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Storyboards Care Provision Domain

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Patient Care Normative Ballot Content


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________________________________________ << Table below has not changed>> ▼ Storyboards (Sorted by Title)

	 	Aged Care Transfer - Domain(DOPC_ST000035UV01)  


	 	Multidisciplinary Care(DOPC_ST000032UV01)  

	 	Patient Populates Personal Health Record(DOPC_ST000033UV01)  

	 	Pediatric Immunization(DOPC_ST000030UV01)  

	 	Primary Physician Refers to Specialist(DOPC_ST000034UV01)  

▼ Storyboards (Sorted by Structured Sort Name)

	 	Care Record Patient Populates Personal Health Record(DOPC_ST000033UV01)  

	 	Care Record Primary Care Physician Interacts With An Immunization Registry(DOPC_ST000030UV01)  

	 	Care Record Primary Physician Refers To Specialist(DOPC_ST000034UV01)  

	 	Care Transfer Multidisciplinary Care(DOPC_ST000032UV01)  

	 	Care Transfer Request Aged Care Service(DOPC_ST000035UV01)  

	 	Requirements Analysis Artifacts Overview Introduction(DOPC_ST000031UV01)  

▼ Storyboards (Sorted by Display Order)


	 	Patient Populates Personal Health Record(DOPC_ST000033UV01)  

	 	Pediatric Immunization(DOPC_ST000030UV01)  

	 	Primary Physician Refers to Specialist(DOPC_ST000034UV01)  

	 	Multidisciplinary Care(DOPC_ST000032UV01)  

	 	Aged Care Transfer - Domain(DOPC_ST000035UV01)  

▼ Care Record Topic Storyboards (Sorted by Display Order)

	 	Mandatory Care Activation(REPC_ST002006UV01)  

	 	Temporary Handover of Care(REPC_ST002005UV01)  

	 	Emergency Encounter(REPC_ST002001UV01)  

	 	Hospital Discharge Summary(REPC_ST002002UV01)  

	 	Ongoing Specialist Care Provision(REPC_ST002003UV01)  

	 	Separation of Care(REPC_ST002004UV01)  

▼ Care Record Query Topic Storyboards (Sorted by Display Order)

	 	Aged Care Assessment Record Query(REPC_ST002201UV01)  

	 	Patient Populates Personal EHR(REPC_ST002202UV01)  

▼ Care Transfer Topic Storyboards (Sorted by Display Order)

	 	Request for Changes in Ongoing Service(REPC_ST004008UV01)  

	 	Completed Specialty Care(REPC_ST004001UV01)  

	 	Multidisciplinary Care Provision(REPC_ST004003UV01)  

	 	Aged Care Transfer Request(REPC_ST004005UV01)  

	 	Aged Care (Lite) Transfer(REPC_ST004006UV01)  

	 	Request Medication Chart Review(REPC_ST004004UV01)  

	 	Request for Pastoral Care(REPC_ST004007UV01)  

	 	Surgical Referral(REPC_ST004002UV01)  

▼ Allergies & Intolerance Topic Storyboards (Sorted by Display Order)

	 	Patient Report Food Allergy(REPC_ST006006UV01)  

	 	Physician Adds Allergy Information(REPC_ST006000UV01)  

	 	Physician Annotates Allergy(REPC_ST006004UV01)  

	 	Physician Clarifies Allergy Information(REPC_ST006003UV01)  

	 	Physician Enters Suspect Environmental Allergy(REPC_ST006007UV01)  

	 	Physician Notes Severe Intolerance(REPC_ST006008UV01)  

	 	Physician Reviews Verifies Allergy Information(REPC_ST006002UV01)  

	 	Physician Updates Allergy Information(REPC_ST006001UV01)  

Reference For details on the interpretation of this section, see the storyboard discussion in the Version 3 Guide.

1.3.1 Introduction (DOPC_ST000031UV01)



For details on the use of storyboards, see the storyboard Investigation Request uses a model that allows virtually any entity to be described, discussion in the HL7 Development Framework, Chapter 2. For the additional storyboards collected from international authors as part of HDF requirements analysis, see the Care Provision Domain Requirements Analysis Artifacts PDF. For the storyboards used to illustrate specific message, service, or document definitions, please see the appropriate topic under the Care Provision Domain.

