Use Case Diagram

3.1.4 Telehealth Consultation - Events
Use Case Diagram Health Service Event #1 – Hospital visit admission Event Diagram

Actors

Patient
Admitting clerk
Hospital’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 admitting clerk is already logged on the hospital’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 admitting clerk 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 hospital’s ADT system searches the local POS and doesn’t find the patient (because it’s her first visit to this hospital), and sends a request to EHRi system to obtain the client’s identification information.
The EHRi system finds the client in the EHR Client registry of the current jurisdiction (e.g. where the patient moved and where the visit takes place), because the patient already exists in the jurisdictional EHR. The EHRi system returns the client’s identification information with a “temporary” unique patient identifier; this “temporary” unique patient identifier (EHRi Transaction Client ID) is always sent with a request to the EHRi system.
The patient is then created in the hospital’s ADT system with the data coming from EHR of the current jurisdiction.
The hospital’s ADT system is interfaced with the hospital’s EMR system. So, when a patient is created/updated in the hospital’s ADT system, the patient index is automatically updated in the hospital’s EMR 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 directive is recorded in the hospital’s ADT system and sends to EHR Consent registry (of the current jurisdiction) at the same time as the request to create the client, but only the consent directive is added in the EHR because the client already exists.
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 hospital’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
The patient presents to the local community hospital with the referral (given by her family doctor) for a psychiatric Telehealth consultation.
Resolution of patient’s identification (in the current jurisdiction)
The patient gives her full name, birth date and provincial health care number.
The admitting clerk checks in the patient through the hospital’s ADT system (with key information).	The POS ADT system searches locally the patient and does not find (because it’s her first visit at this hospital). The POS ADT system sends, to the EHRi system, a request 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) and finds the client.	EHRIP10 Search Patient
		The EHRi System Client Registry returns, to POS system, the corresponding client record (with a EHRi Transaction Client ID).
	The POS ADT system displays the corresponding record of current patient.
Creation of patient record (in the current jurisdiction)
The admitting clerk verifies the information with the patient and asks her consent regarding the storage and use of her health information.
The patient confirms the information and gives her consent.
The admitting clerk records the identification information and the patient’s consent in the hospital’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 add the consent directive for the current patient (for the EHRi Transaction Client ID), for this provider in the current jurisdiction.	The EHRi system adds the patient’s consent directive for this provider in the current jurisdiction (for the EHRi Transaction Client ID).	EHRIP08 Put Patient Consent
		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.
Adding of patient’s demographic information
The admitting clerk searches the demographic information through the hospital’s ADT system..	The POS ADT system searches locally the demographic information and does not find (because it’s her first visit at this hospital). The POS ADT system sends, to EHRi system, a search request (for the EHRi Transaction Client ID) to find the demographic information for the current patient.	The EHRi system searches and finds the demographic information for the current patient (for the EHRi Transaction Client ID).	EHRIP03 Get Patient Demographic Data
		The EHRi system returns, to POS system, the demographic information for the current patient (for the EHRi Transaction Client ID).
	The POS ADT system receives and displays the demographic information.
The admitting clerk confirms the demographic information with the patient.	The POS ADT system adds the demographic information and displays an acknowledgment about the completed update request.
Record the hospital admission (in the current jurisdiction)
The admitting clerk records patient’s visit in the hospital’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 – Hospital visit admission Event Diagram
Type	Use Case Diagram