Phase 1: Discovery - What are the problems? How can technology assist with this problem?

Phase 2. Requirements collection - Goal: to gather and document business requirements

Phase 3. Design - Goal: to translate software development requirements into design

Phase 4. Software development - Goal: To build the actual software

Phase 5. Testing & Tweak- Goal: To ensure the software meets requirements

Phase 6. Deployment - Goal: To deliver completed software to users

Phase 7: Continuous Improvement - Goal: To add, revise, improve functionality per user needs

Phase 1: Discovery - What are the problems? How can technology assist with this problem?

Open

1. Define the audience(s)/stakeholders who will inform the design. Who is impacted? Who are the gatekeepers who will decide if they will use/not use this tool?

   1. Informatics (at CHCs?)

   2. Data

   3. Clinical

   4. Community Health Workers

• Point person as main contact/champion

  • prepare detailed documents that support what is needed for this person to know

  • this person recruits, knows what is needed, who to recruit, how much time, room, food, av, type of person who needs to be there, number of people

  • confidentiality form - Ellen has a form she uses to get permission to be show in pix and video. Sarah and Wanda have them.

• Informational interviews

• Design group of staff

• Design group of patients

Budget Implications

• Honoraria for health centers to comensate for admin time

• Facilitator

• Report writer

• Travel

Phase 2. Requirements collection - Goal: to gather and document business requirements

• Develop user stories examples of how this app could help solve pain points

• Gather Business Requirements: stakeholders, assumptions, high-level system requirements (does this go in Phase 2 or in 3?)

Phase 3. Design - Goal: to translate software development requirements into design

• Write Software Requirements Document (see example Table 1 - check with software developers to see if they use a different kind of form)

Phase 4. Software development -Goal: To build the actual software

• Done by software development company in consultation with NACHC

• Meet with software company periodically to go down the list of requirements and check off those that are addressed, entertain questions about any that need discussion.

Phase 5. Testing & Tweak- Goal: To ensure the software meets requirements

• User Acceptance Testing with 3-5 of each type of user, individually via interview. Focus group(s) optional.

Phase 6. Deployment - Goal: To deliver completed software to users

• Work with CAD Comms and users to identify channels and messages

• CAD Comms creates materials and disseminates

Phase 7: Continuous Improvement - Goal: To add, revise, improve functionality per user needs

Table 1

Open

Julia, Ray, Kathy, Andrea

KM: Think strategically about where we are now, regardless of funding stream, what do CHCs need? Best data we have for VAP is on the FHIR app… the CHWs want to rely on their spreadsheets, don’t have access to EHR.

“FHIR app is the solution for data and for care teams for data and patient engagement outside the four walls of the clinic.”

CHWs do not have the decision-making power re: adopting the app.

 Three types of users for the apps

• HIV negative ppl - no need to integrate with EHR - just messaging and CHC can decide if they want to use those messages.

• VAP - same but sicker - homeless, with HIV, doing sex for work

•  SUD/OUD could linked ppl to care,

Develop a detailed protocol and have CHCs be the ones to conduct tests, work with their vendors etc., better than trying to do from central location (i.e., NACHC)

Sequencing - next step after engagement of the site, is engagement of vendors (JS - all at the same meeting so they can compete) - organize a strategy meeting - what do we want over the next few years…

JS: What is budget for planning activities with vendors? CHCs?

KM: Apart from funding streams, how do we engage vendors in FHIR apps.  That's what is missing.  There are multipliers - UDS Plus, FOM/IT, ask the vendors do a session at FOM/IT on API.

Work with Philip to help us find the right contacts at the vendors.  Many health centers are not getting a response from their vendor - even 2-3 weeks when something goes wrong.

How to narrow it to be successful rather than chunk off too much

1. Work with Philip, id 2 major vendors they get invited to meetings, to FOM/IT,

   1. FHIR app

   2. Terminology problems

   3. Other things

2. Partner with the networks who use those vendors

 Get vendors together and make JS points

• We can make you look good in the marketplace

• You will have an edge

• Work with us to help us create the workplace to do this over and over again.

