Use Case Diagram

3.1.2 New Family Physician - 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 involved jurisdictions (e.g. the jurisdiction where the patient has lived and the jurisdiction where the patient moved and the visit takes place); also, there is two (minimum) EHR.
The receptionist is already logged on the clinic’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 the following key information to find the patient: name, birth date, and provincial 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 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 clinic’s ADT system searches the local POS and doesn’t find the patient (because it’s his first visit to this clinic), and sends a request to EHRi system to 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 the visit takes place), because it’s his first health visit in this jurisdiction.
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 EHRi system returns also a “temporary” unique patient identifier. This “temporary” unique patient identifier (EHRi Transaction Client ID) is always sent with a request to the EHRi system.
Because consent management depends on the legislation of each jurisdiction it is not described in detail in this document.
In this case, the consent is required to obtain and update the demographic and clinical information. The consent is managed with a paper; the consent directive is also recorded in the clinic’s ADT system and sends to EHR Consent registry (of the current jurisdiction) 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 functional capacities of the POS. The definition of an “encounter” also depends on clinical practices of every organization and jurisdiction. In this case, the clinic’s ADT system has the capacity to create an initial “encounter” at the same time as the creation of the admission event.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
When the patient arrives at the clinic, she stops first at the registration desk
Resolution of patient’s identification (in the current jurisdiction)
The receptionist obtains from the patient the key information (ex.: name, birth date, health care number) and enters the data in the clinic’s ADT system.	The POS ADT system searches locally the patient and does not find (because it’s her 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 patient matched any of the input criteria).
	The POS ADT system displays the empty list (because no patient matched any of the input criteria).
Creation of patient record (in the current jurisdiction)
The patient gives her identification information and signs a consent form related to the clinic’s storage and use of her health information.
The receptionist enters the identification information and consent in the clinic’s ADT system.	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 a EHRi Transaction Client ID).
	The POS ADT system displays an acknowledgment about the completed update request.
Adding of patient’s demographic information (in the 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 current jurisdiction)
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.

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