Title column provides this information.

1.140

Provide sender information.

• From column provides name of message sender.

• Name can be person or system.

• In case of email message, sender's address is not shown.

1.141

Provide information on type of message.

• Type column provides this information, which differentiates message sent.

• Types include Alert, Task, and Mail.

1.142

Provide status information of message.

• Message in bold is unread.

• Message in normal font is read.

• Highlighted message indicates current message shown in Message

Display panel.

• Star or asterisk indicates important. User specifies importance in column labeled with star.

• For message of Message type, status is read/unread.

1.143

Provide priority informa- tion on message.

• Priority column provides message priority, where values include

Normal, HIGH, and Critical.

Table 4B (4.2.4.1) — Messages Display Requirements (2)

ID

Description

Scope

1.144

Provide task progress information.

• Task column provides this information dynamically, showing percentage of message task completion.

• For any message without an associated Task Request, column displays no task progress percentage.

1.145

Provide area for displaying message.

• Message Display panel provides text of actual message.

1.147

Display messages according to selected filter category.

• All Messages category drop-down menu provides access to functionality.

• Filtering locates all message types that fit selected categories.

• Unified Collaboration Portal supports complex filtering of multiple categories at one time.

• Category function is available at all times.

1.148

Display unread messages in bold.

• Read messages display in normal type.

1.149

Provide display refresh functionality.

• Refresh icon in toolbar allows user to reload messages to determine whether new messages have been received.

1.150

Control display of functions.

• When Desktop Inbox first opens, first message is selected.

• Type of message selected determines what functions are available to user.

• When user is in compose mode, composition toolbar, and Send, Save Draft, Discard, and Print functions are available.

• Attach is out of scope for this version of Sirona.

1.171

Archive completed task automatically.

• If message contains multiple tasks, archive only after all tasks complete.

• Include archiving action with account registration disclosure message.

1.172

Provide toggle for

Read/Unread status.

1.173

Display warning popup when user tries to archive or delete message with incomplete tasks.

• Archiving or deletion can be completed based on user request.

Table 4-C (4.2.4.2) — Requirements for Actions User Performs on Message

The following table describes the functional requirements for actions that the user can perform on messages:

ID

Description

Scope

1.146

Sort on any column.

• User can sort using Microsoft Windows functions. Inbox messages have priority value for sorting.

• By default, inbox messages are sorted by date in reverse chronological order.

1.152

Compose mail message.

• Function is available at all times.

• Includes extensive composition toolbar that allows user to specify font, type size, character formatting such as italics, and margin justification, among other functions.

• Trashcan icon allows user to clear all text in message.

1.153

Search for text in any message.

• Out of scope for this version of Sirona.

1.154

Delete message.

• Desktop Inbox provides Delete option in Reply drop-down button.

• Deleted message is flagged as Trash and can be viewed in Trash Bin.

• Trash folder allows user to delete message permanently via Delete

Forever option.

• Providers can delete only messages of type email.

• Admin staff can still view deleted message.

• Undelete option in task pull-down menu moves message from Trash to Inbox.

1.155

Forward message.

• Users can forward only Email messages.

• Users can forward only to people listed in their address book.

• Forward button is available only when user has selected message to forward.

1.156

Reply to message.

• Providers can reply only to Email messages.

• Reply, Reply All, and Forward options in Reply drop-down menu are available when Email message is selected for display.

1.157

Print any message in Inbox.

• Out of scope for this version of Sirona.

1.161

Archive messages.

• Archive button provides access to this function.

• Unarchive option in Reply task drop-down button moves message from Archive to Inbox.

1.162

Set message as read.

• If user clicks message and maintains focus on message for defined number of seconds or more, system marks message as read (normal type).

1.163

Save draft of message.

• When user performs no edit functions in the Edit pane during an edit session for more than defined number of seconds, system saves draft.

Table 4-D (4.2.4.3) — Alert Message Requirements

The following table describes the functional requirements for tasks related to alert messages and other alert functions, either performed by the user or by Sirona:

ID

Description

Scope

1.151

Display alert action labels on alert buttons when alert includes action.

• Rule author defines labels independently.

1.158

Specify action for

Alert messages.

• Rule metadata determines possible alert actions, where options include Accept, Reject, Hold, Modify, Escalate, and Discard.

• Above options are dynamic and controlled by DSA rules once alert is retrieved and is in body of message detail.

1.159

Discard Alert message.

• Provider chooses to ignore recommendation.

• Unified Collaboration Portal sends Discard notice to sender of alert message.

1.160

Reject Alert message.

• User reads message and chooses to reject recommendation.