Domain Storyboards:

This section of the Care Provision Document is used to generally illustrate the scope of the Care Provision Domain. These storyboards cover: • Patient care from prenatal to pediatric care to aged care • Care settings from home care to ambulatory care to emergency care to hospital care • Care subjects from populations to individual patients to environments and facilities • Care providers including nurses, physicians, the multi-disciplinary team, the patient themselves, and lay care givers • Care workflows from "direct care" to "transfers of care" to "communication of care records". Note: The storyboards in this section generally illustrate the scope of the domain. They do not exhaustively illustrate the scope of the domain, and additional storyboards are to be found in the Care Provision Domain Requirements Analysis Artifacts PDF and the Care Provision Topics.

The format used in HL7 storyboard sections follows the pattern: Purpose: a short explanation of the content Interaction Diagram: (usually present only at the Care Provision Topic level) Precondition: The state of the participants and information before the story begins Activities: The actions in the story Post-condition: The state of the participants and information after the story is completed Activity Diagram: A UML "flowchart" of sequential actions (usually only present in the Care Provision Domain Requirements Analysis Artifacts PDF) Glossary: A definition of each of the single and multi-word terms used in the storyboard (usually only present in the Care Provision Domain Requirements Analysis Artifacts PDF).

1.3.2 Patient Populates Personal Health Record (DOPC_ST000033UV01)

Purpose This storyboard demonstrates the flow of communication associated with requests for components of a medical record, including whole documents. Populates Personal Health Record (DOPC_SN000033UV01) Precondition: Mr. Adam Everyman wishes to populate a personal health record with information on his condition from Dr. Patricia Primary held in her clinical system. Activities: Mr. Adam Everyman requests specific information relating to his cardiac condition from Dr. Patricia Primary. Dr. Primary responds by sending the answers to the specific information requested to Mr. Everyman who is able to incorporate the information into his own personal health record. Mr Everyman uploads the information on his cardiac condition into his personal health record. Alternate flow: Mr Everyman requests copies of particular test results and treatments relating to his cardiac condition from Dr Primary. Dr Primary responds by sending the requested documents to Mr Everyman. Postcondition: Mr. Everyman now has all the documents and information he requires on his cardiac condition from Dr. Primary.

1.3.3 Pediatric Immunization (DOPC_ST000030UV01)

Purpose This storyboard demonstrates the interaction between a Primary Care Physician (GP) to an immunization registry for the region. Immunization (DOPC_SN000030UV01)

Precondition: Billy Newpatient is 4 years old. He has been seen at other clinics in the region. However, he is a new patient at Dr. Primary's clinic. He is there for a pre-school physical. Dr. Primary's clinic EMR is able to interface with a regional immunization registry. The regional immunization registry conforms to public health standards, e.g. CDC Minimal Functional Standards for Immunization Registries. The clinic EMR conforms to HL-7 EHR-S Functional Model. The regional immunization registry is able to locate the patient's immunization record. Activities: By interview, the nurse discovers Billy's caretaker does not have his immunization record. In preparing his new patient record for Dr. Primary to review, the nurse initiates the clinic EMR to query the regional immunization registry. The immunization registry finds and sends data to clinic EMR. The clinic EMR populates Billy's patient record with that data. The clinic EMR generates immunization recommendations using a decision support engine. Alternate Flow #1: The regional registry uses a decision support engine and sends recommendations along with Billy's immunization data. Dr. Primary reviews the record and notes (amongst other data) Billy's immunization record (or its absence thereof) and recommendations. After taking history from the caretaker and performing physical exam, she orders immunizations. The nurse administers the shots and documents them in the clinic's EMR. The clinic EMR sends the message about the new immunizations to the state registry which updates its record. The nurse also prints an updated paper record of Billy's immunizations. Alternate Flow #2: Dr. Primary determines that Billy does not require or decides to withhold immunizations at this stage. No updates are made to the immunization history in the patient record. No data is sent to the registry. Post-condition: The regional registry has successfully sent Billy's immunization history. The regional registry has successfully recorded Billy's new immunizations. The clinic EMR has an updated immunization record. Billy's caretaker has an updated immunization record.   1.3.4 Primary Physician Refers to Specialist (DOPC_ST000034UV01)

