Description

A Health Care Provider (HCP) in any care setting requests a patient summary to be created at the time of the request (i.e., on-demand), consisting of the patient's most recent health information from an available data source(s) to be used at the point of care or as part of a clinical workflow.

Scenario

Emergency Room providers request a Patient Summary On-Demand

Mr. Sam Khan is a 79 year old male patient, an ex-smoker who lives with multiple chronic medical issues, including Rheumatoid Arthritis, Valvular Heart Disease, Osteoporosis, Prostate Cancer, and significant Anxiety. Over the past few years, his level of frailty has increased, and he relies more on his family for assistance. 

He visits four specialist physicians for appointments during the year, and also regularly sees his family physician, Dr. Anderson, who synthesizes a lot of the specialist advice and treatment planning, and tries to keep her EMR records up to date.  

About a week after a visit to one of his specialists, while visiting his son in a nearby town, he feels acutely short of breath and a little dizzy, accompanied by coughing. His son takes him to the ER, where he is quickly assessed by the triage team.  It is challenging for him to convey his full medical history when he arrives. While his son is very supportive, he isn’t aware of all the details of recent specialist and family physician consultations.  

Unfortunately, they didn’t have a chance to collect all of Sam’s medications before heading to the ER. Sam’s son is not aware that Dr. Anderson had recently started Sam on a couple of inhalers for suspected COPD. These are new medications, and Sam has been having challenges with the delivery mechanism due to his arthritis.  

Through her Hospital Information System interface, the triage nurse requests a Patient Summary, which pulls records from available data source(s) i.e., Central Data Repository, presenting a concise summary of Sam’s medical history. The Patient Summary helps to fill in critical information gaps during the initial nursing assessment. The Patient Summary also helps the attending physician make her initial differential diagnosis more confidently, complementing the more detailed but incomplete records available through the HIS and provincial EHR. 

She and the nursing team realize that Sam had not been taking his new inhalers regularly and is likely experiencing an acute exacerbation of COPD. They start appropriate treatment, and Sam’s condition improves and stabilizes.  

Triggers, Pre-conditions, Post-Conditions

Triggers:

• • Health Care Provider collects health information in support of treating a patient. 

Pre-conditions

• • In jurisdictions where explicit consent is required to create and share the Patient Summary: Patient provides, or has previously provided, consent to share their data
  • Patient has existing health record in the Clinical Data Repository (one data source) or Patient has existing health care data in multiple data sources (EHR repositories, EMR, HIS, CIS,PHR).

Post-conditions

• • Healthcare care Provider obtains/views newly created (on-demand) Patient Summary from the (clinical data repository or directly EHR repositories , EMR, CIS) with options to view and import the Patient Summary into their clinical solution.

Use Case Participants & Diagram

The participants involved in this use case are:

• • PS-CA Consumer (Health Care Provider requesting an on-demand PS-CA via a Health Information System)
  • Clinical Data Repository (Data source for PS)

This use case diagram represents the participants and their role in the use case with a high-level view of flow of information.

Use Case - Primary Flow

The following provides a textual description corresponding to the use case diagram.

1. Health Care Provider (HCP), while treating a Patient, determines that additional information is required for making clinical decisions.
2. HCP, using their clinical system, requests the Patient Summary to be created on-demand from Clinical Data Repository.
3. Clinical Data Repository (CDR)  receives request and retrieves relevant patient data from various sources within it’s repository
4. CDR assembles the Patient Summary with information retrieved from the corresponding patient data sources in the Clinical Data Repository. 
5. CDR applies business rules (e.g., policy, privacy, etc.) to the information that has been collected from the Clinical Data Repository.
6. CDR renders the Patient Summary into a format that is consumable by the requesting system (e.g., PDF document).
7. HCP receives and views the Patient Summary.
8. Optionally, the HCP may choose to consume the Patient Summary into their clinical system.
9. HCP has access to the most recent and available Patient Summary.

Use Case - Alternate Flow

The following list provides possible alternate flows that may occur within this use case.

• Step 8: Health Care Provider receives response from the CDR that the Patient Summary is masked. Health Care Provider completes the applicable jurisdictional consent documentation (e.g., override reason code) and re-submits the request or abandons the request.