Business Context Index > Use Cases

Use Cases

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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

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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

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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.

Use the below section to define the use cases. UC -01 below can be used as a reference.

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.