Use Case Diagram

3.1.1 Depression Assessment - Events
Use Case Diagram Health Service Event #2 – Patient Assessment Event Diagram

Actors

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

Assumptions

The physician uses an EMR system and he is already logged on this system.
The clinic’s ADT system is interfaced with the clinic’s EMR system. So, when a patient is created/updated in the clinic’s ADT system, the patient index is automatically updated in the clinic’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 the ten most recent health service encounters doesn't much matter the place where they took place; the EHRi system localizes the patient in one jurisdiction.
The concept of information masking (and unmasking) is presented here, but the functioning of this one is left with the discretion of jurisdictions considering their legislations and practices. However, the indication that information is masked must be shown.
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.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
The physician attempts to get patient to talk about her current symptoms.
The patient is not very forthcoming about how she is feeling but is occasionally tearful. The patient describes vague abdominal symptoms and hints at having had medical treatment lately.
The physician is concerned and decides to access patient’s EHR, through the clinic’s EMR system, to see if there is any recent information there that might be relevant.
Resolution of patient’s identification (in the current jurisdiction)
The physician verifies the identification information with the patient, and enters them in the clinic’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 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.
View the health service encounters (in the current jurisdiction)
The physician confirms the patient’s identity with the patient, and does a request through his clinic’s EMR system to see the ten most recent health service encounters.	The POS EMR system sends, to the EHRi system, a search request with the criteria of ten most recent health service encounters for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and findsthe ten most recent health service encounters for the current patient (for the EHRi Transaction Client ID).	EHRIP12 List Events (Event Type=Encounter)
		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.
The physician looks at the summary list of health service encounters.
View unmasked information
The physician sees that there is masked information and asks to the patient about this. The physician talks with the patient about the potential relevance.
The patient confides in physician what has happened and gives him permission to unmask the requested records through the clinic’s EMR system.	The POS EMR system sends, to the EHRi system, a request to unmask the information for the current patient (with the EHRi Transaction Client ID).	The EHRi system records the unmask event and retrieve the corresponding information for the current patient (for the EHRi Transaction Client ID).	EHRIP14 Unmask Patient Information
		The EHRi system returns, to POS system, the unmasked information.
	The POS EMR system receives and refreshes the display with the unmasked information.
View details of each 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 is able to then view all of other physician clinical notes, the lab results and the pharmacy records.
The physician has a clear picture of what has recently transpired and is able to get patient to open up more.
The physician diagnoses depression and recommends patient sees a community psychologist and return for follow up.

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General Info
Name	Health Service Event #2 – Patient Assessment Event Diagram
Type	Use Case Diagram