Case Management Storyboards

Case Management Storyboards

These storyboards were developed by the Canadian Public Health Surveillance Project to illustrate use of HL7 messaging in public health case management. The storyboards contain references to interactions from a variety of domains, including PORR.

Case Management Introduction

The purpose of communicable disease case management is to identify, quantify, contain and control risk to public health from instances of communicable disease.

Assumptions:

• Case management begins when Public Health begins investigation into a subject that has been exposed to an infectious agent or shows symptoms suggestive of a notifiable infectious disease.
• During this process of case management, a contact of the case may become a new case.
• Transferring a case from one jurisdiction to another, essentially “closes” the case in the “transfer from” jurisdiction.

Triggers:

• The client presenting to the Public Health Unit
• Public Health is informed about a positive, reportable lab test result
• A health care provider notifies Public Health of a possible case
• An inbound transfer (Alert) e.g. subject transferred from another jurisdiction
• A communicable disease case contact investigation
• Case definition change
• Surveillance function (Alert)

---

StoryBoard #1: TB Surveillance

Preamble:

The purpose of Tuberculosis (TB) immigration medical surveillance among new immigrants to Canada is to determine if TB treatment and/or ongoing follow-up is necessary. Citizenship and Immigration Canada (CIC) requires that new immigrants identified as having a reportable disease such as TB report to Public Health upon arriving at their destination in Canada. When the client enters the country, CIC sends an [Investigation Request] to the provincial health authorities at the client’s anticipated destination. The CIC request contains a CIC ID number, reason for the surveillance requirement and the client’s anticipated address, or address of a sponsoring organization such as a church or university, where the person can be contacted.

The provincial health authorities, upon receipt of the request from CIC, create a “CIC referral” [Investigation Request] that is directed to the Health Unit (HU) at the client’s expected destination . This informs Health Unit staff that they should be receiving a client for TB medical surveillance. The HU is expected to respond later with a report on the outcome(s) of their investigation, including the possibility that the client was not found if he fails to report to the health unit as instructed.

The provincial authorities may also add the person to their jurisdictional client registry, based upon the information already received from the CIC in the investigation request.

---

Storyboard

Based on an Immigration Medical Examination (IME) in his country of origin, Neville Nuclear was diagnosed with a latent TB infection. When he arrives in Canada CIC notes this diagnosis in his file and therefore creates an [Investigation Request] which is sent to the Provincial Health Authority (PHA) in his province of destination. After receiving the request, the PHA records Neville’s name and demographic information in the jurisdictional client registry and sends an [Investigation Request] to the appropriate regional health unit.

This request is eventually received by Nurse Nightingale at the Anytown Public Health Unit. Nightingale checks the address information and confirms that Neville is (will be) living within her district. She sends a response message, [Investigation Request Promise Response] saying that she is undertaking a “TB Medical Surveillance” investigation for Neville (in some regions this may be called a “Suspect TB case”).

Nightingale’s next task is to create a reminder to herself to respond to this referral (aka Investigation Request) within 30 days, at which point she will respond in one of two ways. Nightingale will either confirm that the client has made contact with the health unit and medical surveillance has been initiated, or she will respond to the referral by sending a [message –tbd] stating that the referral can not be “acted upon”, because the client can not be located. If Neville does not make contact with the health unit, this “Medical Surveillance” case will be closed, with a discharge classification of “Failure to Report”.