Test Intake Form Revision
Impact analysis
Calculated from the submitted answers by fixed rules.
20/ 100
Contained enough to be decided close to the work.
- Recommended review route
- Department / Site Manager
- Highest individual impact identified
- Minor
- What drove this score
- How severely those areas are affected · How severely those groups are affected · Departments affected
Where the points came from
- How many areas are affected2.7 / 15
2 of the 11 listed areas were rated above N/A.
- How severely those areas are affected5.0 / 15
Across the 2 areas that were rated, the average is 1.0 on the Minor-to-Major scale. Areas marked N/A are excluded here — they are counted in the breadth dimension above.
- Departments affected3.0 / 15
1 of 5 departments were selected.
- Operational categories affected1.3 / 10
1 of the 8 operational categories were answered Yes.
- How many stakeholder groups are affected2.5 / 10
2 of the 8 stakeholder groups were rated above N/A.
- How severely those groups are affected3.3 / 10
Across the 2 groups that were rated, the average is 1.0 on the Minor-to-Major scale.
- Compliance and risk position0.0 / 10
Compliance review: no. Risk assessment: yes. A completed risk assessment scores zero here — the points reflect what is outstanding.
- Implementation complexity2.0 / 15
Training no, pilot no, rollback plan yes, 1 communication method, go-live in 17 days.
This score reflects the breadth and severity of the structured impacts identified in the request. Written descriptions provide review context but do not directly change the score.
How this was calculated
Each dimension is scored against its own maximum and the eight are added together. Grid questions are read twice, once for breadth and once for severity, because those are different questions with different denominators:
- Breadth counts rows marked N/A in the denominator. That is what makes a change touching one of eleven areas read as narrow, and a change touching eight read as wide.
- Severity excludes them. One area hit as hard as possible is fully severe; it should not read as mild merely because the form lists eleven areas.
The highest individual impact identified above is a fact about the answers, not a second classification. Its role in the calculation is to trigger the escalation floors below.
- Weighted total
- 19.8 / 100
- After escalation floors
- 19.8 → displayed as 20
- Classification bands
- Minor below 50 · Moderate 50–74 · Major 75 and above
- Scoring version
- change-impact-score-v1
These weights are a draft. They were proposed for review and have not been approved as IDEL policy. Changing them produces a new scoring version, so past scores keep meaning what they meant when they were calculated.
Overview
- Organization
- Test Community Health
- Requestor
- Test Submitter One
- Role
- Admin Staff
- Executive sponsor
- Test Executive B
- Date submitted
- Jul 24, 2026
- Target go-live
- Aug 10, 2026in 4 days
- Departments impacted
- Patient Services
- Rationale
- Process / Workflow Adjustment
- Assigned reviewer
- Unassigned
Description of change
Fictional demonstration record. Reorders two questions on the intake form and adds a short clarifying note.
Affected areas
- Patient ServicesMinor
- Billing / Revenue CycleMinor
Description of impact
Two questions move; nothing else changes.
Compliance and risk
- Is a regulatory or compliance review required?
- No
- Has a Risk Assessment been completed?
- Yes
Operational impact
- Clinical CareNo
- IT & DataNo
- Finance & Revenue CycleNo
- Patient Access & ExperienceYes
- Workforce & StaffingNo
- Operational & AdminNo
- Equity & AccessNo
- OtherNo
Stakeholders
- Front DeskMinor
- PatientsMinor
Engagement strategy
Reviewed with the front-desk team at a standing meeting.
Training, communication, and implementation
- Training required
- No
- Training formats
- No Training Required
- Communication methods
- Email update(s)
- Pilot
- No
- Rollback plan
- Yes
- Target go-live
- Aug 10, 2026
Review activity
History
- DraftTest Submitter One · Jul 20, 2026, 9:00 AM
- Draft → SubmittedTest Submitter One · Jul 24, 2026, 4:40 PM
Workflow
Recommended next steps
For a Minor change. Current status: Submitted.
- 1.Department or Site Manager review
- 2.Confirm the affected team
- 3.Confirm the communication approach
- 4.Approve, revise, or return the request
These steps follow from the impact level. They are recommendations — the platform does not record any of them as complete, and none of them is an approval.
Established impact logic
The earlier reading, kept for continuity. The official classification is the impact score above.
- Highest individual impact identified
- Minor
- Recommended review route
- Department / Site Manager
How this was reached
- Highest affected-area impact: Minor.
- Highest stakeholder impact: Minor.
- Overall impact is the higher of the two: Minor.
- Recommended review route: Department / Site Manager. Overall impact: Minor. This is a routing recommendation and does not record an approval decision.
- Moderate areas
- 0
- Major areas
- 0
- Moderate stakeholders
- 0
- Major stakeholders
- 0
- Unresolved items
- 0
- Days to go-live
- 17
These figures describe the answers; they are not a second classification. This request has one official classification, shown with the impact score above. The recommended route indicates who should review this change. It does not record that an approval has been given. Calculated by logic revision cia-logic-v1 from the answers as submitted.
IDEL internal
- Client
- Test Community Health
- Request id
- req_th_005
- Template version
- change-impact-analysis-v1
- Submitted by (member)
- mem_th_submitter
- Internal notes
- 0 on this request
This panel and every internal note are excluded from client responses by the serializer, not by this page.
Impact reference
- Minor
- Form update, scripting change — Department / Site Manager
- Moderate
- Workflow change across multiple departments — Operations Leader
- Major
- New service line, major EHR change — CEO / Board
Highest individual area rating: Minor · Highest individual stakeholder rating: Minor