Business Context Index > Use Cases

Use Cases

This section contains use cases to illustrate health care practitioners using their point of service systems to create, update, invalidate, and view Patient Summaries for their patients. The Patient Summary Repository plays a central role by storing Patient Summaries submitted by HICs and making the Summaries available for viewing.

These use cases are intended to provide context for the submit, search, and retrieve Patient Summary operations defined in this specification. These use cases are not intended to prescribe practitioner workflow.

Actors

Participant Type Description
Point of Service (PoS) System System An electronic product, service or system that uses electronic means to collect, use, modify, disclose, retain or dispose of PHI, and that is selected, developed or used by a HIC. Examples include but are not limited to: an electronic medical record (EMR), a hospital information system (HIS), and clinical viewer.
Patient Summary Repository System An Ontario Health digital health asset that supports sharing of Patient Summaries among health care practitioners. The repository provides APIs to be used by authorized systems to submit, retrieve, and display Patient Summaries to/from the repository. The Patient Summary Repository resides within the Electronic Health Record (EHR) that is developed and maintained by Ontario Health as a Prescribed Organization in accordance with Part V.1 of PHIPA.
Provincial Consent Override Interface (PCOI) System A unified interface for all consent override requests for Ontario Health EHR assets.
Health Care Practitioner Human A person who is a member within the meaning of the Regulated Health Professions Act, 1991 and who provides health care, or a member of the Ontario College of Social Workers and Social Service Workers and who provides health care, or any other person whose primary function is to provide health care for payment

For brevity, other actors involved in the orchestration of complementary EHR services, including identity management, authorization and authentication are not included.

Roles

Three key roles support the creation of Patient Summaries:

Role Name Description
Author The Health Care Practitioner who is responsible for the information in the Patient Summary composition before it is submitted to the Repository.
Where a HIC has opted into automated compilation and submission of a Patient Summary by the Point of Service System, the Author would be the point of service system.
Attester The individual or organization who has attested to the accuracy of the information provided in a Patient Summary composition.
The Health Care Practitioner who authored the Patient Summary is also the Attester for the Summary. If the Author is a Point of Service System, then the Attester would be the HIC.
Custodian The HIC (as that term is defined in PHIPA) that provides the Patient Summary to Ontario Health as a Prescribed Organization for the purposes of the EHR.

UC-01: Health Care Practitioner Creates New Patient Summary

Actors

  • Health Care Practitioner
  • Patient Summary Repository
  • PoS System

Summary

Health Care Practitioner creates the first Patient Summary for the patient from the records held in the HIC’s PoS System.

Pre-Conditions

  • Patient is under the care of the Health Care Practitioner and visits a Health Care Practitioner for consultation and/or treatment.
  • Health Care Practitioner is logged into their HIC’s PoS System and retrieves the patient’s record.
  • The HIC has not yet provided to the provincial repository a valid Patient Summary for the patient based on records held in the PoS System.
  • It is assumed that the Health Care Practitioner/HIC has the legal authority to collect, use, and disclose personal health information based on implied consent

Primary Flow

  1. Health Care Practitioner uses the PoS System to update the patient’s chart with relevant information derived from the patient encounter and signs off the changes made.
    • 1a) Alternative flow: Health Care Practitioner may view the patient’s Summary(s) created by other HIC/PoS System(s) (see UC-04) and use relevant information to update the patient’s chart.
  2. PoS System automatically assembles a Patient Summary based on:
    • available information in the patient’s chart
    • pre-defined patient data exclusion criteria (if any)
    • business rules for determining the Patient Summary’s Author, Attester, and Custodian.
    • 2a) Alternative flow: Where the Practitioner or HIC has opted-out of automatically triggering the creation of a Patient Summary, assembly of a new Patient Summary is manually initiated by the Practitioner.
    • 2b) Alternative flow: If the Health Care Practitioner or HIC has opted-in to automatic submission of Patient Summaries, steps 3 and 4 are not executed.
  3. PoS system displays the auto-assembled Patient Summary to the Health Care Practitioner.
  4. Health Care Practitioner reviews and signs off the Patient Summary.
    • 4a) Alternative flow: The Health Care Practitioner may exclude patient data from the Patient Summary before signing off. If the Practitioner wants to alter patient data appearing in the Patient Summary, the Practitioner must close the Patient Summary without signing off and make the desired changes to the patient’s chart (i.e. restart the process at step 1).
  5. PoS System submits the Patient Summary to the Patient Summary Repository.
  6. Patient Summary Repository adds the Patient Summary to the repository as the current version.
  7. PoS System confirms to the Health Care Practitioner that the Patient Summary has been submitted.
  8. Alternative flow: Health Care Practitioner may provide a copy of the signed-off Patient Summary to the patient upon request.