• We have reach into the CHC world

Epic - problematic

Athena - is open but slow moving

Nextgen - JS will approach

Cerner - very good but we don't have Cerner clients

KM: Vendor roundtable - this is what CHCs are saying they need, what are you doing towards that goal?  Engage in a discussion as to where they are going…

KM: We need to be able to influence the vendors and convince them persuade them that the future is/issue is for example with HIV users are healthy, they are not sick, they want to use an app not going into the clinic.  High tech low touch.

KM: RFP closes tonight for Learning Community - mostly on pain management, not IT.  If there are 10 really strong health centers - would you also be willing to look at elements for care management, etc the technical people not the ones who originally applied.  10 CHCs? 5?

JS: We do have partners who want to test.
KM: We need to wait until we find out -how much CAI can pay
OUD SUD figure out what the data elements are what do we need? More meetings? Yes - in June and July 2 more sessions with kate and ??

OUD end point? we said we'd do a FHIR app.

For FOM/IT meeting meetings with vendors: Find out who they send and tell them we are setting this up and who would they suggest.
1. Data terminology
2. UDS Plus mapping
3. FHIR apps
Invite them and say we need ppl who can answer these 3 questions not a sales person.

 Kathy will reset the meetings that LeeAnn had set up Courtney is out for 3 months.

Andrea

Some thoughts...on CAI Task 5 - 856-01 CAI Global - Confluence (atlassian.net)

856-02 Detailed Implementation Plan for pilot partners DRAFT 2023-03-31[2305843009215849045].docx

Andrea

Should we propose that NACHC CAD engage a consulting company experienced in UAT and/or the front end of user development instead of building this expertise inside NACHC? Pros? Cons? What kind of consultant - UAT? Voice of the Customer?

Andrea

Consider: Should we combine LeeAnn’s model and Andrea’s Phases?

Andrea

Introduce document and request LeeAnn’s review and thinking about 856-02 Detailed Implementation Plan for pilot partners DRAFT 2023-05-17.docx

LeeAnn

Workplan and budget progress - review?

What data is collected by the app store - they only know it was downloaded once. Not if it is being used.

Who else sees the data collected?

Andrea

What is meant by iInteroperability?

User will have the option to share info to CHC care team and (anything other than “share”? see appointments?)

Care Team will have the option to (read the content allowed by the patient – risk score, desire for appt, desire for PrEP)?

EHR will… store info that comes in as messages from the app in the right place???

Desired Outcomes:

1. Define the needs for centralization of FHIR App software development and the projects to which these apply

2. Define roles and responsibilities

   1. Julia and Ray are ultimate owner of the FHIR apps - they are SMEs on standardized data elements from data dictionary, measurements from the Bureau, interoperability, value sets.

   2. LeeAnn and Andrea work on each project (funding streams) - design and execute

      1. OUD - From the beginning

      2. CAI - Testing

3. Establish timeline(s)

Agenda

1. Describe the ideal situation – Kathy - 5 min

   1. One FHIR app, with different funding streams and different end users

   2. Standardized how we test and roll out

   3. Need a systematic way to standardize and test with end users (or any time there is software development) - standardize the way we engage end-users in the development process.

   4. How much is content knowledge important on the part of end users, or is it more about how we functionally use apps.

2. Describe each product and its current state – All – 2 min

   1. VAP - Product is out there, being used by one health center. Posted on athena. July 31st end of year, new funding likely.

   2. CAI - Product is there. Launching a new year. Project year just began April 1.

   3. OUD - Initiating requirements gathering process. Project year ends July 31.

3. Review software development model 35 min

4. Discuss roles, responsibilities, timeline

5. Next steps 5 min

Software Development Model (LeeAnn and Andrea to further develop)

Phase 1: Discovery - What are the problems? How can technology assist with this problem?

