Use Case - Receive and Validate Patient Summary Submission

This use case provides the capability for the “Hub” provincial service to receive and validate patient summary submissions from authoring provider POS systems.

Pre-Condition 1: The submitting POS is authenticated and authorized for this service.

Basic Flow: Validate and Accept Patient Summary Submission

The Basic Flow is initiated when the Hub Provincial Service receives a data transmission through the patient summary submission service point.

1. Validate Patient Summary Submission Structure

Hub Provincial Service validates the structure of the patient summary submission against the published provincial standards.

  • Business Rule – Submission Structure Validation: Patient summary message must conform to the provincial message structure (mandatory data, formats, structural integrity, etc.)

  • Business Rule – Submission Data Content Validation: Patient summary contents must conform to defined terminology sets and conditional data element rules.

  • Business Rule – Submission Type Validation: A valid patient summary submission must meet all the following rules:

    • Composition Type must be coded for ‘patient summary’
    • Composition Identifier must be a globally unique identifier (specific to a single combination of patient + authoring provider)
    • Composition Status is ‘final’, ‘amended’ or ‘entered in error’

  • Business Rule – Capture Submitter Information: The authoring provider, provider role, site and EMR product are captured to inform the provincial provider-role-location directory service.

  • Alternate Flow: Patient Summary Submission Fails Validation

2. Verify Patient Identity

Hub Provincial Service verifies the submitted patient demographics against the Alberta Provincial Client Registry (pCR).

  • Business Rule – Validate Alberta Identification: If the patient is identified with an Alberta Unique Lifetime Identifier (ULI), patient demographics must pass pCR matching algorithm (“MatchULI” service).

    • Patient PHN/ULI, first name, last name, administrative gender and birth-date are used to verify a matching patient identity in pCR.
    • If pCR returns a primary PHN/ULI for the patient (meaning that the submitted PHN/ULI is deemed a ‘secondary’ or ‘alternate’ identifier for this patient), the Provincial Service replaces the submitted patient identifier with the primary PHN/ULI received from pCR; and creates a record of the substitution.

  • Business Rule – Validate Jurisdictional Identification: If the patient is identified with another Canadian jurisdiction’s healthcare number, the corresponding AB ULI must be retrieved from pCR.

  • Alternate Flow: Patient Summary Submission Fails Validation

  • Exception Scenario: pCR Query Failure

3. Verify Authoring Provider Identity

Hub Provincial Service verifies the submitted authoring provider identity against the Alberta Provincial Provider Registry (PPR).

  • Business Rule – Validate Provider Identity: The authoring provider identifier, identifier type and role must match with an existing provider record in PPR.
  • Alternate Flow: Patient Summary Submission Fails Validation
  • Exception Scenario: PPR Query Failure

4. Accept Patient Summary Submission Data

Hub Provincial Service accepts validated patient submission data and stores in the provincial message repository for subsequent publication and/or distribution.

  • (Record retention and disposition requirements are documented separately.)

5. End

Use Case ends.

Alternate Flow: Patient Summary Submission Fails Validation

This flow is initiated when any validation step in the Basic Flow results in a validation error.

1. Log Validation Error

Hub Provincial Service logs each error found.

  • Business Rule – Capture Patient Summary Validation Error: Each validation error is logged separately. Each error log contains the data in error, the processing step as applicable, and an error code or message specific to the type of error found.
    • Validation continues through the entire processing step to the extent possible, to capture all identifiable errors at time of processing.

2. Return Validation Error Response

Hub Provincial Service returns a patient summary submission error response to the submitting POS.

  • Business Rule – Patient Summary Error Response to Submitting System: Error responses contain the patient summary submission identifier from the source POS, and a codified descriptor identifying the nature of the error for each error found.
    • Multiple errors on the same patient summary submission are bundled into a single error response.

3. End

Use Case ends.

Exception Scenario: pCR Query Failure

This flow is initiated by the Verify Patient Identity step of the Basic Flow, when the pCR query fails during execution.

1. Attempt Re-Try

Hub Provincial Service attempts to re-execute the query, if the error is due to an outage or unavailable resource.

  • If re-try succeeds – flow returns to the initiating step of the Basic Flow.

2. Log pCR Query Error

Hub Provincial Service logs an error for pCR query failure.

  • Business Rule – PCR Query Error Log: Details of the pCR query failure are logged including patient identification elements, pCR query type, and error code or message.
    • Notification is issued for technical support attention.

3. End

Use Case ends.

Exception Scenario: PPR Query Failure

This flow is initiated by the Verify Authoring Provider Identity step of the Basic Flow, when the PPR query fails during execution.

1. Attempt Re-Try

Hub Provincial Service attempts to re-execute the query, if the error is due to an outage or unavailable resource.

  • If re-try succeeds – flow returns to the initiating step of the Basic Flow.

2. Log PPR Query Error

Hub Provincial Service logs an error for PPR query failure.

  • Business Rule – PPR Query Error Log: Details of the PPR query failure are logged including provider identity, provider role and error code or message.
    • Notification is issued for technical support attention.

3. End

Use Case ends.