Document Revision History

Attached Documents:

Sexual Health Program Use Case download document:

Sexual Health Use Case Document_v.1.6.doc

Sexual Health Program Business Flow download document:

Sexual Health Work Flow_MAIN_v.1.pdf

1      Overview

1.1      Introduction

This Use Case document is structured to describe each Use Case Model per the existing system in terms of:

• Summary
• Users
• Relationships
• Activity Diagrams
• Flows of Events

The purpose of this document is to describe and identify steps and actions between a user (actor) and software system.  Sexual Health protocol contains two modules:

• Sexual Health Clinic Module
• Sexual Transmitted Disease (STD) Clinic Module (one umbrella)

Defined users:

1. MD doctors, PHN - Public Health Nurses, NP – Nurse Practitioner, receptionist and other medical staff with the credentials and rights to access Sexual Health protocol in OSCAR. General user is given administrative rights.
2. Roles and Responsibilities MATRIX

1.2   References/Inputs

1.3    Glossary

1.4    Use Case Purpose

• To hold Functional Requirements in an easy to read, easy to track text format.
• To represent the goal of an interaction between users and the system. The goal represents a meaningful and measurable objective for the user.
• To record a set of paths (scenarios) that traverses an actor from a trigger event (start of the use case) to the goal (success scenarios).
• To record a set of scenarios that traverses an actor from a trigger event toward a goal but fall short of the goal (failure scenarios).
• Multi-level: one use case can use/extend the functionality of another.

2. Sexual Health and STD clinics - Sexual Health Program

2.1 Summary

Main purpose of the Sexual Health program is: To provide sexual health confidential services for females and males at clinics by PHN, NP, MD.

2.1.1    Business Need:

Objective of this document is to represent scenario and functionality of the “Sexual Health” Protocol and it’s interaction with OSCAR system

2.1.2  Sexual Health Clinics Module 

The City of Hamilton provides confidential sexual health services to females and males at clinics by physicians, nurse practitioners and public health nurses. Low cost birth control is limited to clients age 19 and under

Sexual Health Clinics are providing the following services to the public:

• Counseling about abstinence from sexual activity
• Information about birth control options
• Birth control pill (low cost if eligible) and teaching

• Birth control patch (Ortho Evra) available
• Birth control ring (Nuva Ring) available Test3
• Free Emergency Contraceptive Pill (ECP) also know as Plan B and the Morning After
• Testing for sexually transmitted infections and HIV
• Free treatment for diagnosed or contacts of chlamydia and gonorrhea infections.
• Symptomatic clients may also be treated
• Referral to other services as needed
• Free condoms
• Free needle exchange is available
• Free urine pregnancy testing when applicable, counseling and referrals as needed
• Rapid HIV Testing (also known as Point of Care) is now offered at all of our clinics.
• Emergency Contraceptive Pill (ECP)

2.1.3      Sexually Transmitted Disease (STD) Clinic Module

Sexual Health Clinics are providing the following services for the sexually transmitted diseases:

• Confidential sexual health services are provided to public by physicians, public health nurses and clinic registered nurses and aides

• Testing for chlamydia, gonorrhea, hepatitis, syphilis, herpes (if sore present)

• Confidential HIV testing available with your consent--your initials are used and the result is part of your medical record. A positive HIV result is reported to the local Health Department.

• Point of Care HIV testing  at the STD clinic

• Free treatment for diagnosed cases of  chlamydia and gonorrhea infections and their contacts. Symptomatic clients may also be treated.

• Treatment for HPV (genital warts)

• Pap test may be done as part of sexually transmitted infection (STI) exam

• Pregnancy  urine testing and counseling

• Free hepatitis A and B vaccine for persons at risk 

• Free Emergency Contraceptive Pill (ECP) also known as Morning After Pill (may be given up to 5 days after unprotected sex)*

• Free condoms

• Pamphlets and teaching about sexually transmitted infections, abstinence, pregnancy, STI prevention and birth control

2.1.4      Description

Sexual Health Program use case is presenting the summary of the business flow, outlining user’s roles and presenting numerous scenarios. It also includes Business Flow diagram, preconditions and post conditions and detailed flow of events.

