Use Case Diagram

1.1.1 New Family Physician Visit - Events
Use Case Diagram Health Service Event #1 - Clinic Visit Admission Event Diagram

Actors

Patient
Receptionist
Clinic’s ADT system (POS)
EHRi systems

Assumptions

There are two jurisdictions involved (e.g.the jurisdiction where the patient lives and the jurisdiction where thevisit takes place); also, there is two (minimum) EHR.
The receptionist is already logged on theclinic’s ADT 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 receptionist uses thefollowing key information to find the patient: name, birth date, andprovincial health care number.
The resolution of patient’s identification is also necessary to obtain a “temporary” unique patient identifier, from EHR, to allow the consultation and the update of 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 serviceevent, and another resolution of the patient’s identification is requiredto obtain another “temporary” unique patient identifier (EHRi Transaction Client ID).
The clinic’s ADT system searches the local POS and doesn’t find the patient (because it’s the first visit tothis clinic), and sends a request to EHRi systemto obtain the client’s identification information
The EHRi system does not find the client in the EHR Client Registry of the current jurisdiction (e.g. where thevisit takes place), because it’s his first health visit in thisjurisdiction.
The patient is then created in the clinic’s ADT system and also in the EHR Client registry of the current jurisdiction (e.g. where the clinic visit takes place); in this case, the EHRisystem returns also a unique patient identifier. This unique patientidentifier is always sent with a request to the EHRi system.
Because consent management depends on thelegislation of each jurisdiction it is not described in detail in thisdocument.
In this case, the consent is required to obtain and update the demographic and clinical information. The consent is managed with a paper document; the consent directive is also recorded inthe clinic’s ADT system and sent to EHR Consent registry (of the currentjurisdiction) at the same time as the request to create the client.
The grouping of events realized during a same “encounter” depends and varies according to the functionality of the POS. The definition of an “encounter” also depends on clinical practices of every organization and jurisdiction. In this case, the clinic’s ADTsystem has the ability to create an initial “encounter” at the same timeas the creation of the admission event.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
The patient checks in at the clinic’s registration desk.
Resolution of patient’s identification (in thecurrent jurisdiction)
Using the clinic’s ADT system, the receptionist enters key information (ex. name, birth date, provincial health care number) to search for the patient.	The POS ADT system searches locally the patient and does not find (becauseit’s his first visit at this clinic). The POS ADT system sends a request, to the EHRi system, with the key information (ex. name, birth date, provincial health care number) to search for the patient.	The EHRi system searches 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 does not find the client in the current jurisdiction and returns, to POS system, an empty list (because no patientmatched any of the input criteria).
	The POS ADT system displays the empty list (because no patientmatched any of the input criteria).
Creation of patient’s record (in the currentjurisdiction)
The receptionist asks the patient to give their identifying information and consent.
The patient gives the identifying information and signs a consent form relating to the use of his health information.
The receptionist enters, into the clinic’s ADT system, the patient’s identifying information and the consent directive.	The POS ADT system adds the new patient with the consent directive. The POS ADT system sends, to the EHRi system, an update request to create a new client record and to add the consent directive for this jurisdiction.	The EHRi system adds a new client record into the EHR Client registry with the patient’s identifying information. The EHRi system synchronizes with others jurisdictional EHR Client registries. The EHRi system adds the client’s consent directive for the current jurisdiction.	EHRIP11 Add New Client Registry Patient
		The EHRi system returns, to POS system, an acknowledgment that the update request is completed (with the EHRi Transaction Client ID).
	The POS ADT system displays an acknowledgment about the completed update request.
Adding of patient’s demographic information (inthe current jurisdiction)
The receptionist records the demographic information in the clinic’s ADT system: Address, Phone number, Email, Emergency contact person, Emergency contact number.	The POS ADT system adds the demographic information for the current patient. The POS ADT system sends, to EHRi system, an update request to add the demographic information for the current patient (for the EHRi Transaction Client ID).	The EHRi system adds the demographic information for the current patient (for the EHRi Transaction Client ID).	EHRIP06 Add New Patient
		The EHRi system returns, to POS system, an acknowledgment that the update request is completed.
	The POS ADT system displays an acknowledgment about the completed update request.
Record the clinic admission (in the currentjurisdiction)
The receptionist records patient’s admission in the clinic’s ADT system.	The POS ADT system records the admission for the current patient. The POS ADT system sends, to the EHRi system, an update request to record the admission event and create a health service encounter for the current patient (for the EHRi Transaction Client ID ).	The EHRi system adds the new admission event for this provider, and links this event with a new health service encounter for the current patient (for the EHRi Transaction Client ID). The EHRi system adds a role event to identify the patient role for the current client (for the EHRi Transaction Client ID), for this provider.	EHRIP15 Put Event
		The EHRi system returns, to POS system, an acknowledgment that the update request is completed.
	The POS ADT system displays an acknowledgment about the completed update request.
Creation of patient’s paper chart
The receptionist creates a paper chart for the patient.

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General Info
Name	Health Service Event #1 - Clinic Visit Admission Event Diagram
Type	Use Case Diagram