Ontario Provincial Consent Override Interface HL7® FHIR® Implementation Guide v1.0.0-draft1

For a full list of available versions, see the Directory of published versions

2.3. Use Cases

2.3.1. Actors

Participant	Type	Description
Health-Care Provider	Human	An individual acting on behalf of a Health Information Custodian (HIC) or non-Health Information Custodian who is authorized to access patient information and initiate consent override requests.

Actors

Health-Care Provider

Summary

As a Health-Care Provider, I want to act on a patient’s authority to override Meds records.

Pre-Conditions

#	Precondition
i.	Health-Care Provider must have successfully logged into the EMR system/Clinical Viewer.
ii.	Single Page Application (SPA) displays the Health-Care Provider’s information:
	a. First and last name (cached from the Context Management System (CMS)).
	b. Under the Authority Of (UAO) organization name (cached from the OAuth token).
iii.	Single Page Application (SPA) displays the patient’s information:
	a. First and last name (cached from the Context Management System (CMS)).
	b. Gender, date of birth (DD-MM-YYYY) and Health Card Number (HCN).

Primary Flow

Step	Description
1	A list of records available for override is displayed. Select the Meds option.
2	The SPA displays radio buttons to select the authority under which the override is being carried out:
	i. "Expressed consent from patient"
	ii. "Expressed consent from substitute decision maker (SDM)"
	iii. "Provider concern - significant risk of bodily harm to the patient"
	iv. "Provider concern - significant risk of bodily harm to another person"
3	Select "Expressed consent from patient".

Actors

Health-Care Provider

Summary

As a Health-Care Provider, I want to view the landing page of the Single Page Application (SPA). This user case identifies the base page for the SPA.

Pre-Conditions

#	Precondition
i.	Health-Care Provider must have successfully logged into the EMR/Clinical Viewer system.
ii.	Health-Care Provider must have successfully selected the "Yes" button in the EMR/Clinical Viewer to initiate an override.

Primary Flow

Step	Description
1.	The SPA launches in a new window and displays context from the Context Management System (CMS).
	i. Provider first and last name
	ii. Under the Authority Of (UAO) organization name
	iii. Patient first and last name
	iv. Gender
	v. Date of Birth
	vi. Health Card Number
2.	The SPA displays the available record types for override:
	i. Acute Care
	ii. Labs
	iii. Medical Imaging
	iv. Meds
3.	The SPA displays radio buttons to select the authority under which the override is being carried out:
	i. "Expressed consent from patient"
	ii. "Expressed consent from substitute decision maker (SDM)"
	iii. "Provider concern - significant risk of bodily harm to the patient"
	iv. "Provider concern - significant risk of bodily harm to another person"
4.	The SPA displays the "Unblock Records" and "Cancel" buttons.

Actors

Health-Care Provider

Summary

As a Health-Care Provider, I want to act on the authority of a substitute decision-maker (SDM) to override a Meds record.

Primary Flow

Step	Description
1.	A list of records that can be unblocked will be displayed. Select the Meds option.
2.	Displays radio buttons to select under whose authority the override is being carried out:
	i. "Expressed consent from patient"
	ii. "Expressed consent from substitute decision maker (SDM)"
	iii. "Provider concern - significant risk of bodily harm to the patient"
	iv. "Provider concern - significant risk of bodily harm to another person"
3.	Select 'Expressed consent from substitute decision maker (SDM)'.
4.	A free-text field is displayed for the SDM's first and last name.
5.	Enter the SDM's first and last name.

2.3.5. UC-04 : A Health-Care Provider wants to successfully override Meds records

Actors

Health-Care Provider

Summary

As a Health-Care Provider, I want to override a patient's Meds record.

Pre-Conditions

#	Precondition
i.	Health-Care Provider must have successfully logged into the EMR/Clinical Viewer system.
ii.	Health-Care Provider selects the Meds and chooses "Unblock Records" to override.
iii.	Health-Care Provider must have selected the authority under which the override is being performed.
iv.	If the authority is by the SDM, the Health-Care Provider must have successfully entered the SDM's first and last name.

Primary Flow

Step	Description
1.	The SPA displays the "Unblock Records" and "Cancel" buttons.
2.	Select the "Unblock Records" button.
3.	An "All available records have been unblocked” dialog box is displayed, indicating that Meds records are available for an 8-hour override period. "Only use unblocked records for the purpose for which they are intended. If you need to use the records for a different purpose, please obtain consent and unblock again."
4.	Select the "Close Window" button.
5.	If the "Cancel" button is selected, see Step 4 of UC-05.
6.	The SPA screen closes.
7.	The EMR/Clinical Viewer screen is displayed.

Business Rules:

Message displayed will vary based on override access to different LOBs.
If multiple records are selected for override, all selected LOBs (e.g., DHDR, OLIS, and acCDR) will be displayed in a single "Override Success" message.

Actors

Health-Care Provider

Summary

As a Health-Care Provider, I want to cancel my override.

Primary Flow

Step	Description
1.	Select "Cancel"
2.	A message dialog box is displayed informing the user that all information entered will be lost if the user proceeds with cancellation. Two buttons are displayed:
	i. "Go back"
	ii. "Cancel session"
3.	Select "Cancel" session
4.	The PCOI window closes, and the Health-Care Provider is returned to the EMR/Clinical Viewer.

Actors

Health-Care Provider

Summary

As a Health-Care Provider, I want to understand when an override request is unsuccessful.

Primary Flow

Step	Description
1.	Select "Unblock Records"
2.	The system is unable to process the override request.
3.	An "Unblock Failed" dialog box appears with the message: “Sorry, something went wrong. Please try again. If this problem continues, call eHealth Ontario Service Desk at 1-866-250-1664 and copy the details below."
4.	Select on the “Show details” link to display the error details.
5.	Select the "Close Window" button on the "Unblock Failed" dialog box.
6.	The Health-Care Provider may attempt the override again.

Version: 1.0.0 FHIR Version: R4.0.1

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2.3. Use Cases

2.3.1. Actors

2.3.2. UC-01 : A Health-Care Provider wants to override Meds records using patient consent

2.3.3. UC-02 : A Health-Care Provider wants to view the PCOI consent override page

2.3.4. UC-03 : A Health-Care Provider wants to override Meds records using substitute decision-maker consent

2.3.5. UC-04 : A Health-Care Provider wants to successfully override Meds records

2.3.6. UC-05 : A Health-Care Provider wants to cancel a consent override request

2.3.7. UC-06 : A Health-Care Provider wants to understand why a consent override request failed