Purpose This storyboard demonstrates a referral for specialist care, including the provision of detailed clinical data showing evidence of arrhythmias and a request for an appointment. Primary Physician Refers to Specialist (DOPC_SN000034UV01) Precondition: Dr. Patricia Primary has been seeing Mr. Adam Everyman, a 45-year old male patient, in her office with a complaint of episodes of rapid heart beat with shortness of breath. She decides to refer Mr. Everyman to cardiologist, Dr. Patrick Pump. Activities: Dr. Primary performs a history and physical as well as a 12-lead EKG on Mr. Everyman. The machine in Dr. Primary's office reads out "shortened PR-Interval, possible Delta Wave; consider WPW". Dr. Primary decides to refer Mr. Everyman to Dr. Pump for further evaluation. She also places Mr. Everyman on an anti-arrhythmic. Mr. Chris Clerk, administrative clerk for Dr. Primary, requests an appointment from office staff in Dr. Pump's office for Mr. Everyman and sends the following data in the referral written by Dr. Primary: 1. REASON FOR REFERRAL: Possible WPW. 2. Chief Complaint: Shortness of Breath. 3. History of Present Illness : Patient suffers from a several month history of episodes of rapid beat associated with shortness of breath which have not improved with rest. 4. Problem List: shortness of breath; palpitations. 5. Medication List: anti-arrhythmic. 6. Allergies and Adverse Reactions: No Known Drug Allergies. 7. Review of systems: otherwise negative 6. Physical Exam: (structured exam). 8. DATA & TESTS: EKG Report and Image as above. 9. Care Plan: EXPECTATION FOR FOLLOW UP / RECOMMENDATIONS--Please let me know your evaluation and long-term treatment recommendations. Mr. Clerk receives confirmation from Dr. Pump's practice of an appointment for Mr. Everyman for the following Tuesday. Postcondition: The above information is available to Dr. Pump when Adam Everyman attends Dr. Pump's offices for a full cardiology work up.

1.3.5 Multidisciplinary Care (DOPC_ST000032UV01)

Purpose This storyboard demonstrates the communication flow associated with requests by a Primary Care Physician (GP) to other clinical or allied health care providers to contribute to the delivery of a multidisciplinary care plan, such as a Chronic Disease Management care plan (CDM). CDMs are designed to improve the medical management of care for a person with chronic or complex care needs who typically are taken care of by many people with many roles. Multidisicplinary Care - Domain (DOPC_SN000032UV01)

Precondition: Dr. Patricia Primary is preparing a multidisciplinary care plan for Mr Adam Everyman to improve his health outcomes and quality of life goals associated with his diabetes and hypertension. She recommends to Mr. Everyman involving a physiotherapist, a nutritionist and his daughter, Nancy Nuclear. Dr. Primary obtains Mr. Everyman's authorization to share his medical history and goals with the other providers and his daughter. Activities: Request shared care provision Dr. Primary sends an individual request to Physiotherapist Seth Stretcher, Nutritionist Connie Chow and to Mr. Everyman's daughter, Nancy Nuclear. Each in turn sends a response to confirm they will make arrangements to meet with Mr. Everyman to develop a plan to meet the particular goals specified by Dr. Primary. In turn Seth Stretcher and Connie Chow meet with Mr. Everyman and his daughter to review his goals in relation to his diabetes and hypertension. Each prepares a care plan for Mr. Everyman which they summarize and forward to Dr. Primary. Dr. Primary distills these contributions into an overall Chronic Disease Management (CDM) care plan with action items for each of the members of the care team and provides copies of the care plan to each of the members of the multidisciplinary care planning team. The team includes Mr. Everyman's daughter, who under the plan has been identified as responsible for assisting Mr. Everyman with his meals and the condition of his kitchen. Each acknowledges their undertaking to complete the action items in the revised, composite care plan. Ongoing shared care provision Each provider continues to see or communicate with Mr. Everyman to review his response to the respective action items in the plan of care. They provide a summary report on progress during the first phase of the care plan to Dr. Primary. Review shared care provision Three weeks later, Dr. Primary meets with Mr. Everyman and his daughter to review progress in the first phase of the care plan for the management of his diabetes and hypertension. While he has achieved some of his goals, Mr. Everyman is disappointed in the progress with those relating to stabilizing his blood sugar levels. Dr. Primary amends the goals for the next phase of Mr. Everyman's care plan and sends these to Connie Chow and Nancy Nuclear along with the revised set of orders and requests for the following phase. Connie Chow and Seth Stretcher review their care plans for Mr. Everyman in light of the new goals from Dr. Primary and provide ongoing progress reports on the new care plans. Postcondition: Mr. Everyman receives team-based care, coordinated and reviewed by his Primary Care Physician, Dr. Primary. Each care provider has updated copies of the care plans including progress reports towards implementation of the action items in the care plans in the respective local care records.

