Overview

The following uses cases have been identified for this implementation guide.

Use Case Diagram

Use Case Context

This use case supports integration between the EMR and lab systems in order to effectively process lab requests and have the results returned to the EMR for diagnosis.

In addition, this use case illustrates the need for a Centralized Data Repository (DR) and a Client Registry (CR) to enable regional and/or national COVID19 case reporting.

The technical specification documentation for the Data Integration Strategy & Implementation reference platform identifies the following technologies for the two aforementioned centralized repositories.

1. DR: HAPI FHIR
2. CR: SanteMPI

• The use case summary is limited to the specification for this implementation guide and will not discuss the architectural components for the DR, CR and Data Mart.
• For more information regarding the implementation of a the architectural components, please see the technical specification documentation.

Use Case Summary

Register Client

Before an individual can be screened and assessed (diagnosis) for COVID19, the individual must be registered into the EMR at the assessing facility/organization.

Assess Client

A nurse must be able to retrospectively capture existing screening and assessment data for individuals who are continuing with their vaccination series at a different facility where it is a first-time visit or if the visited facility has older data in regards to the progression towards being up-to-date vaccinated for COVID19.

In addition, this use case enables the nurse to capture the following key data.

• Metadata
• Presentation information (Asymptomatic, Symptomatic)
• Presenting symptoms and any pre-existing conditions and/or comorbidities
• History of hospitalization for COVID19
• The COVID19 diagnosis taken from the most recent lab examination
• Treatment needs

Document Client Outcome

An individual who has been diagnosed positive for COVID19, typically, has one of the following outcomes.

• Metadata
• Outcome codes
  • Recovered (symptoms resolved)
    • Those individuals who previously suffered from the disease are no longer showing any symptoms.
  • Long COVID / Post-COVID
    • Those individuals who suffer long-term affects which could range anywhere between a few weeks to even years (Post-COVID Conditions, 2022).
  • Death
    • Those individuals who have suffered death due to exposure to COVID19.

Submit lab order

A nurse must be able to submit a request from the EMR for a sample to be collected and examined at the laboratory.

A lab request, in the context of this implementation guide, will typically contain the following key data.

• Metadata
• Order number
• Test requested codes
  • SARS-CoV-2 (COVID-19) Ag [Presence] in Respiratory specimen by Rapid immunoassay
  • SARS-CoV-2 (COVID-19) RNA [Cycle Threshold #] in Respiratory specimen by NAA with probe detection
• Reason for the test
• Specimen types
  • Nasopharyngeal
  • Oropharyngeal swab
  • Unknown
• Specimen ID

Sample Collection

A lab assistant must be able to collect samples that have been submitted for testing from the EMR.

Sample collection in the context of this implementation guide, will typically contain the following key data.

• Metadata
• Sample collection date & time
• Specimen type
  • Same as the submit lab order use case
• Specimen ID

Process Lab Request

A lab assistant must be able to close the request for sample examination using one of the following three statuses.

1. The specimen was successfully examined and the result issued (lab result)
2. The request for sample examination was cancelled by the lab order requester (lab cancellation)
3. The specimen examination was rejected by the lab performer without carrying out any part of the test (lab rejection)

Process lab request in the context of this implementation guide, will typically contain the following key data.

• Metadata
• Order number
• Reason for not performing test
  • Only applicable for lab cancellations and lab rejections
• Output code
  • Only applicable to lab orders that have been successfully examined and issued with a result
  • Currently, the code of Result represents the successful completion of a lab order
• Test requested code
  • Same as the submit lab order use case
• Specimen ID
  • Same as the sample collection use case
• Specimen type
  • Same as the submit lab order use case
• Result code
  • Only applicable to lab orders that have been successfully examined and issued with a result.
    • Positive
    • Negative
    • Inconclusive

References