Use Case Diagram

3.1.4 Telehealth Consultation - Events
Use Case Diagram Health Service Event #2 – Patient’s EHR evaluation Event Diagram

Actors

Psychiatrist
Hospital’s EMR system (POS)
EHRi systems

Assumptions

The psychiatrist uses an EMR system and he is already logged on this system.
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.
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 psychiatrist 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 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 psychiatrist wants to review the patient’s 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 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
Resolution of patient’s identification (in the current jurisdiction)
Just before seeing the patient, the psychiatrist does a request, through the hospital’s EMR system, to identifies the patient (with key information).	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 psychiatrist does a request, through the hospital’s EMR system to review patient’s records (with search criterion and unmasked permission).	The POS EMR system sends, to the EHRi system, a search request with the criteria and the unmask specification, for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches, finds (in the two involved jurisdictions) and unmasks the 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 details of each health service encounters
The psychiatrist looks at the summary list of health service encounters and selects an encounter to see more detail. (the psychiatrist 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 psychiatrist looks at the summary list of health service events and selects an event to see more detail. (the psychiatrist 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 psychiatrist views the referral request along with the clinical notes from the family doctors and psychologists referenced in the request.

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General Info
Name	Health Service Event #2 – Patient’s EHR evaluation Event Diagram
Type	Use Case Diagram