• Unified Collaboration Portal sends Reject notice to sender of alert message.

1.164

Display alert messages from CDS system.

• Alert messages notify patient of impending required/suggested tasks.

• Alert message can be for information only (FYI), for example, news about trial.

1.165

Associate task(s) with alert message.

• Alert message may have associated task that patient is recommended to perform.

• Examples: Recommendation to get prostate-specific antigen

(PSA) baseline or mammogram.

1.166

Allow inclusion of sur- vey or questionnaire.

• Link can provide access to survey/questionnaire. Once clicked, link takes patient to embedded survey page.

• Can also be embedded Tohu Drools survey.

1.167

Allow request to accept new appointment with health care provider.

• If accepted, entry is inserted into calendar; no redirection to calendar page needed.

• If rejected, no entry.

• If modified, patient is redirected to calendar and allowed to select different date on calendar. If patient selects new open appointment from calendar, alert task is updated appropriately.

1.168

Allow inclusion of new results to view.

• Access to results may be through link that takes user to Results page.

1.170

Display alert message and any embedded tasks.

• Message Display panel provides this functionality when user selects alert.

Table 4-E (4.2.5.1) — Calendar Requirements

The following table provides the functional requirements for displaying the calendar:

ID

Description

Scope

1.179

Provide calendar module for providers to view and monitor their health events and appointments.

• Calendar module supports today, daily, weekly, and monthly views.

• In Patient Records, Appointments module of Medical Records navigation menu provides viewing access to medical calendar of selected patient.

1.180

Display all past and pending appointments of provider within selected view.

• Medical Calendars area can display all calendars containing past and pending medical appointments for provider.

• Personal Calendars area lists provider's personal calendars, such as home or work.

1.181

Display all open education classes within selected view.

• Individual education and support calendars appear under

Medical Calendars.

1.182

Display details of education class, when requested.

• Out of scope for this version of Sirona.

1.183

Display details of appointment.

• Calendar provides this information in date designation.

• Medical Calendars area provides checkboxes for other facilities depending on provider associations.

• For unbooked consult orders, if PCM makes referral to specialist, rule engine sees order and displays subspecialty clinic calendar checkboxes, which allows provider to view times available for patient to book appointment with specialist.

• Medical Calendars area provides checkboxes for common public access clinics, such as mammogram clinics and other routine diagnostic and preventative clinics, as determined

by medical facility.

1.184

Cancel pending appointment.

• Out of scope for this version of Sirona.

1.185

Reschedule pending appointment.

• Out of scope for this version of Sirona.

1.186

View all open specialty clinic appointments, select appointment, associate it with open consult order list, and book appointment.

• Out of scope for this version of Sirona.

1.187

View all open appointments of patient's primary care manager, select appointment, and book it.

• Out of scope for this version of Sirona.

Table 4-F (4.2.6.1) — Contacts Requirements

The following table describes the functional requirements for the Medical Address Book:

ID

Description

Scope

1.188

Provide access to contacts maintained in address book.

• Organizer > Contacts provides complete medical contact information for provider, including personal address book and global addresses associated professionally with medical facility. This function is available only when Desktop tab is active.

• Clicking Compose Email > To field also displays provider contacts.

1.189

Add names of relevant health care providers automatically to address book when appointment or consult requested.

• Out of scope for this version of Sirona.

1.190

Allow additions, deletions, and changes to contacts in personal provider address book.

• When provider selects Desktop tab, he or she can modify personal address book.

• Out of scope for this version of Sirona.

1.191

Allow providers to add their names to patient address book.

• To follow patient case, providers within medical facility can add their names to address book of patients who aren't yet their patients.

• Providers can add their name to patient address book only if they are providers at medical facility where patient receives primary treatment.

• Out of Scope for this version of Sirona.

Table 4-G (4.2.7.1) — Personal Info Requirements

The following table provides the functional requirements for displaying the Personal Info data:

ID

Description

Scope

1.192

Allow providers to view demographic data and contact information provided for them- selves.

• Organizer > Personal Info in Application Menu provides this capability when provider has selected Desktop tab.

• When Patient Records tab is active, providers view Demographics module under Medical Records to learn related information on their selected patient. Demographics option provides data on selected patient only.

1.193

Provide database of personal information on provider.

1.194

Provide list of persons provider has submitted for family, legal, and emergency contacts.

• Display in upper pane.

1.195

Provide appropriate column fields to depict demographic information.

• Upper pane lists data on age, gender, date of birth, whether person is next of kin, relationship to patient, whether HIPAA release is on file, designated emergency contact, power of attorney (POA), and health care POA.

