Use Case Diagram

4.1.1 Referral to Ophthalmologist - 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 encounters with diagnoses related to the eye and for encounters with optometrists or ophthalmologists 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
The physician takes the history of the current problem and does a pertinent physical exam.
The patient reports having had a similar episode about 5 years prior that resolved fully. The patient saw her family physician in the jurisdiction she was living in at the time but can’t recall the details of the diagnosis or treatment. The patient remembers the symptoms settled and that she had been too busy at that time to follow through on a referral to an ophthalmologist that had been ordered. The patient has seen a few different optometrists in the past for routine eye exams.
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 encounters with diagnoses related to the eye and for encounters with optometrists or ophthalmologists.	The POS EMR system sends, to the EHRi system, a search request with the criteria of health service encounters with diagnoses related to the eye and for encounters with optometrists or ophthalmologists, for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds (in the two involved jurisdictions) the health service encounters with diagnoses related to the eye and for encounters with optometrists or ophthalmologists, for the current patient (for the EHRi Transaction Client ID).	EHRIP12 List Events (Event Type=Encounter) (Provider Type= ophthalmologists or optometrists)
		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 of the most recent 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 finds a record of the encounter with her family doctor from her home province from 5 years ago, along with optometrists’ reports.
The physician is concerned with these findings and makes an urgent referral to an ophthalmologist, who can see the patient the next day in his community office.

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