Sexual Health protocol is designed to monitor the incidence of sexually transmitted infections, generate prescriptions, to control drugs inventory, to keep track of lab tests and to populate eForms, print labels etc.

This protocol interacts with Master Record module, eChart module extracting existing information from the following subsections: Preventions, eForms, and Consultation.

2.1.5      Basic Business Scenario

Basic Scenario:

Precondition:

At the very first visit of the clinic patient has to present personal information. Upon receiving this information Receptionist is opening new Demographic Record for the new patient. Client has to present valid OHIP card, to read and sign consent.

1. General user with the correct credentials (MD doctors, PHN - Public Health Nurses, NP – Nurse Practitioner and other medical staff with the credentials and rights to access Sexual Health protocol in CASI) login in into Case Management system

      2. Once User is activating  Sexual Health, he/she is getting full access to the patient information

• Top navigation menu panel is presenting access and communication with OSCAR.
• Case Management View navigation panel is on the top of personal information
• Demographic information is presented at the middle of the screen
• Navigator and Administration section are presented on the left part of UI

Business Flow:

Receptionist: Creates new chart w/file label, forms, labels for lab tests (if needed)

• Appointment is created (booked) for the client

PHN:

• Review demo. Review consent w/client, PHN sign & date
• Review intake HHX w/client & determine required services & forms
• Complete required services & counseling w/client
• If client needs to see MD/NP a visit  then put chart in queue in MD/NP slot
• Complete all charting & documentation before seeing next client
• Complete Record of Interaction & submit with chart to receptionist for data entry in DB.

CLIENT VISIT MD/NP

• Next available MD/NP takes next chart in line between booked appointments & calls client into room.
• Reviews client reasons to see MD/NP & determines required services & forms
• Completes required services & counseling with client
  Completes all charting & documentation before seeing next client
  a. NP
  i.    Completes NP Record of Interaction & submit it with the chart to receptionist for data entry in DB
  
  b. MD
   i.    Completes OHIP Billing Codes Sheet & submit it with the chart to receptionist for data entry in
   ii.    Provides hours worked for clinic & submit it to the clinic coordinator for payment calculation

PHN ASSESSMENTS

• Pregnancy
• ECP
• Hormonal Contraception
• Immunization
• STI Screening
• STI Treatment
• Anonymous HIV

MD/NP ASSESSMENTS

• General Exam (business flow)
  • Performs visual exam
  • May note placement of lesions/marks w/picture
  • Provides counseling and determine if client requires any treatment or testing
  • Some types of screening or injections may be referred back to PHN

• General Warts Treatment

• Hormonal Contraception
• STI Treatment
• STI Screening
• PAP Testing
• Depo-Provera

2.1.6  Functionality available:

Sexual Health application providing the following functionality:

1.   Information could be inputted and saved

2.   eForms can be generated

3.   File Labels can be generated

4.   Appointment can be booked

5.   Drugs prescriptions are generated

6.   Drugs inventory is tracked

7.   Ability to sort and save lab tests that are transferred electronically into Oscar by clinics.

8.   Lab test labels are generated

9.   Color code for lab test list

10.  Creates billing templates for clinic MDs, NPs/PHNs and for medication sales

11.  Interacts with Billing module, generate billings and payments

12.  Vaccine. Interacts with Prevention

13.  Sexual Health module is interacting with eChart

Sexual Health Program protocol interacts with the following modules:

1. Case Management View
2. Demographic record
3. Master Record
4. eChart
5. Billing

2.2    Conditions/Assumptions

2.2.1      Assumptions

• Users login have been established within the system
• Clinics/Labs/Personnel information is created
• Drugs Inventory information is entered

2.2.2      Successful End Condition

• Information is inputted and saved in Sexual Health Protocol.
• Client case with test results, drug prescription etc is created.
• All labels/eForms are generated
• Prescriptions are given to client.
• Client left clinic getting service.
• Case is created for the client and saved in the system. Case can be re-opened/printed at any time for the next 2 years.