• If applicable, Available indicates that document exists; user clicks

Available to retrieve document.

1.196

Provide tabs in lower pane for additional related information for person selected in upper pane.

• Addresses tab includes contact addresses for person highlighted in list.

Type of address includes Home, Work, Vacation.

Indicates whether account is active; also indicates whether it is preferred.

• Telcom tab includes phone numbers. Type includes Home, Work, Cell.

Indicates whether phone number is preferred.

• EmailAddress tab provides email address information.Indicates whether address is active, preferred, or both.

1.197

Provide photo in lower pane of person selected in upper pane, if available.

1.198

Allow authenticated provider to modify this data.

• Out of scope for this version of Sirona.

Table 5-A (5.0.1) — General Requirements (1)

The following table provides the general functional requirements for displaying Electronic Medical Record information:

ID

Description

Scope

1.206

Allow authenticated providers to view only their patients' health records.

1.207

Provide capability for user to list selectively entries based on status.

• Drop-down Status menu in upper left corner of center pane provides this capability. Status depends on medical record section, and might be Preliminary, Completed, Draft, and so on.

• Option of all on drop-down Status menu allows user to view all list entries, instead of limiting status attribute to specific status.

• Functional requirement applies to all sections of medical record, including Allergies, Documentation, Immunizations, Medications, Problems, Results, and Vital Signs.

• Out of scope for this version of Sirona.

1.208

Disallow deletion, addition, or edition of information from or to electronic medical record.

1.209

Provide major modules of medical record.

• Include Admissions, Allergies, Documentation, Equipment, Immunizations, Medications, Problems, Results, and Vital Signs.

• Adhere to standards documented in Healthcare Information Technology Standards Panel CDA Content Modules Component, Version 1.1, July 2008.

1.210

Highlight modules of medical record that re- quire close monitoring.

• Highlighted module indicates condition health care professionals

want to watch over time, and do not indicate patient is in critical state.

• Triangle alert icon next to module name indicates condition to watch. Alert icon appears both in Patient Records tab and to right of Medical Records module name in navigation menu.

1.211

Display and organize data into upper and lower panes, as appropriate.

1.212

Provide means of selecting row or item.

• Row selection determines what information appears in lower pane of medical record screen.

• Clicking row selects it.

• All Messages drop-down menu allows user to select all items in upper pane list.

Table 5-A (5.0.1) — General Requirements (2)

ID

Description

Scope

1.213

Provide means of print- ing medical record data.

• Print button provides this functionality.

• Out of scope for this version of Sirona.

1.214

Display dates in

YYYY-MM-DD format.

• This version of Sirona allows other date formats.

Table 5-B (5.1.1) — Patient Search Requirements

The following table describes the functional requirements to search for patient medical records:

ID

Description

Scope

1.199

Provide access to Elec- tronic Medical Record module through tab.

• Patient Records tab provides access to EMR functionality.

* Tab title changes to name of patient, once selected, for example,

Patient: Jane Doe.

1.200

Search for patient record using predefined parameters.

• Parameters include patient last name, first name and middle initial, date of birth, gender, social security number, and medical record number.

* Search button on Search For Patient screen initiates Patient Search

* Magnifying glass icon on Patient Records tab displays Search For Patient screen allowing provider to specify search criteria for another patient.

* Cancel button cancels patient search.

1.201

Specify relevant type of entity with which patient is associated.

• Types include NHIN, organization, medical center, and clinic.

• Data helps to narrow search function.

• Tells rule engine to determine whether local search is sufficient or whether more elaborate, distributed search across organizations needs to be done.

1.202

Provide means to initi- ate patient search after provider has specified required information.

• Search button provides this functionality.

• Cancel button cancels patient search

1.203

Display list of possible patients found in search.

• Search Results pane provides this functionality.

1.204

Provide means to select patient from results list.

• Select button provides this functionality.

1.205

Highlight patient's

name if that patient has diagnoses that require close monitoring.

• If patient has condition that providers must watch, red cross appears to right of name of patient in tab and to right of name of medical record module to which condition pertains, such as Allergies.

Table 5-C (5.2.1) — Admissions Requirements

The following table describes the functional requirements for displaying the Admissions medical record of the authenticated patient:

ID

Description

Scope

1.215

Provide reverse chronological list of hospital admissions.

• Upper pane provides this information.

• Row fields include data on history of admissions, sorted from most current down.

1.216

Provide appropriate column fields to depict admission information.

• Fields include

Date of admission Date of discharge Admitting doctor Discharge doctor Follow-up doctor Diagnosis 1

Diagnosis 2

Status, such as final

Data source, such as Indian Health Service (IHS)

1.217

Provide detail and summary information.

