dft-preBallot - This is the first draft of the P-Care IG. For a full list of available versions, see the Directory of published versions

Use Cases

The following examples illustrate clinical use cases that this implementation guide could support. They are illustrative rather than prescriptive and do not define required behaviour. There are no conformance expectons related to these cases.

Actors

Table 1 - Use Case Participants

Participant	Type	Description
EMR	System	Software system responsible for capturing and managing primary care data
SMART App	System	Independent application launched from an EMR to perform specialized, user-directed activity
Jurisdictional System	System	Software system maintained by a provincial, territorial, or national entity that provides data or services to an EMR or consumes them from an EMR
User	Person	Individual, typically a clinician, who interacts with EMRs and SMART apps

---

PCareUC-1 Create a Patient Summary from EMR Data

Primary Workflow: Create a new document

1. The user launches a SMART App that supports document creation and indicates they wish to create a patient summary.
2. The SMART App reads the Patient referenced in launch context, then searches for allergies, conditions, procedures, observations, and other information appropriate for inclusion in the summary.
3. The SMART App generates a draft document and default narrative from the records returned.
4. The user reviews the draft, removes irrelevant content, and searches for and adds any additional information they consider relevant.
5. The user reviews and edits the narrative as needed.
6. The SMART App stores the Patient Summary Bundle and its associated DocumentReference in the EMR.

Alternate Workflows:

1. Editing an existing document

   1. The user launches a SMART App that supports document creation.
   2. The user searches for existing Patient Summary documents for the patient in context.
   3. The user selects a document to edit.
   4. The process continues with the applicable steps in the primary workflow.

2. Transmit a document

   1. The user completes the primary workflow.
   2. The user chooses to transmit the document to another provider or system.
   3. The SMART App searches EMR and/or Jurisdictional System records for the intended practitioner, organization, or endpoint.
   4. The SMART App submits the document through an appropriate method, such as a RESTful action, operation, etc.

PCareUC-2 Update the EMR from a Patient Summary

Primary Workflow: Integrate data for an existing patient

1. The user launches a SMART App that supports Patient Summary integration.
2. The user retrieves a Patient Summary document from the EMR or a Jurisdictional System.
3. The SMART App searches the EMR for the associated patient record, using identifiers and demographics as needed.
4. The SMART App retrieves the patient's allergies, conditions, and other relevant records from the EMR.
5. The SMART App compares the document content with EMR data and matches corresponding information wherever possible.
6. The SMART App identifies candidate additions and updates and presents them to the user.
7. The user selects the changes to apply, adding or removing candidate changes as appropriate.
8. The SMART App creates or updates EMR resource instances as directed.
9. If they are not already present, the SMART App creates a Bundle and DocumentReference for the Patient Summary document in the EMR.

Alternate Workflows:

1. New patient
   1. The user launches a SMART App that supports Patient Summary integration.
   2. The SMART App retrieves a Patient Summary from a Jurisdictional System or another EMR.
   3. The SMART App searches the EMR but cannot confirm a match with an existing patient.
   4. The user reviews potential matches and confirms that the patient is new to the practice.
   5. The SMART App displays the Patient Summary information and asks the user which components to import.
   6. The SMART App creates the Patient resource and the selected additional resources in the EMR.
   7. The SMART App creates a Bundle and DocumentReference for the Patient Summary document in the EMR.

PCareUC-3 Create a Referral

Primary Workflow: App-managed referral

1. The user launches a SMART App that supports referral creation.
2. The user specifies the type of referral.
3. The SMART App retrieves information from the referral Jurisdictional System to identify potential recipients.
4. The user selects the intended recipient.
5. The SMART App retrieves the recipient's data requirements.
6. The SMART App retrieves available EMR data that meets those requirements.
7. The user reviews and confirms the information to transmit.
8. The SMART App creates a copy of the ServiceRequest and any other associated resources in the EMR.
9. The SMART App transmits the Task seeking fulfillment of the ServiceRequest to the target EMR or an intermediary Jurisdictional System.

Alternate Workflows:

1. EMR-managed referral
   1. Follow the primary workflow but skip step 9.
   2. Instead, the EMR transmits the Task to the intended recipient and manages any additional workflow.

PCareUC-4 Complete a Questionnaire

Primary Workflow: Complete a New QuestionnaireResponse

1. The user launches a SMART App that supports questionnaire completion.
2. The SMART App retrieves the Questionnaire from a Jurisdictional System using information supplied in the launch context.
3. The SMART App runs any prepopulation logic and searches the EMR for relevant data.
4. The SMART App displays the partially populated QuestionnaireResponse for the user to review and complete.
5. The SMART App creates the completed QuestionnaireResponse in the EMR.

Alternate Workflows:

1. Edit a previously completed QuestionnaireResponse
   1. The user launches a SMART App that supports questionnaire completion.
   2. The SMART App retrieves an existing QuestionnaireResponse, either by using an identifier from the launch context or by searching with user-specified parameters.
   3. The SMART App retrieves the associated Questionnaire from a Jurisdictional System.
   4. If requested, the SMART App repopulates unanswered questions by searching the EMR for relevant data.
   5. The SMART App displays the partially populated QuestionnaireResponse for the user to review and complete.
   6. The SMART App updates the existing QuestionnaireResponse in the EMR.

PCareUC-5 Extract Information from a QuestionnaireResponse

Primary Workflow

1. The user launches a SMART App that can process QuestionnaireResponses.
2. The SMART App retrieves a QuestionnaireResponse from a Jurisdictional System or the EMR, based on the launch context or a user-initiated search.
3. The SMART App retrieves the referenced Questionnaire from a Jurisdictional System.
4. The SMART App applies the Questionnaire's extraction logic to the QuestionnaireResponse.
5. The SMART App creates or updates EMR resources using the extracted data.

PCareUC-6 SMART app retrieves immunization information

Primary Workflow

1. The user launches a SMART App that can process immunization information.
2. The SMART App retrieves an immunization package from a Jurisdictional System.
3. The SMART App retrieves immunization information already stored in the EMR.
4. The SMART App compares the immunization package with the EMR record and presents any differences to the user.
5. The user selects the information to add to or update in the EMR.
6. The SMART App applies the requested changes to the EMR immunization records.