Use Case Diagram

7.1.2 Acute care hospital admission - Events
Use Case Diagram Health Service Event #1 – Patient Assessment Event Diagram

Actors

Patient
Internal medicine resident
ER’s EMR system (POS)
EHRi systems

Assumptions

There is one involved jurisdiction (for this health service encounter); also, there is one (minimum) EHR.
The patient was transferred and already registered in the ER of the tertiary care hospital.
The internal medicine resident uses an ER’s EMR system and is already logged on this 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 internal medicine resident 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 “health profile” is an organized collection of specific events, whose definition depends on practices of each organization and jurisdiction.
The internal medicine resident wants to see specific type of events (lab results) and the encounters with a specific type of providers (primary care providers).
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 internal medicine resident on call that evening, assesses patient in the ER to admit him to hospital.
The internal medicine resident gets as much history as possible from patient and his wife, but this is limited.
The internal medicine resident examines patient then reviews the CT images.
Resolution of patient’s identification (in the current jurisdiction)
The internal medicine resident accesses patient’s records with some 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 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.
Review locally the ER’s notes
The internal medicine resident reviews the ER’s EMR notes.	The POS EMR system searchs locally and displays notes.
Consultation of the patient’s health profile (for the current jurisdiction)
The internal medicine resident retrieves patient’s health profile.	The POS EMR system sends, to the EHRi system, a search request to obtain the patient’s health profile for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds (in current jurisdiction) the information of health profile for the current patient (for the EHRi Transaction Client ID).	EHRIP09 Get Patient Health Profile
		The EHRi system returns, to POS system, the health profile for the current patient.
	The POS EMR system receives, organizes and displays the patient’s health profile.
The internal medicine sees his current and past medical problem list. He can also see the medications which have been prescribed.
View a specific type of events (in the current jurisdiction)
The internal medicine resident searches for the 15 most recent lab results in the ER’s EMR system.	The POS EMR system sends, to the EHRi system, a search request with the criteria of health service events about the 15 most recent lab results, for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds the 15 most recent health service events about recent lab results, for the current patient (for the EHRi Transaction Client ID).	EHRIP12 List Events (Event Type = Lab Results)
		The EHRi system sends, to POS system, a summary list with key identifiers indicated in the health service events.
	The POS EMR system receives and displays the summary list of health service events.
The internal medicine resident looks at the summary list of health service events and selects an event to see more detail. (the internal medicine resident 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 internal medicine resident has an idea of patient’s anticoagulation status.
View encounters with a specific type of provider (in the current jurisdiction)
The internal medicine resident searches for the 10 most recent encounters with primary care providers, in the ER’s EMR system.	The POS EMR system sends, to the EHRi system, a search request with the criteria of the 10 most recent health service encounters with primary care providers, for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds the 10 most recent health service encounters with primary care providers, for the current patient (for the EHRi Transaction Client ID).	EHRIP12 List Events (Event Type = Primary Care Provider)
		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.
The internal medicine resident looks at the summary list of health service encounters and selects an encounter to see more detail. (the internal medicine resident 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 (Event Type = Encounter ID)
		The EHRi system returns, to POS system, a health service event list.
	The POS EMR system displays the health service event list.
The internal medicine resident looks at the summary list of health service events and selects an event to see more detail. (the internal medicine resident 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 internal medicine resident sees patient has been poorly compliant with recommendations made to him.
After reviewing this information, internal medicine resident feels patient has had a stroke secondary to atrial fibrillation with poor anticoagulation.

Get SVG Format

General Info
Name	Health Service Event #1 – Patient Assessment Event Diagram
Type	Use Case Diagram