• Detail and Summary Information tabs in lower pane provide this information, which is narrative.

Table 5-D (5.3.1) — Allergies Requirements

The following table describes the functional requirements for displaying the Allergies medical record of the selected patient:

ID

Description

Scope

1.218

Provide reverse chronological list of allergies.

* Upper pane provides list of substances to which patient has allergies.

* Row fields include name of allergies sorted from most current down.

1.219

Provide appropriate column fields to depict allergy information.

• Fields include

Name of allergen, such penicillin or peanuts

Type, such as medication, chemical, pollen, or food

Severity, such as mild or severe

Age on onset

Status, such as active, resolved, or inactive

1.220

Provide details relevant to item selected in upper pane.

• Lower pane contains information available through Detail, Summary Information, Diagnoses, Treatment, and Literature.

1.221

Provide appropriate delineation of data in lower pane, per selected row in

upper pane.

• Column titles for Detail, for example, include

Report date Onset date Resolution date Allergen name

Reaction, such as shortness of breath or rash

Severity

Recorder, health care professional's name

1.222

Provide summary, diagnosis, and treat- ment information.

• Summary Information, Diagnoses, and Treatment tabs in lower pane provide this information, which is narrative and dependent on Educational Content Service license of medical facility.

1.223

Provide for Allergies education of user.

• Literature tab in lower pane provides further educational information, also dependent on Educational Content Service license of medical facility.

Table 5-E (5.4.1) — Appointment Requirements

The following table describes the functional requirements for displaying the Appointments Module for the selected patient:

ID

Description

Scope

1.287

Allow provider to view appropriate medical calendars.

• In addition to selected patient medical calendar, provider can view general access calendars determined by medical facility and any medical clinic calendar of currently logged-in provider.

Table 5-F (5.5.4.1) — Communications Display Requirements

The same display requirements described in Section 4.2.4.1, Messages Display Requirements, apply to the

Communications Module, except for the following:

ID

Description

Scope

1.131

Hide all buttons allowing actions upon messages.

* Reply drop-down button is hidden.

• All message selections checkboxes and status indications are disabled.

* Message cannot be starred, marked as read, or deleted.

1.132

Limit available locations for messages.

• Location drop-down menu adjacent to title of current view provides options only for Inbox, Sent, and Archive.

Table 5-G (5.5.4.2) — Requirements for Actions User Can Perform on Communications Messages

Because the Patient Medical Record cannot be altered, the provider can perform few actions in the Communications Module. The following table contains the functional requirements describing the actions that the provider can perform:

ID

Description

Scope

1.288

Compose message.

• Provider can compose message in Communications module.

• Patient must be recipient of message. Sirona automatically lists patient as recipient.

• Providers can add other recipients from Contacts list. They must also select checkbox for patient when requesting other recipients.

• Provider can save drafts of messages composed in Communications module. These drafts reside in Drafts location in provider's Desktop Messages function.

Table 5-H (5.5.4.3) — Alert Message Requirements

The following table describes the functional requirements for alert messages displayed in the

Communications Module::

ID

Description

Scope

1.289

View patient's alert messages and their progress.

• This is the only action that provider can perform on alert messages.

Table 5-I (5.5.4.4) — Document Request and Retrieval Requirements

The following table describes functional requirements for the request and retrieval of NwHIN and other documents related to the selected patient's medical care.

ID

Description

Scope

1.176

Request NwHIN

documents on demand.

• User clicks Request NwHIN Documents button to request all available NwHIN documents at any time. Button displays message Processing Request while request is sent and processed.

• Sirona broadcasts request to all NwHIN-affiliated institutions and automatically submits document requests to any facility with new data not previously downloaded. No refined Document Search capability is necessary.

• Only documents that were not included in last request and retrieval are consolidated in new NwHIN Document message that is sent to Patient Inbox.

• Refresh icon allows user to reload Messages list to find new NwHIN documents. If request results in no new documents, system displays message indicating that request was successful and no new documentation was available.

• Patients can view provider-requested NwHIN documents when accessing Patient Inbox in Patient Portal.

• Providers can view patient-requested NwHIN documents when accessing Communications Module in EMR Medical Records in the Provider Portal.

1.174

Provide Browse combo box.

• Provider can browse local disk for document and upload it.

• Out of scope for this version of Sirona.

1.175

Provide drag and drop function for documents.

• Message Display panel provides place where provider can drag document from his or her computer and then click to upload it.

• Out of scope for this version of Sirona.

1.178

Send received document to rule engine for analysis.

