Use Case Diagram

6.1.3 Orthopaedic consultation - Events
Use Case Diagram Health Service Event #1 - Patient Assessment Event Diagram

Actors

Patient
Physician
Hospital’s EMR system (POS)
EHRi systems

Assumptions

There is one jurisdiction involved (e.g. the jurisdiction where the visit takes place is the same as that where the patient lives); also, there is one (minimum) EHR.
The patient is already registered in the hospital’s ADT system.
The hospital’s ADT system is interfaced with the hospital’s EMR system. So, when a patient is created/updated in the hospital’s ADT system, the patient index is automatically updated in the hospital’s EMR system.
The physician is already logged on the hospital’s EMR system.
To resolve the patient’s identification, the provincial health care number is also used, because it is key information to find the patient. In this case, the physician uses the following key information to find the patient: name, birth date, and provincial health care number.
The resolution of the patient’s identification information is also necessary to obtain a “temporary” unique patient identifier from the EHR, to allow the user to view and update the patient’s record. The “temporary” unique patient identifier (EHRi Transaction Client ID) is provided by the EHRi only for one user session (without a break in the time), for the same patient and the same provider (person) who are engaged in the health service event. If there is an interruption during a health service, this becomes another health service event, and another resolution of the patient’s identification is required to obtain another “temporary” unique patient identifier (EHRi Transaction Client ID).
The physician wants to see encounters related to a prior knee injury.
The summary list of health service encounters contains only the key identifiers of each selected (with parameters) health service encounters.
The detail of the selected health service encounter can contain many events (ex.: admission, illness history, exam, diagnosis, prescription) and sub-events.
The hospital’s EMR system can displays the x-ray in digital format on a screen with diagnostic quality.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
The physician reviews the referral letter sent to him by patient’s clinic partner to understand the reason for the consultation.
The physician then takes a history of the current injury along with patient’s past medical and surgical history.
The patient reports a prior injury to a knee years ago, although he cannot recall which side was affected The patient that the injury assessed by a different orthopaedic surgeon in a community office
The physician examines the knee.
Resolution of patient’s identification (in the current jurisdiction)
The physician accesses patient’s record and enters patient’s identification information in the hospital’s EMR system.	The POS EMR system searches locally and finds the patient. The POS EMR system sends, to the EHRi system, a request with the key information (ex. name, birth date, provincial health care number) (and to obtain a EHRi Transaction Client ID).	The EHRi system searches and finds for the client in the current jurisdiction, with the provided key information (ex. name, birth date, provincial health care number).	EHRIP10 Search Patient
		The EHRi System Client Registry returns, to POS system, the corresponding patient record (with a EHRi Transaction Client ID).
	The POS EMR system displays the corresponding record of current patient.
View the health service encounters (in the current jurisdiction)
The physician does a request through the hospital EMR system to the information related to a prior knee injury.	The POS EMR system sends, to the EHRi system, a search request with the criteria of health service encounters related to a prior knee injury for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds the health service encounters related to a prior knee injury for the current patient (for the EHRi Transaction Client ID).	EHRIP12 List Events (Event Type = Encounters “Knee Injury”)
		The EHRi system returns, to POS system, a summary list with key identifiers indicated in the health service encounters.
	The POS EMR system displays the summary list with key identifiers indicated in the health service encounters.
View details of each of health service encounters
The physician looks at the summary list of health service encounters and selects an encounter to see more detail. (the physician can repeat this step for each health service encounter as needed, and depending on the health service encounter structure)	The POS EMR system sends, to the EHRi system, a search request, with the key identifiers indicated in the selected health service encounter, to find the detail of the selected health service encounter for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches, with the key identifiers indicated in the selected health service encounter, and finds every contained event in the selected health service encounter.	EHRIP12 List Events
		The EHRi system returns, to POS system, a health service event list.
	The POS EMR system displays the health service event list.
The physician looks at the summary list of health service events and selects an event to see more detail. (the physician can repeat this step for each health service event as needed, and depending on the health service event structure)	The POS EMR system sends, to the EHRi system, a search request, with the key identifiers indicated in the selected health service event, to find the detail of the selected health service event for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches, with the key identifiers indicated in the selected health service event, and finds the detail of event in the selected health service event.	EHRIP13 Get Event
		The EHRi system returns, to POS system, the detail of health service event.
	The POS EMR system displays the detail of health service event.
The physician obtains the x-ray image that was done shortly after the recent injury and confirms that there was no fracture. He chooses not to repeat the image.
The physician obtains a consultation report from a colleague who described a mild injury to the opposite knee.
The physician’s diagnosis for the current injury is a complete ACL tear with possible medial meniscus tear.
The physician completes the appropriate paper referral form to refer the patient to a physiotherapist for rehab.

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General Info
Name	Health Service Event #1 - Patient Assessment Event Diagram
Type	Use Case Diagram