1. Define the audience(s)/stakeholders who will inform the design. Who is impacted? Who are the gatekeepers who will decide if they will use/not use this tool?

   1. Informatics (at CHCs?)

   2. Data

   3. Clinical

   4. Community Health Workers

• Point person as main contact/champion

  • prepare detailed documents that support what is needed for this person to know

  • this person recruits, knows what is needed, who to recruit, how much time, room, food, av, type of person who needs to be there, number of people

  • confidentiality form - Ellen has a form she uses to get permission to be show in pix and video. Sarah and Wanda have them.

• Informational interviews

• Design group of staff

• Design group of patients

Budget Implications

• Honoraria for health centers to comensate for admin time

• Facilitator

• Report writer

• Travel

Phase 2. Requirements collection - Goal: to gather and document business requirements

• Develop user stories examples of how this app could help solve pain points

• Gather Business Requirements: stakeholders, assumptions, high-level system requirements (does this go in Phase 2 or in 3?)

Phase 3. Design - Goal: to translate software development requirements into design

• Write Software Requirements Document (see example Table 1 - check with software developers to see if they use a different kind of form)

Phase 4. Software development -Goal: To build the actual software

• Done by software development company in consultation with NACHC

• Meet with software company periodically to go down the list of requirements and check off those that are addressed, entertain questions about any that need discussion.

Phase 5. Testing & Tweak- Goal: To ensure the software meets requirements

• User Acceptance Testing with 3-5 of each type of user, individually via interview. Focus group(s) optional.

Phase 6. Deployment - Goal: To deliver completed software to users

• Work with CAD Comms and users to identify channels and messages

• CAD Comms creates materials and disseminates

Phase 6: Continuous Improvement - Goal: To add, revise, improve functionality per user needs

Table 1

Action Items

OUD

CAI -

Contracts - Budget and timeline for user testing, interoperability testing

Andrea and LeeAnne

We each know what the other is thinking for software development process and user acceptance testing.

We have identified any needs/gaps in knowledge (should UAT be designed by or done by a consultant?  HealthFlow does not have this strength).

 Assignment – watch 1-2 videos from Linked in Learning or read a web site that explains the process of UAT.

Possible discussion topics:

• Review Kathy’s comments

• Discuss typical software development process - what we do, what HealthFlow does, where to find information.

• Andrea ask LeeAnn for help with questionnaire

• Discuss learnings from LinkedIn Learning and web research (see notes below)

• Invite Sarah P to talk about what she would do differently and critique the plan?

 Andrea’s notes and thoughts prompted by Linked In Learning

1. There is a standard software development process. HealthFlow takes direction from us, but we are not equipped, experienced, or using a traditional software development process on our end. Example of STEVE (State and Territorial Exchange of Vital Events) -I managed a major overhaul and was guided through the process by the software developers. There is a whole process starting with requirements gathering. LeeAnn dis-covered that in her thinking process, i.e., asking potential users what they want rather than starting with what we think they need.

2. Agile vs Waterfall

   1. Software development process

Establish requirements now (Source 2)

Establish acceptance criteria (Source 2)

Phase 1. Requirement collection - Goal: to gather and document business requirements

• Develop user stories for what you WANT the software to do

• Gather requirements (there is an entire field on this - and a format for requirements that makes it easy to communicate to the software developers)

Phase 2. Design - Goal: to translate software development requirements into design

Phase 3. Software development -Goal: To build the actual software

Phase 4. Testing - Goal: To ensure the software meets requirements

Phase 5. Deployment - Goal: To deliver completed software to users

Source: https://ncube.com/blog/software-development-life-cycle-guide

LeeAnn is developing an app for Opioid care plan app.

We are doing software development for three projects:

• AIM care plan app - 1 out of 15 sites is using the app.

•  Opioid Care plan

•  CAI HIV Care plan app