• Sirona performs this function.

Table 5-J (5.6.1) — Demographics Requirements

The following table describes the functional requirements for displaying the Demographics Module for the selected patient:

ID

Description

Scope

1.224

Provide list of persons patient has submitted for contacts.

• Display in upper pane.

• Patient provides this information when first requesting services at medical facility.

1.225

Provide appropriate column fields to depict demographic information.

• Upper pane lists data on age, gender, date of birth, whether person is next of kin, relationship to patient, whether HIPAA release is on file, whether person is designated emergency contact, has power of attorney (POA), and health care POA.

• If applicable, Available indicates that document exists; user clicks

Available to retrieve document.

1.226

Provide tabs in lower pane for additional re- lated information for person selected in upper pane.

• Addresses tab includes contact addresses for person highlighted in list.

Type of address includes Home, Work, Vacation

Indicates whether account is active; also indicates whether it is preferred.

• Telcom tab includes phone numbers. Type includes Home, Work, Cell.

Indicates whether phone number is preferred.

• EmailAddress tab provides email address information. Indicates whether address is active, preferred, or both.

1.227

Provide photo in lower pane of person selected in upper pane, if available.

Table 5-K (5.7.1) — Documentation Requirements

The following table describes the functional requirements for displaying the Documentation Module for the selected patient::

ID

Description

Scope

1.228

Provide means of selecting inpatient or outpatient documentation.

• Only outpatient documentation is in scope for this version of Sirona.

• Display in upper pane.

1.229

Provide appropriate tabs to allow access to specific areas of interest in outpatient documentation.

• Upper pane provides outpatient tabs in these areas: Clinic Note, Consults, Directives, Telcon, Letters, and Other.

• Only Clinic Note is in scope for this version of Sirona.

• Other includes miscellaneous documents, such as hand written notes, logs, and other forms.

1.230

Provide appropriate column fields to depict outpatient documentation information.

• Columns of information vary according to tab selected and include these examples:

For Clinic Note - Date, Description, Provider Name, Specialty, Document Type, Status, Source.

For Directives - Date, Description, Expiration Date, Status, Source.

1.231

Provide appropriate tabs to allow provider to access specific areas of interest in in-

patient documentation.

• Upper pane provides columns of information in these areas: Admission, Progress, Procedure, Nursing, Discharge, and Other.

• Other includes miscellaneous documents, such as hand written notes, logs, and other forms.

• Inpatient documentation is out of scope for this version of Sirona.

1.232

Provide appropriate column fields to depict inpatient documenta- tion information.

• Upper pane provides columns of information in these areas, among others, depending on tab: Date, Description, Provider Name, Specialty, Role, Status, Source.

• Inpatient documentation is out of scope for this version of Sirona.

1.233

Provide in lower pane summary information or actual text of document selected in upper pane.

Table 5-L (5.8.1) — Immunizations Requirements

The following table describes the functional requirements for displaying the Immunizations Module for the selected patient::

ID

Description

Scope

1.234

Provide chronological and alphabetical list of Immunizations administered.

• Upper pane provides this information without tabs.

• Column fields include name of immunization sorted alphabetically and dates each was administered in chronological order.

1.235

Provide details relevant to item selected in upper pane.

• Lower pane contains specific information on vaccines for each date administered, including vaccine name, dosage, dose number, reac- tion, date to re-administer, lot number, route and site of administration.

1.236

Provide background and disease information.

• Background and Disease tabs in lower pane provide this information, which is narrative.

1.237

Provide further immunizations education of user.

• Podcasts and Videos tabs provide further educational information, depending on Educational Content Service license of medical facility.

Table 5-M (5.9.1) — Medications Requirements

The following table contains functional requirements for displaying the Medications Module for the selected patient:

ID

Description

Scope

1.238

Provide appropriate column fields and tabs for Medications domain.

• Upper pane contains rows of information for each medication prescribed.

• Column fields include content for following data: Order date

Medication name

Signature of prescribing health care professional

Formulation, such as tablet or capsule

Unit, such as mg or ml. Dosage

Route of administration

Frequency

Duration, such as Indefinite or number of days

Quantity in numerical form

Refills allowed and number of refills filled, in format <number of refills filled/number of refills allowed>

Prescriber

Order expiration date

Indication, condition that medication addresses

Source medical facility

1.239

Provide dispensation and description details and other relevant information.

• Lower pane provides these tabs: Dispensation, Description, Instructions, Indications, Side-Effects, and Potential Interactions.

1.240

Provide appropriate delineation of data in lower pane, per

selected row in upper pane.

