Use Case Diagram

5.1.4 ER visit - Events
Use Case Diagram Health Service Event #1 – Pre-exam (or clinical data collect) Event Diagram

Actors

Patient
ER nurse
ER’s EMR system (POS)
EHRi systems

Assumptions

There are two involved jurisdictions (e.g. the jurisdiction where the patient lives and the jurisdiction where the visit takes place); also, there is two (minimum) EHR.
The patient is already registered (for the first time) at the ER. So, the patient is created in the hospital’s ADT system and in the EHR (including the Client registry) of jurisdiction where the ER visit takes place (e.g. the current jurisdiction).
The hospital’s ADT system is interfaced with the ER’s EMR system. So, when a patient is created/updated in the hospital’s ADT system, the patient index is automatically updated in the ER’s EMR system.
The ER nurse is already logged on the ER’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 ER nurse 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 in an “encounter”.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
The patient is taken to an examination room and assessed by the ER nurse.
Resolution of patient’s identification (in the current jurisdiction)
The ER nurse verifies the identification information and enters them in the ER’s EMR system.	The POS EMR system searches and finds locally the identification of 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.
Record of collected clinical data (in the current jurisdiction)
The ER nurse takes the history of the current illness and the vital signs. The ER nurse records these information into the ER’s EMR system: - History of present illness, - Past medical history, - Allergies, - Medications, - Vital signs.	The POS EMR system is updated with the current illness history and the vital signs of patient. The POS EMR system sends, to the EHRi system, an update request to record the current illness history and vital signs events and to link these events with a specific health service encounter for the current patient (for the EHRi Transaction Client ID).	The EHRi system adds the new illness history and vital signs events and links them with the specific health service encounter for the current patient (for the EHRi Transaction Client ID).	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 #1 – Pre-exam (or clinical data collect) Event Diagram
Type	Use Case Diagram