Post-Conditions

  • A new Patient Summary for the patient is recorded in the provincial repository where is it is available to authorized Health Care Practitioners upon request.

UC-02: Health Care Practitioner Replaces Existing Patient Summary

Actors

  • Health Care Practitioner
  • Patient Summary Repository
  • PoS System

Summary

Health Care Practitioner creates an updated Patient Summary for the patient from the records held by the HIC’s PoS System.

Pre-Conditions

  • The patient is under the care of the Health Care Practitioner.
  • The patient may be visiting the Practitioner for consultation and/or treatment and/or the Practitioner is ready to update the patient’s chart based on information received from other health care provider(s).
  • Health Care Practitioner is logged into their HIC’s PoS System and retrieves the patient’s record.
  • The HIC has previous provided to the provincial repository a valid Patient Summary for the patient based records held in the PoS System.
  • It is assumed that the Health Care Practitioner/HIC has the legal authority to collect, use, and disclose personal health information based on implied consent.

Primary Flow

  1. Health Care Practitioner uses the PoS System to update the patient’s chart with relevant information derived from clinical notes, test results, and/or the current patient encounter. and Health Care Practitioner signs off the changes made.
  2. PoS System determines that updates were made to the patient’s chart that may affect the content of the patient’s current Patient Summary.
    • 2a) Alternative flow: The PoS System determines that changes made to the patient’s chart do not affect the content of the current Patient Summary. Hence, an updated Patient Summary is not created and the use case ends.
  3. PoS System automatically assembles a new Patient Summary based on:
    • available information in the patient’s chart
    • pre-defined patient data exclusion criteria (if any)
    • business rules for determining the Patient Summary’s Author, Attester, and Custodian.
    • 3a) Alternative flow: Where the Practitioner or HIC has opted-out of automatically triggering the creation of a Patient Summary, assembly of a new Patient Summary is manually initiated by the Practitioner.
    • 3b) Alternative flow: If the Health Care Practitioner or HIC has opted-in to automatic submission of Patient Summaries, steps 4 and 5 are not executed.
  4. PoS System displays the auto-assembled Patient Summary to the Health Care Practitioner.
  5. Health Care Practitioner reviews and signs off the Patient Summary.
    • 5a) Alternative flow: The Health Care Practitioner may exclude patient data from the Patient Summary before signing off. If the Practitioner wants to alter patient data appearing in the Patient Summary, the Practitioner must close the Patient Summary without signing off and make the desired changes to the patient’s chart (i.e. restart the process at step 1).
  6. PoS System submits the Patient Summary to the Patient Summary Repository.
  7. Patient Summary Repository adds the Patient Summary to the provincial repository as the new current version.
  8. PoS System confirms to the Health Care Practitioner that the Patient Summary has been submitted.
  9. Alternative flow: Health Care Practitioner may provide a copy of the signed-off Patient Summary to the patient upon request.

Post-Conditions

  • An updated Patient Summary for the patient is recorded in the provincial repository where it is available to authorized Health Care Practitioners upon request. Previous (historical) versions continue to be available too.

UC-03: Health Care Practitioner Invalidates a Current Patient Summary

Actors

  • Health Care Practitioner
  • Patient Summary Repository
  • PoS System

Summary

Health Care Practitioner invalidates a current Patient Summary they authored under the authority of the HIC or the HIC previously authored for a patient from the given PoS System.

Pre-Conditions

  • Patient is under the care of the Health Care Practitioner.
  • Health Care Practitioner is logged into their HIC’s PoS System and retrieves the patient’s record.
  • Health Care Practitioner has viewed the patient’s current Summary previously authored by the Health Care Practitioner or by the HIC under whose authority the Practitioner is acting using the given PoS System.
  • Health Care Practitioner determines that the Patient Summary is not fit for use, e.g. it was entered in error or is inaccurate, corrupted, or incomplete.

Primary Flow

  1. Health Care Practitioner uses their PoS System to identify that the Patient Summary is invalid.
  2. PoS System submits a request to to the Patient Summary Repository to invalidate the Patient Summary in the repository.
  3. Patient Summary Repository updates the Patient Summary’s status indicator to “entered-in-error”.
  4. PoS System confirms to the Health Care Practitioner that the selected Patient Summary has been invalidated.

Post-Conditions

  • Patient Summary is marked as invalid in the provincial repository

Alternative Flows: None

Future Alternative Flow: Whenever a Patient Summary is invalidated, a notification is sent to Practitioners who have viewed the now-invalid Patient Summary.

