Use Cases

Introduction

A key consideration for the Alberta Patient Summary is that authoring providers will be able to curate the compiled record before submitting or sharing, which will optimize both the quality and the meaningfulness of the information being shared.

PS-AB use cases describe the capabilities needed for an authoring provider to curate and submit a new patient, to update a previously submitted summary, to cancel a patient summary submitted in error, and to retract a previous submission for patient privacy reasons.

Actors

Actor Type Description
Authoring Provider Human The healthcare provider (HCP) who is responsible for assembling chart information into the patient summary, and approving its submission to the Province.
Submitting EMR (POS) System A software system or service that is used to collect and maintain the information needed to deliver patient care. For the purposes of PS-AB Release 1, this is limited to clinical systems used in comprehensive care settings such as Electronic Medical Record (EMR) products.
Provincial Data Hub Service System A software system that acts as an information broker between healthcare provider POS systems and provincial assets such as Alberta Netcare.

Use Case 1: Submit Patient Summary Data to Provincial Service

This use case provides the capability for an authoring provider to curate and send a new or updated patient summary for publication through the Provincial Data Hub Service.

Basic Flow: Submit New Patient Summary Data to Provincial Service

1. Initiate Patient Summary Data Extract

Authoring provider chooses to generate a patient summary extract from their EMR patient chart.

  • Business Rule – Standard Patient Summary Data Scope: A standard patient summary contains the following information, extracted from the patient’s EMR record:
    • Patient identification and demographics
    • Submitting provider identification and name
    • Clinic name and location (address and contact information)
    • Available data in each of the following categories is extracted:
      • Problem list (includes current and history for curation)
      • Vital Signs / observations
      • Allergies and adverse reactions
      • Prescribed medications
      • Lifestyle and risk factors
      • Medical history (surgeries / procedures)
      • Family history
2. Curate Patient Summary Data for Submission

Authoring provider reviews the standard data extract, and curates to include or exclude information for publication purposes.

  • Business Rule – Patient Summary Data Curation: Provider is able to remove or edit any of the standard data extracted. New information must first be added to the chart, then re-incorporated into the generated patient summary.
  • Business Rule – Retain Provider Curation Decisions: EMRs must retain the provider’s decision for included and excluded data, so there is a digital record of the curated data for subsequent review by the provider and clinic staff; and so that subsequent updates do not have to repeat prior curation steps.
3. Submit Patient Summary Data

Authoring provider chooses to submit the curated patient summary data to the Provincial Data Hub Service for publication and/or distribution.

  • Business Rule – Assemble Curated Data for Submission: Date and time of the submission are captured, as the effective date of the patient summary record.
    • Provider’s EMR records the patient summary submission event, and details of the curated submission for subsequent reference and future updates.
    • Provider’s EMR assigns a unique identifier to the patient summary, to enable traceability of all future updates to the same record (same patient, same authoring provider and/or same clinic).
      • Subsequent updates from the same patient chart must retain the originally assigned unique patient summary identifier. Either the authoring provider’s identity or the clinic (location) identity must match the previous submission, along with the same patient summary identifier. (This accommodates scenarios where a new provider takes over care of the patient using the same EMR chart; or where the authoring provider remains the same but the clinic has been issued a new location identifier.)
4. Generate and Send Standardized Patient Summary to Provincial Service

Submitting EMR formulates the curated data into the standardized structure, and submits through the Provincial Data Hub Service.

  • Business Rule – Patient Summary Submission Metadata: The following submission metadata is included:

    • Submitting site identifier – must be a provincially-issued site identifier that is approved for patient summary submissions
    • Submitting EMR vendor and product – must be provincially-assigned values
    • Submission identifier – a unique identifier assigned by the submitting system, that is unique for each submission (will change on future submissions of the same patient summary)
    • Submission date and time
    • ubmission type – must be the provincially-assigned value for patient summary

  • Business Rule – Conform to Established AB Patient Summary Terminologies: Data is mapped or associated to the standardized code-sets and terminologies as applicable.

5. Acknowledge Patient Summary Submission

Provincial Data Hub Service sends an acknowledgement of the patient summary submission back to the submitting EMR.

  • Business Rule – Patient Summary Submission Acknowledgement: A positive acknowledgement (“ACK”) is issued upon receipt of a patient summary submission that is successfully recognized as a patient summary FHIR bundle. A negative acknowledgement (“NAK”) is issued if the submission cannot be successfully recognized.
6. End

Use Case ends.

