Use Case Diagram

8.1.1 Birth of the Twins - Events
Use Case Diagram Health Service Event #1 - Birth of the Twins Event Diagram

Actors

Patient
Midwife
Obstetrical nurse
Pediatric medical and nursing staff
Hospital’s EMR system
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 mother 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 obstetrical nurse is already logged on the hospital’s EMR system.
To resolve the patient’s (mother’s) identification, the provincial health care number is also used, because it’s key information to find the patient. In this case, the obstetrical nurse 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).

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
The midwife who has followed patient through the pregnancy assesses her and the presentation of each twin is favourable for a vaginal delivery.
Throughout the labour, the obstetrical nurse accesses to hospital’s EMR system to keep a record of events.
Resolution of patient’s identification (in the current jurisdiction)
The obstetrical nurse enters the patient’s identification information in the hospital’s EMR system.	The POS EMR system searches locally and finds the patient (because she is a patient of this hospital). The POS EMR system sends, to the EHRi system, a request with the key information (ex. name, birth date, provincial health care number) to search for the patient (and to obtain a EHRi Transaction Client ID).	The EHRi system searches the client, in the current jurisdiction, with the provided key information (ex. name, birth date, provincial health care number) and finds the client.	EHRIP10 Search Patient
		The EHRi System Client Registry returns, to POS system, the corresponding client record (with a EHRi Transaction Client ID).
	The POS EMR system displays the corresponding record of current patient and the local information (e.g. patient’s consent directive).
Record obstetrical events (in the current jurisdiction)
The obstetrical nurse enters in the hospital’s EMR system this information: - Labour stage times, - Type of delivery, - Procedures, - Medications, - Time of birth, - Gender baby, - APGAR scores.	The POS EMR system is updated with the obstetrical events. The POS EMR system sends, to the EHRi system, an update request to record the obstetrical events for the current patient (for the EHRi Transaction Client ID).	The EHRi system adds the obstetrical events for the current patient (for the EHRi Transaction Client ID).	EHRIP15 Put Event
		The EHRi system returns, to POS system, an acknowledgment that the update request is completed.
	The POS EMR system displays an acknowledgment about the completed update request.
Birth of twins
Eight hours later patient gives birth to the first twin.
Ten minutes after that the second twin is born.
Each twin is being attended to by the pediatric medical and nursing staff.

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General Info
Name	Health Service Event #1 - Birth of the Twins Event Diagram
Type	Use Case Diagram