1.3.6 Aged Care Transfer - Domain (DOPC_ST000035UV01)

Purpose This storyboard demonstrates the flow of communication between a party seeking a community or residential aged care service place and the admissions system of an ageing services provider organization. Note the outcome of this storyboard relates to the success or otherwise of a request to access services ("do you have a vacancy?") - it says nothing about whether an admission occurs. Aged Care Transfer - Domain (DOPC_SN000035UV01) Precondition: Peter Process is the social worker at Good Health Hospital (GHH) responsible for coordinating in patient discharges for older patients. His role is to maximize the successful return of frail elderly inpatients to the community, including to residential aged care services. He works closely with the ageing services (home care and residential) in the surrounding area. He is looking for a nursing home placement for a Mr. Everyman who requires some intensive rehabilitation following a fall before he can safely return to living with his daughter who works full time. He recommends Green Acres Retirement Home (GARH) as a suitable provider organization to Mr. Everyman and his daughter, Nancy Nuclear, who authorize him to approach GARH on his behalf, along with three other nursing homes within 5 miles radius of Ms Nuclear's home.

Activities: Send request for bed Peter Process sends a request for a nursing home place to Alice Admitter, the Admissions Officer at GARH. When she processes requests for places at GARH, Alice Admitter firstly checks that all baseline administrative details have been provided by the referring party (as GARH is not certified to accept some clients). She also checks her admissions data base to assess the likelihood of being able to accommodate the request within the timeframe indicated by the referring party. On this occasion one of the two respite beds at GARH is vacant in the nursing home. However, as she is processing the referral Alice Admitter notes Peter Process has not included all of Mr. Everyman's insurance details. She sends the request back to Peter Process, indicating the request cannot be processed in its current form. Peter Process returns an updated request to Alice Admitter with all the required administrative information. Alice Admitter responds to Peter Process that she is now processing the request for clinical appropriateness with nursing. Confirm undertaking to process request Alice Admitter sends all referrals to the nursing home administrator or relevant care coordinator, who at GARH is Nancy Nightingale. Nancy Nightingale assesses the request and as required will request any additional information from the referring party. On this occasion she is keen to understand whether cognitive impairment is a factor that will impact on Mr. Everyman's capacity to be rehabilitated within the optimistically short time frame suggested by the discharging physician at GHH.

Query care record information Nancy Nightingale sends a request for further clinical information on Mr. Everyman's cognitive functional capacity to Peter Process at GHH who on this occasion had not attached the full cognitive assessment findings. As he had already obtained Mr. Everyman's consent to share his assessment findings with other service providers, Peter Process attaches the summary of Mr. Everyman's cognitive and behavioral assessment scales, including the scores from the assessments undertaken in the hospital of his cognitive, behavioral and mood status. He sends this to Nancy Nightingale.

Promise bed Following her review of Mr. Everyman's rehabilitation and care needs, Nancy Nightingale is happy to offer a remaining vacant bed at GARH to Mr. Everyman. She advises Alice Admitter of this decision. Alice Admitter promptly promises Peter Process the bed for Mr. Everyman. This action simultaneously updates GARH's 'Active Referrals' file, maintained by Alice Admitter, completing the audit trail for this request for services. Mr. Everyman's name is not removed from the 'Active Referral's file until notification is received that all contractual documentation is in place and that he has actually been admitted to GARH. Post-condition: Mr. Everyman has a bed reserved in GARH. Records have been updated in both the hospital and nursing home with Mr. Everyman's administrative and clinical information. Audit trails for the requests made and promises given are complete.

Alternative flows: 1. Following the promise from GARH to provide services, Peter Process receives a call from Mr. Everyman's daughter to advise she is taking parental leave for two months so her father can be discharged directly home to live with her. Following the leave (when she returns to work) she will reassess whether her father still needs to receive formal ageing services. Peter Process immediately notifies Alice Admitter and Nancy Nightingale that the request for services for Mr. Everyman is withdrawn. Post-condition: Peter Process discharges Mr. Everyman home.

2. Having reviewed the detailed cognitive and behavioral assessment scales for Mr. Everyman, Nancy Nightingale determines the respite bed she currently has available (for short term admission only) will not be adequate to meet the rehabilitation goals set for Mr. Everyman. She notifies Alice Admitter who in turn notifies Peter Process, Mr. Everyman and his daughter of the decision to decline the request for a bed. Post-condition: Peter Process contacts the other nursing home facilities in the area in the hope of finding a suitable placement for Mr. Everyman.

3. 3. Alice Admitter advises Ms Nuclear that GARH will be able to offer the next permanent nursing home bed to her father when it becomes available but she is unable to say precisely when that date will be. Ms Nuclear is delighted and happy to wait on a place as GARH is her father's preferred choice of nursing home. Alice Admitter adds Mr. Everyman's name to the GARH Waiting List for permanent placement. She notifies Peter Process of this outcome as Mr. Everyman has yet to be discharged from hospital. Post-condition: Peter Process delays Mr. Everyman's discharge until a bed becomes available for him at GARH.