• For dispensations, columns contain following data on medications: Fill date and time

Dispense date and time

Name of drug dispensed Manufacturer Dispensation amount Expiration date Dispensation location Pharmacist

• For other tabs, data are provided in narrative and images, depending on Educational Content Service license of medical facility.

Table 5-N (5.10.1) — Problems Requirements

The following table contains functional requirements for displaying the Problems Module for the selected patient:

ID

Description

Scope

1.241

Provide appropriate tabs for delineation of problem types.

• Upper pane includes tabs All, Concerns, Complaints, Problems, and

Diagnoses.

• All shows all records in list array without filtering by state or type.

1.242

Provide appropriate data fields in upper pane.

• Column fields include

Last recorded date of problem

Description of problem

Date of onset

Status of problem, such as Active, Resolved, Remission, Rule Out

Source of information

1.243

Provide further infor- mation in lower pane.

• Tabs include Detail, Summary Information, Diagnosis, and Treatment.

1.244

Provide column fields for Detail information on item selected in upper pane.

• Detail data fields include

Date observed Name of problem Name of provider

Status, such as Active, Resolved, Remission, Rule Out

Source of information, such as patient, EMR, or medical facility.

• Other tabs contain narrative information on treatment, diagnosis, and so on.

1.245

Provide access to fur- ther educational information.

• Literature, Podcasts, and Videos tabs in lower pane provide access to more information, depending on Educational Content Service license of medical facility.

Table 5-O (5.11.1) — Results Requirements

The following table contains functional requirements for displaying the Results Module for the selected patient:

ID

Description

Scope

1.246

Provide appropriate delineation of Results data.

• Upper pane provides tabs accessing following types of information: All, Micro, Cytology, Pathology, Imaging, Surgical, and Procedures.

• All shows all records in list array without filtering by state or type.

1.247

Provide fields of data defining upper pane tab information.

• Column fields depend on test type, and might include these for labs

Date and time of test

Name of provider ordering test

Accession ID Type of test Specimen Type

Source of information, such as VA or medical facility

Status, such as Complete or Preliminary

Date and time result becames available

1.248

Provide supporting information and details.

• Lower pane provides this information, accessed via tabs.

• Results tab information and fields depend on test run. For blood panel example, fields might include

Test name

Result

Interpretation of code Unit, such as percentage High value

Low value

Tabs include Description, Images, Summary Information, Indication, and Risk-Benefit.

• For Description, Images, Summary Information, Indication, and

Risk-Benefit tabs, data are provided in narrative and images.

1.249

Provide access to edu- cational information.

• Depending on Educational Content Service license of medical facility, Description, Images, Summary Information, Indication, Risk-Benefits, Literature, Podcasts, and Videos tabs in lower pane provide further information in narrative and images.

Table 5-P (5.12.1) — Vital Signs Requirements

The following table describes the functional requirements for displaying the Vital Signs Module for the selected patient::

ID

Description

Scope

1.250

Provide data on vital signs over time.

• Upper pane provides this information, with most current data to the far right.

• Left panel of upper pane lists relevant vital signs, such as diastolic heart pressure, heart rate, height, and so on.

1.251

Provide means of navigating vital signs data.

• Arrow buttons above upper pane provide navigation to previous or next page or column.

• Beginning and end buttons are also provided to navigate to beginning and end of listing.

• Dynamic paging mechanism is available only if number of data columns exceeds viewable columns.

1.252

Provide graphical representation of selected vital sign data.

• Lower pane provides graphical representation.

5.13.1 Clinical Analytics Drawer Requirements

This section describes functional requirements for the Clinical Analytics Drawer, including functionality for the output pane display, such as adding diseases to the drawer, and for provider interactions with the drawer, such as requesting models and inputting data.

Table 5-Q (5.13.1.1) — Display Requirements (1)

The following table describes the functional requirements to display the Clinical Analytics drawer:

ID

Description

Scope

1.253

Create output pane as expandable drawer on right-hand side of GUI.

• Clinical Analytics drawer is available only when provider has selected patient via Select A Patient tab, not when Desktop is active.

• Drawer title bar appears only after provider has selected patient.

• Drawer pops open when selected patient is at risk.

1.254

Summarize medical illnesses and risks in output pane.

1.255

Add illness to clinical analytics summary for given patient.

• Arrow next to disease name allows provider to add and remove illnesses from patient summary.

1.256

Signal provider if model exceeds its default relative risk display threshold.

• Arrow in handle drawer flashes color reflecting degree of current relative risk for patient. Color coding is consistent with colors and degrees of risk described in requirement 1.261.

• If user sets personal display threshold for any given model in configuration parameters, new threshold overrides default and controls auto expansion of output pane.

