Use Case Diagram

10.1.1 TB First Assessment - Events
Use Case Diagram Health Service Event #1 – Clinic Visit Admission Event Diagram

Actors

Patient
Receptionist
Clinic’s ADT system (POS)
EHRi systems

Assumptions

There are two involved jurisdictions (e.g. the jurisdiction where the patient lives and the jurisdiction where the patient going to university and the visit takes place); also, there is two (minimum) EHR.
The receptionist is already logged on the clinic’s ADT system.
The receptionist uses only the name to find the patient. The clinic’s ADT system searches the local POS and doesn’t find the patient (because it’s his first visit to this clinic), and sends a request to EHRi system to obtain the client’s identification information. The patient already exists in the EHR of the current jurisdiction but the EHRi system returns a list of three people with the same name (and birth date, provincial health care number, and a “temporary” unique patient identifier (EHRi Transaction Client ID)).
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 patient is then created in the clinic’s ADT system with the data coming from EHR of the current jurisdiction.
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.
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 clinic’s ADT system has the capacity to create an initial “encounter” at the same time as the creation of the admission event.

Workflow Event Step	POS Action	EHRi System Action	EHR IP reference
When he arrives at the clinic, the patient stops first at the registration desk.
Resolution of patient’s identification (in the current jurisdiction)
The receptionist enters the patient’s name, in the clinic’s ADT system, to search for records on him.	The POS ADT system searches locally the patient and does not find (because it’s his first visit at this clinic). The POS ADT system sends, to the EHRi system, a request with the key information (in this case, only the name) to search for the patient.	The EHRi system searches the client, in the current jurisdiction, with the provided key information (in this case, only the name) and finds three clients.	EHRIP10 Search Patient
		The EHRi System Client Registry returns, to POS system, a list with corresponding patients (three patients with the name, birth date and provincial health care number – with a EHRi Transaction Client ID).
	The POS ADT system displays the list with corresponding patients (three patients with the name, birth date and provincial health care number).
The receptionist verifies the name, birth date and provincial health care number with the patient and she is able to determine which of these is the correct record.
Update locally the patient’s demographic information
The receptionist selects the right patient’ record and requests the demographic information.	The POS ADT system searches locally the demographic information and does not find (because it’s his first visit at this clinic) . The POS ADT system sends, to EHRi system, a search request to find the demographic information for the current patient (for the EHRi Transaction Client ID).	The EHRi system searches and finds the demographic information for the current patient (for the EHRi Transaction Client ID).	EHRIP03 Get Patient Demographic Data
		The EHRi system returns, to POS system, the demographic information for the current patient (for the EHRi Transaction Client ID).
	The POS ADT system receives and displays the demographic information.
The receptionist confirms the demographic information with the patient and records locally the patient’s identification information and this information: - Current address, - Phone number. - Email, - Permanent address, - Emergency contact person, - Emergency contact number.	The POS ADT system adds locally the patient’s record and the demographic information, and displays an acknowledgment about the completed update request.
Record the clinic admission (in the current jurisdiction)
The receptionist records the patient’s admission in the clinic’s ADT system.	The POS ADT system records the admission for the current patient. The POS ADT system sends, to the EHRi system, an update request to record the admission event and create a health service encounter for the current patient (for the EHRi Transaction Client ID).	The EHRi system adds the new admission event for this provider, and links this event with a new health service encounter for the current patient (for the EHRi Transaction Client ID). The EHRi system adds a role event to identify the patient role for the current client (for the EHRi Transaction Client ID), for this provider.	EHRIP15 Put Event (Event Type = Admission)
		The EHRi system returns, to POS system, an acknowledgment that the update request is completed.
	The POS ADT system displays an acknowledgment about the completed update request.

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General Info
Name	Health Service Event #1 – Clinic Visit Admission Event Diagram
Type	Use Case Diagram