Use Case Diagram

4.1.2 Ophthalmologist - Events
Use Case Diagram Health Service Event #3 - Patient Assessment Event Diagram

Actors

Patient
Ophthalmologist
Clinic’s EMR system
EHRi systems

Assumptions

The ophthalmologist 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 ophthalmologist 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 ophthalmologist wants to see the health service encounters by provider type (ophthalmologists or optometrists) and by ophthalmologic diagnoses 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.
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.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
The ophthalmologist takes the history of the patient which patient reports some vision loss and pain in her right eye that came on acutely.
The ophthalmologist does a pertinent examination and the exam shows some swelling of the disc.
The ophthalmologist poses a diagnosis of optic neuritis.
Resolution of patient’s identification (in the current jurisdiction)
The ophthalmologist 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 ophthalmologist confirms the patient’s identity with the patient. Based on patient’s description of a similar previous episode, the ophthalmologist reviews his records to see the clinical notes from that time. The ophthalmologist submits a search for encounters by provider type (ophthalmologists or optometrists) and by ophthalmologic diagnoses in his clinic’s EMR system.	The POS EMR system sends, to the EHRi system, a search request of health service encounters by provider type (ophthalmologists or optometrists) and by ophthalmologic diagnoses, 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 by provider type (ophthalmologists or optometrists) and by ophthalmologic diagnoses, 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 health service encounters
The ophthalmologist looks at the summary list of health service encounters and selects an encounter to see more detail. (the ophthalmologist 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 ophthalmologist looks at the summary list of health service events and selects an event to see more detail. (the ophthalmologist 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 ophthalmologist is able to review the encounter note from the family physician from five years ago. The findings reported are limited but he feels that it may have been the same problem and that this is now a second episode.
The ophthalmologist gives the possibility that the optic neuritis could be related to multiple sclerosis
DI order and referral (in the current jurisdiction)
The ophthalmologist orders an MRI of the brain through the clinic EMR system.	The POS EMR system is updated with the MRI order. The POS EMR system sends, to the EHRi system, an update request to record the MRI order event and to link this event with a specific health service encounter for the current patient (for the unique patient identifier).	The EHRi system adds the new MRI order event and links it with the specific health service encounter for the current patient (for the unique patient identifier).	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.
The ophthalmologist refers the patient to a neurologist.

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General Info
Name	Health Service Event #3 - Patient Assessment Event Diagram
Type	Use Case Diagram