1.257

Once closed, leave output pane closed until user reopens it.

• User might choose to reopen Clinical Analytics drawer when handle arrow of drawer reflects color of model's current risk probability value.

1.258

List only models not yet loaded into rule session.

• When a risk model is unavailable, a message appears indicating that it is unavailable and that Dx Guide has not yet been started.

1.259

Display patient's calculated risk prediction score (%) and plus/minus range in each model.

• Plus/minus value range depicts Confidence Interval.

1.260

Display graphic that visualizes patient's risk probability.

• Selected model determines type of graphic.

• Out of scope for this version of Sirona.

Table 5-Q (5.13.1.1) — Display Requirements (2)

ID

Description

Scope

1.261

Use color to indicate patient's relative risk probability for developing disease.

• Drawer uses this color coding:

Yellow: Low-level alert, relative risk value between 0 and 25%. Orange: Average degree of concern warranted, relative risk value

between 15 and 50%.

Dark Orange: High alert, attention warranted, relative risk value between 50 and 75%.

Red: Very high warning, immediate attention warranted, relative risk value between 75 and 100%.

• When confidence interval is high and risk threshold is exceeded, redden drawer handle arrow icon and auto-expand right-hand drawer and bar.

• Color adjusts based on new data that changes relative risk score. Color is reflected in arrow to right of disease name and in drawer handle arrow.

1.262

Display process nodes for diagnostic and clinical analytics in diagnostic workup center pane dynami- cally when user launches Diagnostic Guide.

• Start Dx Guide button provides this functionality. This button is visible when Diagnostic Guide has not been started yet for model.

• Show Dx Guide is visible when Diagnostic Guide exists for model, but is not now displayed.

• Clinical Analytics Drawer remains open while Dx Guide runs.

• If Dx Guide is running in background for patient, drawer provides page icon next to disease name, which pulsates when that model is running.

• Dx Guide runs for only one patient per disease at time.

Table 5-R (5.13.1.2) — Requirements for Provider Interactions With System

The following table describes the functional requirements for provider interactions with the system:

ID

Description

Scope

1.263

Request model input parameters for which given patient has no data.

• Questions display in Clinical Analytics Drawer and are differentiated between required and optional.

• Undo button to right of input field allows user to reset question to null.

• When user provides missing data, probability score is recalculated.

• Clinical Analytics Drawer provides Submit button for submitting entered text data to rule engine.

• Clicking radio button to answer questions results in immediate submission of answer to rule engine.

1.264

Store requested questions for each input parameter with model as metadata.

• These questions are used for missing patient data and may have lower than desired predictive scores.

1.265

Provide separate button to allow manual launching of Diagnostic Guide tool from drawer.

• Start Dx Guide button is provided.

• Show Dx Guide button in drawer allows user to return to Dx Guide when he or she has navigated away from Dx Guide to review other information in Provider Portal.

1.266

Allow manual opening of drawer.

• Left-side arrow provides this functionality.

Table 5-S (5.13.1.3) — Requirements for System Administrator Actions on Models

The following table describes the functional requirements for actions on models that the user can take:

ID

Description

Scope

1.267

Add and delete models from user model list.

• Only System Administrator can perform this function.

• Some models are considered Enterprise, that is, assigned to all providers of health care organization. Enterprise models cannot be deleted.

1.268

Sort model list using configuration file.

• Only System Administrator can perform this function.

• Default sorting is descending, based on relative risk probability scores.

Table 5-T (5.15.2.1) — Display Requirements (1)

The following table describes the functional requirements for displaying Diagnostic Guide information:

ID

Description

Scope

1.269

Process data from node tasks vertically, building on accumu- lated data to reach solution.

• Diagnostic Guide processes data incrementally and keeps chronological sequence of tasks and data.

• Diagnostic Guide is model specific.

• Multiple states of diagnosis are possible, depending on user choices.

1.270

Optionally display other utilities for assessing choices.

• Current release focuses only on Diagnostic Guide, while accommodating future additional modules.

1.271

Expand number of diagnostic actions displayed in rows of center pane.

• This feature allows more actions to be displayed across pane per row, for users with larger monitors.

• Out of scope.

1.272

Allow grabbing and correct positioning of image in center pane.

• Enable user to navigate easily to desired area when Diagnostic

Guide display is larger than center canvas.

1.273

Highlight path and decisions that have resulted in current state.

• At start, four best options display in Diagnosis center pane, with respective diagnostic utility scores.

• Recommended option displays is slightly darker color.

• User selection of option displays option description.