Alternate Scenario: Update Previously Submitted Patient Summary

This flow is initiated as an alternate entry to this use case, when an authoring provider chooses to update any of the data or data categories in a previously submitted patient summary.

1. Update Patient Chart for Submitted Data Category

Authoring provider adds, edits or removes information associated to any of the standard patient summary data categories within their EMR patient chart.

  • Business Rule – Edit Chart Data for Inclusion in Patient Summary: Provider is able to remove or edit any of the standard data for inclusion in a patient summary. EMR chart is able to identify prior curation decisions in some manner, such that the provider does not have to repeat previous curation steps for inclusion or exclusion of existing data. Only new or modified data is subject to additional curation. New data is automatically included in an updated patient summary and can be excluded as desired by the authoring provider. Updated data is automatically included in the patient summary based on prior curation decisions.
2. Finalize Chart Update and Generate Patient Summary Extract for Submission

EMR system applies the updates when the entry is finalized in the patient’s chart, and enables the option for the authoring provider to curate as desired before submission.

  • Authoring provider chooses to curate the added or updated patient summary extract upon finalizing the patient chart entry:
    • Branch to the Curate Patient Summary Data for Submission step of the Submit Patient Summary Data to Provincial Service Basic Flow.
  • Authoring Provider finalizes the patient chart entry without any further curation:
    • Branch to the Submit Patient Summary Data step of the Basic Flow.
3. End

Alternate Flow ends.

Use Case 2: Cancel Previously Submitted Patient Summary

This use case provides the capability for a submitting EMR to generate and submit a cancellation of a previously submitted patient summary; either upon request of an authoring provider or upon deletion of the patient summary from the patient’s EMR chart.

Basic Flow: Authoring Provider Issues Cancellation of Previously Submitted Patient Summary

1. Initiate Cancellation of Previously Submitted Patient Summary

Authoring provider instructs the EMR to cancel a previously submitted patient summary.

  • Business Rule – Patient Summary Cancellation by Author: A cancellation action is available to the authoring provider or authoring clinic at any time after previous submission of a patient summary, so that the summary can be retracted for situations such as chart entries made on the wrong patient, summary submitted in error, or provider chooses to retract after patient has expressed a wish to have this information kept confidential.
2. Apply Patient Summary Cancellation Request

EMR assigns the cancellation action to the patient summary record within the patient’s chart.

  • Business Rule – Remove Curation from Cancelled Patient Summary: All previous curation actions are removed from the patient’s chart.
    • If any authoring provider later chooses to produce a new patient summary for this patient, any curated inclusions, exclusions or edits will not be available. Any previously entered notes for patient summary purposes will not be retained.
  • Business Rule – Preserve Identifier for Cancelled Patient Summary: The unique identifier assigned to the previously submitted patient summary is retained and associated to the cancellation request action. It cannot be used again, if a new patient summary is later issued from that patient’s chart.
3. Submit Cancelled Patient Summary to Provincial Service

Submitting EMR formulates and submits a patient summary cancellation to the Provincial Data Hub Service.

  • Business Rule – Patient Summary Cancellation Submssion: Submission contains the minimum data necessary for a patient summary cancellation service.

    • The EMR’s unique identifier from the previously submitted patient summary is included in the cancellation, so that publicating and consuming systems can correctly identify the record to be cancelled.
    • Patient summary is assigned a status of “entered-in-error”.

  • Business Rule – Retract (“mask”) Previously Submitted Patient Summary: An appropriate masking value is populated on the submission:

    • “PRS” is used to indicate a patient-requested masking (“expressed wishes” under HIA)
    • “PHY” is used to indicate any other reason for a masking request by the authoring provider
4. End

Use Case ends.

Alternate Scenario: Automatic Cancellation of Previously Submitted Patient Summary

This flow is an alternate entry into this use case, when a patient’s chart containing a previously submitted patient summary record is deleted from the submitting EMR (deletion of a chart created in error or created on the wrong patient).

1. Apply Chart Deletion to Previously Submitted Patient Summary

EMR applies the cancellation of the patient summary record as part of the patient chart deletion.

2. End

Alternate Scenario ends - Branch to the Submit Cancelled Patient Summary to Provincial Service step of the Basic Flow.