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Universal Storyboard – ReportDocument Events

Incomplete ReportDocument
A pathology resident performs a gross dissection examination of the tissue submitted from a surgical procedure
to remove the gall bladder of a 37 year old female patient. The pathologist assigns a surgical case number to
the study and dictates his observations into a central dictation system. A transcriptionist keys the text into
a document application. This application exchanges the document from the Transcription Manager to the surgical
pathology system.

Since a complete surgical pathology exam contains microscopic findings and conclusions the Document Completion
Status of the document is marked as "Incomplete".

Pre-Authenticated ReportDocument
Later, another junior pathology resident performs the microscopic exam and dictates the remainder of the
pathology report. 

A transcriptionist keys the text additional text into a document application. This application exchanges the
document from the Transcription Manager to the surgical pathology system with the document completion status of
'pre-authenticated'. Now that the content is presumed complete, the information exchange includes the pathology
examination notification as well as the findings.

Authentication
Later a staff (board certified) pathologist "over-reads" the slides and the text of the report and agrees that
the junior resident's findings were correct. This pathologist has sign-out authority. He thus legally authenticates
this surgical pathology exam document.

Based on the business rules of an information exchange, the document is generated from the document application
and communicated to the surgical pathology system containing the full report content and an authentication
status of "legally authenticated".

The above narratives are the basis for the increasingly complex narratives which follow.

Document Addendum Notification
During the initial gross dissection of the gall bladder tissue, the prosector discovered a small, hard, 4mm
brownish green inclusion that the pathology resident felt was consistent with a gall stone. This "stone" was
removed and sent out to a reference laboratory for X-ray Crystallography analysis to confirm that the inclusion
is indeed a gallstone and to determine the composition of the stone. 

In preparing the specimen for submission to the reference laboratory, a requisition is filled out where the
surgical case number assigned to the gallbladder surgical pathology exam is listed as the parent document ID
together with the patient demographics and identifiers and the exam requested. The reference lab performs the
steps of the specimen intake process for requested study with the original surgical case number being used as
the parent document ID and their own reference laboratory assigned accession number being used as the report
identifier. 

The reference laboratory document manager application generates a document addendum notification exchange to
the referring hospital's surgical pathology document manager application indicating the assigned document ID
with a document completion status of "in progress". 

Document Addendum Notification and Content
The reference lab performs the analysis and confirms the presence of a gall stone and identifies the chemical
composition of the crystals that make up the stone. 

The text is verified by the X-ray Crystallography technician who then reviews the text online and authenticates
its accuracy. In the reference laboratory the technician has, by institutional policy, the authority to sign
out reports.

The reference laboratory document manager application generates a document addendum notification and content
exchange to the referring hospital's surgical pathology document manager application indicating the assigned
document ID with a document completion status of "legally authenticated". 

Document Edit Notification
Only documents that have not been released for patient care (i.e. have a statusCode of "new") can be edited.
Once a document is "active" or "completed", it needs to be formally revised. The pathology resident has
authenticated the original full text of the gall bladder surgical pathology exam, but because of institutional
business rules, the document remains "new" until it is legally authenticated. The need for a change is discovered
by the staff pathologist "over-reading" the case findings. The pathologist dictates the changes that will be
subsequently keyed into the transcription manager application. 

An information exchange containing the notification of the intended edit is generated by the transcription
manager application and sent to the Document Manager application. Note that the ID and Set ID field values
do not change during edits. Local business rules in each application domain dictate whether a document's
version number is incremented with successive edits. 

Document Edit Notification and Content
The pathologist over-reading that surgical pathology exam identifies additional benign morphologic changes to
the gall bladder and dictates the changes that are now keyed into the transcription manager application. Once
the edited modification to the gall bladder surgical exam has been applied, a message will be generated. 

An information exchange containing the modified content is generated by the transcription manager application
and sent to Document Manager application. Because the content has not been released for patient care the
Document Manager receiving the document via exchange over-writes the original content with the content supplied. 

Document Replacement Notification
Only documents that have not been released for patient care (i.e. have a statusCode of "new") can be edited.
Once a document is "active" or "completed", it needs to be formally revised. The pathology resident has
authenticated the original full text of the gall bladder surgical pathology exam, and at the resident's
institution, the policy is to make documents available for patient care before they are legally authenticated,
so the document is advanced to "active" status. The need for a change is discovered by the staff pathologist
"over-reading" the case findings. The pathologist dictates the changes that will be subsequently keyed into the
transcription manager application. 

An information exchange containing the notification of the intended revision is generated by the transcription
manager application and sent to Document Manager application. In this case there is an earlier document available
for patient care that has been found to be inaccurate.

Document Replacement Notification and Content
The pathologist over-reading that surgical pathology exam identifies additional benign morphologic changes to
the gall bladder and dictates the changes that are now keyed into the transcription manager application. Once
the revision to the gall bladder surgical exam has been applied, a message will be generated. 

An information exchange containing the notification and content of the change is generated as a replacement 
document by transcription manager application and sent to Document Manager  application. 

Document Cancel Notification
The gall bladder surgical pathology exam document was inadvertently assigned to the wrong patient. While an
original document was generated it contained a status code value of 'new' (because it had not been made available
for patient care). The document can be cancelled. 
If a document has been made available for patient care, then this interaction cannot occur. Once any form of a
document has been released for patient care it must be replaced or repudiated. An information exchange containing
the cancellation is generated by the document management application and sent to any and all previous recipients
of Medical Document Management messages for this document. 

Document Repudiation Notification
The gall bladder surgical pathology exam document was inadvertently assigned to the wrong patient, and the
document was subsequently made available for patient care. An original document was generated and has acquired
a status of 'active', so can no longer be canceled. Instead, the original document is repudiated, and its status
is changed to 'nullified'. 

Business Process

This business process shows how document objects are different than the result object itself. The document is a point-in-time artifact and has properties as such. Therefore there are document-specific trigger events which are captured above.

Storyboard Objects

This storyboard illustrates additional ReportDocument object states:

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