User stories as lightweight requirements for agile clinical decision support development

Vaishnavi Kannan, Mujeeb A. Basit, Puneet Bajaj, Angela R. Carrington, Irma B. Donahue, Emily L. Flahaven, Richard Medford, Tsedey Melaku, Brett A. Moran, Luis E. Saldana, Duwayne L. Willett, Josh E. Youngblood, Seth M. Toomay

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: We sought to demonstrate applicability of user stories, progressively elaborated by testable acceptance criteria, as lightweight requirements for agile development of clinical decision support (CDS). Materials and Methods: User stories employed the template: As a [type of user], I want [some goal] so that [some reason]. From the "so that" section, CDS benefit measures were derived. Detailed acceptance criteria were elaborated through ensuing conversations. We estimated user story size with "story points," and depicted multiple user stories with a use case diagram or feature breakdown structure. Large user stories were split to fit into 2-week iterations. Results: One example user story was: As a rheumatologist, I want to be advised if my patient with rheumatoid arthritis is not on a disease-modifying anti-rheumatic drug (DMARD), so that they receive optimal therapy and can experience symptom improvement. This yielded a process measure (DMARD use), and an outcome measure (Clinical Disease Activity Index). Following implementation, the DMARD nonuse rate decreased from 3.7% to 1.4%. Patients with a high Clinical Disease Activity Index improved from 13.7% to 7%. For a thromboembolism prevention CDS project, diagrams organized multiple user stories. Discussion: User stories written in the clinician's voice aid CDS governance and lead naturally to measures of CDS effectiveness. Estimation of relative story size helps plan CDS delivery dates. User stories prove to be practical even on larger projects. Conclusions: User stories concisely communicate the who, what, and why of a CDS request, and serve as lightweight requirements for agile development to meet the demand for increasingly diverse CDS.

Original languageEnglish (US)
Pages (from-to)1344-1354
Number of pages11
JournalJournal of the American Medical Informatics Association
Issue number11
StatePublished - Jul 22 2019


  • agile development
  • clinical decision support
  • electronic health records
  • implementation
  • requirements

ASJC Scopus subject areas

  • Health Informatics


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