UC-04: Health Care Practitioner Views a Current Patient Summary

Actors

Actors

  • Health Care Practitioner
  • Patient Summary Repository
  • Provincial Consent Override Interface (PCOI)
  • PoS System

Summary

A Health Care Practitioner uses their PoS System to view relevant current Patient Summary(s) for their patient.

Pre-Conditions

  • Patient is under the care of the Health Care Practitioner.
  • Health Care Practitioner is logged into their HIC’s PoS System and retrieves the patient’s record.

Primary Flow

  1. Health Care Practitioner requests to view the current Patient Summaries for the patient in context.
  2. PoS System queries the Patient Summary Repository for the patient’s current Patient Summaries. The patient is identified by the health card number and/or medical record number recorded in the PoS System.
    • 2a) Alternative flow: Health Care Practitioner uses the Provincial Consent Override Interface to override a patient consent directive affecting access to the patient's Summaries where direct care is being provided.
  3. Patient Summary Repository responds with a list of current Patient Summary(s) submitted by any HIC/PoS system for the identified patient. The list includes a unique identifier for each Patient Summary and the following information about each Summary to help the Health Care Practitioner select the one(s) that may be relevant:
    • Patient’s name
    • Name of the HIC that provided the Patient Summary
    • Date authored
    • Version number
    • Name of the author (i.e. Health Care Practitioner or PoS System if compiled/submitted automatically)
    • Author’s specialty (if available)
    • Status indicator (i.e. whether the Patient Summary has been invalidated or not)
    • 3a) Alternative flow: If there are no Patient Summaries in the provincial repository matching the PoS System’s search criteria, then:
      • Patient Summary Repository informs the PoS System
      • PoS System displays a message to the Health Care Practitioner and the use case ends
  4. PoS System displays the list of Patient Summary(s) to the Health Care Practitioner, sorted in descending order by date.
  5. Health Care Practitioner selects from the list a Patient Summary of interest to them.
  6. PoS System retrieves the selected Patient Summary from the Patient Summary Repository.
  7. PoS System displays the full Patient Summary to the Health Care Practitioner.
  8. Health Care Practitioner reads the Patient Summary. The Practitioner may continue to select and read other current Patient Summary(s) in the list.

Post-Conditions

  • Health Care Practitioner has used their PoS system to view relevant current Patient Summary(s) for their patient.

UC-05: Health Care Practitioner Views Historical Patient Summary(s)

Actors

Actors

  • Health Care Practitioner
  • Patient Summary Repository
  • PoS System

Summary

A Health Care Practitioner uses their PoS System to view relevant historical Patient Summary(s) for their patient.

Pre-Conditions

  • Patient is under the care of the Health Care Practitioner.
  • Health Care Practitioner is logged into the PoS System and retrieves the patient’s record.
  • Health Care Practitioner has viewed a current Patient Summary for the patient and has a clinical reason to view historical version(s) of the Summary.
  • Where there is a consent directive affecting access to the patient’s Summaries, the Health Care Practitioner has already overridden the consent directive to enable viewing of the patient’s Summaries where direct care is being provided.

Primary Flow

  1. Health Care Practitioner requests to view historical version(s) of a current Patient Summary.
  2. PoS System queries the Provincial Patient Summary Repository for historical version(s) of the current Patient Summary identified by its unique identifier.
  3. Provincial Patient Summary Repository responds with a list of historical Patient Summary(s). The list includes a unique identifier for each Patient Summary and the following information about each Summary to help the Health Care Practitioner select the one(s) that may be relevant:
    • Patient’s name
    • Name of the HIC that provided the Patient Summary
    • Date authored
    • Version number
    • Name of the author (i.e. Health Care Practitioner or PoS System if compiled/submitted automatically)
    • Author’s specialty (if available)
    • Status indicator (i.e. whether the Patient Summary has been invalidated or not)
  4. PoS System displays the list of Patient Summary(s) to the Health Care Practitioner, sorted in descending order by date. The display clearly indicates that the Patient Summary(s) are historical versions.
  5. Health Care Practitioner selects from the list a Patient Summary of interest to them.
  6. PoS System retrieves the selected Patient Summary from the Provincial Patient Summary Repository.
  7. PoS System displays the full Patient Summary to the Health Care Practitioner.
  8. Health Care Practitioner reads the Patient Summary. The Practitioner may continue to select and read other historical Patient Summary(s) in the list.

Post-Conditions

  • Health Care Practitioner has used their PoS system to view relevant historical Patient Summary(s) for their patient.