Use Case Diagram

3.1.4 Telehealth Consultation - Events
Use Case Diagram Health Service Event #5 – Finalize consultation report Event Diagram

Actors

Psychiatrist
Hospital’s EMR system (POS)
Digital Dictation system
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.
The psychiatrist uses a Digital Dictation system, which is interfaced with 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 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 POS has the capacity to group the events with the “encounter” initially created at the admission.
In this case, the psychiatrist also sends a notification to referring physician to inform him that the final consultation report is ready. The POS can also manage this notification by directly sending another form of notification to the referring physician (ex.: to his POS, on his pager). For the EHR, a notification is a class of event, which links together some clinical events for a specific provider (and it gives him right access to these clinical events).

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
Resolution of patient’s identification (in the current jurisdiction)
Two days later, the psychiatrist enters the patient’s identification information in the hospital’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 and finds for 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 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.
Finalize the consultation report (in the current jurisdiction)
The psychiatrist reviews the final version of consultation report (completed by the clerk) in the hospital’s EMR system. The consultation report contains this information: - Patient name - Patient birth date - History of present illness - Past psychiatric history - Past medical history - Allergies - Medications - Examination - Provisional diagnosis - Management plan	The POS EMR system searches, finds and displays the consultation report.
The psychiatrist puts his electronic signature in the hospital’s EMR system and updates the final report with a notification to referring physician.	The POS EMR system updates the final version of consultation report with the electronic signature. The POS EMR system sends, to EHRi system, an update request to add the consultation report (with voice record) for the current patient (for the EHRi Transaction Client ID) with a notification to referring physician.	The EHRi system adds the new encounter events and links them with the specific health service encounter for the current patient (for the EHRi Transaction Client ID) and it attaches its a notification event to specific provider.	EHRIP15 Put Event
		The EHRi system returns, to POS system, an acknowledgment that the update request is completed.
	The POS EMR system displays an acknowledgment about the completed update request.

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General Info
Name	Health Service Event #5 – Finalize consultation report Event Diagram
Type	Use Case Diagram