Use Case Diagram

6.1.2 ER Knee - Events
Use Case Diagram Health Service Event #1 - Pre-exam Event Diagram

Actors

Patient
ER nurse
ER’s EMR system (POS)
EHRi systems

Assumptions

There are two involved jurisdictions (e.g. the jurisdiction where the patient lives and the jurisdiction where the patient is on vacation and the visit takes place); also, there is two (minimum) EHR.
The patient already exists in the EHR of the current jurisdiction because the patient was previously assessed at a rural community health centre of this jurisdiction (where the patient is on vacation).
The patient is already registered (for the first time) at the ER. So, the patient is created in the hospital’s ADT system and in the EHR (including the Client registry) of jurisdiction where the ER visit takes place (e.g. the current jurisdiction).
The hospital’s ADT system is interfaced with the ER’s EMR system. So, when a patient is created/updated in the hospital’s ADT system, the patient index is automatically updated in the ER’s EMR system.
The ER nurse is already logged on the ER’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 ER 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).
The “health profile” is an organized collection of specific events, whose definition depends on practices of each organization and jurisdiction. In this case, two jurisdictions are involved but the ER nurse wants to see the “health profile” for the current jurisdiction.
The updating of “health profile” is only the adding of patient’s events in the EHR of the current jurisdiction.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
The patient is taken from the waiting room to an examination room by an ER nurse.
Resolution of patient’s identification (in the current jurisdiction)
The ER nurse verifies the identification information and enters them in the ER’s EMR system.	The POS EMR system searches and finds locally the identification of 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 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 patient record (with a EHRi Transaction Client ID).
	The POS EMR system displays the corresponding record of current patient.
Record of collected clinical data (in the current jurisdiction)
The ER nurse reviews the reason for the visit and acquires information from patient about any allergies and current medications.
David is feeling the effects of the recent narcotic analgesic and is a bit vague in providing history.
The ER nurse obtains his blood pressure, heart rate and temperature, and records this data in the ER’s EMR system.	The POS EMR system is updated with the collected clinical data. The POS EMR system sends, to the EHRi system, an update request to record the collected clinical data for the current patient (for the EHRi Transaction Client ID).	The EHRi system adds the new collected clinical data 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.
Consultation of patient’s health profile (for the current jurisdiction)
The ER nurse accesses the ER’s EMR system to view the patient’s health profile.	The POS EMR system sends, to the EHRi system, a search request to obtain the patient’s health profile for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds (in current jurisdiction) the information of health profile for the current patient (for the EHRi Transaction Client ID).	EHRIP09 Get Patient Health Profile
		The EHRi system returns, to POS system, the health profile for the current patient.
	The POS EMR system receives, organizes and displays the patient’s health profile.
The ER nurse sees patient’s health profile.
Update of patient’s health profile (in current jurisdiction)
The ER nurse notes the allergy to non-steroidal anti-inflammatory drugs (NSAIDs).	The POS EMR system updates the local health profile. The POS EMR system sends, to the EHRi system, an update request to record the allergy event for the current patient (for the EHRi Transaction Client ID).	The EHRisystemadds the allergy event (for the EHRi Transaction Client ID).	EHRIP15 Put Event (Event Type = Allergy)
		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.

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General Info
Name	Health Service Event #1 - Pre-exam Event Diagram
Type	Use Case Diagram