• Once started, option presents user with possible next steps and possible questionnaires.

• Once option is running, arrow indicates path.

1.274

Indicate current

choices and diagnostic utility score via graphics visualizing

recommended choices.

• Center canvas displays option, stage, and status summary graphics.

1.275

Do not initially display values of choices below configured threshold.

• Lower-Utility Options are collected in box to left of higher-utility options.

• Lower-Utility Options box contains options below a configured threshold.

• Provider selects option via radio button.

1.276

Use Business Process Modeling Notation (BPMN) 2.0 terminol- ogy and icons for Diagnostic Guide icons and decision nodes, as appropriate.

Table 5-T (5.15.2.1) — Display Requirements (2)

ID

Description

Scope

1.277

Redisplay current choice and prior alternatives if decision is canceled before

it is completed.

• Canceled choice appears not to have been made.

1.278

Display diagnostic utility of action user plans to take.

• Diagnostic utility score is indicated under option title.

• Range is 0-1, where 0 is insignificant action and 1 is recommended action.

1.279

Display status of all options.

• Box at bottom of center canvas summarizes status of all options running in current state.

• Status of committed and running options is also shown under option box in center canvas.

• Intermediate stage summary boxes display disease certainty and confidence interval values. These values are color coded:

Yellow: Low-level alert, disease certainty value between 0 and 25%. Orange: Average degree of concern warranted, disease certainty

value between 25 and 50%.

Dark Orange: High alert, attention warranted, disease certainty value between 50 and 75%.

Red: Very high warning, immediate attention warranted, disease certainty value between 75 and 100%.

Table 5-U (5.15.2.2) — Score Calculation Requirements

The evaluation of a constraint set on an intermediate or final solution allows Diagnostic Guide to compute the score of that solution. The score is evaluated by applying all the included constraints to a solution.

The following table describes the functional requirements of calculating disease certainty scores, confidence intervals, and diagnostic utility of diagnostic options:

ID

Description

Scope

1.280

Continuously recalculate disease certainty score throughout process.

• Progress bar displays disease certainty warning level above center canvas. Alert levels are color coded:

Yellow: Low-level alert, disease certainty value between 0 and 25%. Orange: Average degree of concern warranted, disease certainty

value between 25 and 50%.

Dark Orange: High alert, attention warranted, disease certainty value between 50 and 75%.

Red: Very high warning, immediate attention warranted, disease certainty value between 75 and 100%.

• Both Disease Certainty and Confidence Interval values display in stage summary boxes.

• Confidence Interval value is optional and is displayed if supported by selected model.

• Confidence Interval is measure of reliability of disease certainty estimate and determines whether diagnostic workup is complete. When Confidence Interval is high (close to a value of 1.0), disease certainty is high and launching further diagnostic tasks in Dx Guide is unwarranted. When Confidence Interval is low (low decimal values), disease certainty is low.

1.281

Depict utility score as relative or absolute, as appropriate.

• Diagnostic utility score is measure of usefulness of action taken.

1.282

Record prior and post disease certainty scores, prior diagnostic utility score, and selected choice for every node.

Table 5-V (5.15.2.3) — User Interaction Requirements

The following table describes the functional requirements for interaction between the user and Diagnostic

Guide::

ID

Description

Scope

1.283

Allow system to ask user for additional information or actions at action node.

• Response is returned to system and subsequently to diagnostic model, as appropriate.

1.284

Allow user response

of one of three states, once choice is made: Started, Committed and Completed.

• Once possible questionnaire and data are submitted, option becomes committed and cannot be canceled.

• Option works in background to processed submitted information,

• User can cancel process if it is not in Committed or Completed state.

1.285

Allow multiple choices.

• Before user can explicitly choose to proceed and view next options available, all choices must be either completed or canceled with at least one completed action present.

• Cancel button in Status box cancels diagnostic workup and returns

Dx Guide to null state.

• If user has canceled all choices, system returns to original state; original choices still apply and new additional choices are not applicable.

• Any started task (without intent to cancel) or committed task must be completed before user is given option to proceed to next state.

• User can view Lower Utility Options by clicking on LU box and can start lower-utility action by choosing radio button for desired LU option; once opened, LU option has its own box in Diagnosis center canvas.

1.286

Allow user to move to next state.

• All options in current state must have completed before moving forward. Stage status boxes provide current status of all options running. Only when all running options have status of Resulted can user move to next state.

• Move Forward button provides this functionality.

• System takes results of all running options and interprets them to create next state with new current disease certainty percentage and color and associated new options.

• Complete Dx Guide button allows users to end Dx Guide processing when they have accumulated enough data and analysis.

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