2.2.3      Failed End Condition

For a few reasons client sexual health case cannot be completed

• Application Server is down
• Slow performance, user can experience “frozen” interface of grayed out buttons or fields
• Patient can’t present valid Health Card
• Patient refuses to sign concept 
• Prescription cannot be printed and given to client
• Client is refused to go for tests
• Test labels can’t be printed
• Sexual Health clinic can’t provide service
• Patient is living clinic for some reason without getting any services
• Client cannot get Hormonal Contraception if it doesn’t meet low-cost criteria
• Client requested PAP test but does not meet current guidelines for testing or has their own family physician who can perform the testing
• Client cannot be approved for Referrals/consultations that are outside of scope of Sexual Health
• Client is directed to clinic from Case Management but does not show to clinic for testing and/or treatment
• Client presents to clinic with issues requiring physician services but there is no physician booked at the clinic

2.2.4      Preconditions

Log in to Sexual Health with the correct credentials.

• Users of Sexual Health Module have right credentials and work at the clinic. If user is not entering right credentials (user name / password) account will be temporary suspended after the 3-rd attempt. Further User has to contact OSCAR Administrator to reactivate account.
• OSCAR server or OSCAR database/CASI is up and running. In a case of sudden interruption of the connection to the OSCAR server of database, user can experience “frozen” interface of grayed out buttons of fields. In this case user has to wait until connection to the server is re-established. Then user has to verify if the record is saved (to avoid duplicate records). If record is not saved – then redo the whole record. If record is saved partially – then to add or edit information.
• New patient presents personal information to the receptionist upon the first visit.
• Consent agreement HAS to be read and signed by patient
• Patient has to present valid required personal information
• Patient has to present valid OHIP card

2.2.5      Post conditions

• Case is saved for the next 2 years and can be printed at any point.
• After reaching 2 years mark, case is archived and becoming inactive.
• As inactive, case is saved for the next 20 years

2.2.6      Validation

The following are validated:

• Search function
• Demographic record

2.2.7      Required fields and functions:

Fields:

• Date of Birth
• First Name,
• Last Name
• Address
• Bed Program or Residential Status

Functions:

• Create Demographic record
• Generate eForm
• Generate a labels
• Generate consultation
• Print and Sign…
• Save and Archive

2.3 Users/Systems

Systems

Patient’s information is located in the Master File module.

The other modules that are interacting with the Sexual Health module:

• Master File
• Demographic record
• eChart
• Consultation
• Billing
• RX
• Inventory Tracking System Module

Users

Sexual Health Protocol users are mainly:

• Admin
• MD Doctor
• Nurse Manager
• Nurse Practitioner
• Receptionist
• Secretary
• Public Health Nurse

With the correct credentials and administrative rights to access Sexual Health protocol in OSCAR.

2.4      Use Case Relationships

To be Determined

2.4.1      Use Case Relationship Diagram

To be Determined

2.4.2    Use Case Relationship Description

Current case is actively interacting with the following Use cases:

• Consultation Module Use Case
• Inventory Tracking System Module Use Case
• Book Appointment Use Case
• New Patient Registration Use Case
• eChart Use Case
• Master File Use Case

2.5    Activity Diagram

Sexual Health Program Business Flow download document:

Sexual Health Work Flow_MAIN_v.1.pdf

2.6 Flow of Events

This section describes the main flow of the Use Case and system responses.

2.6.1.1     Main Flow 1

Create New Demographic Record for new patient for Sexual Health program

2.6.2      Alternative Flows of Events

This section describes alternative flow(s) of events based on the variations if the main Use Case scenario that still result in a Successful End Condition at completion of Case.

2.6.2.1     Alternative Flow 1

Use Case Management View system to book appointment for the new patient in Sexual Health program

2.6.2.2     Alternative Flow 2

Use Case Management View system to book consultation for the patient in Sexual Health program

2.6.2.3     Alternative Flow 3

Use OSCAR & Case Management system connect to Sexual Health Protocol