Use Case Diagram

3.1.2 New Family Physician - 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 five last health service encounters doesn't much matter the place where they took place (because there is two involved jurisdictions); the EHRi system localizes the patient in two jurisdictions.
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 talks with the patient about her symptoms.
The patient feels very comfortable with the physician and relates her history.
Given the presenting problem of this new patient, the physician chooses to quickly view the most recent information and searches for the last five encounters with the health care system.
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 two involved jurisdictions)
The physician confirms the patient’s identity with the patient, and does a request through his clinic’s EMR system to see the last five health service encounters.	The POS EMR system sends, to the EHRi system, a search request with the criteria of last five health service encounters for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds (in the two involved jurisdictions) the last five 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.
View unmasked information
The physician sees that there is masked information and the patient gives the permission to unmask her records and view the content 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 views the clinic notes from other physician and the psychologist, and also happens to notice the abnormal Pap result.
The physician is able to see the referral for colposcopy but realizes there is no colposcopy report in the record. The physician asks patient about this, who reports she did not feel up to going to the appointment, so did not attend.
The physician realizes she must follow up on the Pap result, in addition to addressing the presenting complaint of depression.
The physician counsels patient about her depression and prescribes an antidepressant medication. The physician refers the patient to a gynaecologist.

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