Use Case Table of Contents
FHIR Write Use Cases
Meducation Write PDF Back to EMR and Access from Patient Portal
When Meducation materials are printed out for the patient, those materials (i.e., PDF) could be stored in the patient record via storage of 1) electronic PDF file, 2) scanned PDF printout, or 3) unique Meducation identifier code can be link to the PDF. Hospitals require a record of any materials that were provided to a patient. Any document provided to patients should be tagged as "patient materials" so that they are automatically posted to the patient portal (this is how many EHRs work – if a document is tagged as being for patient use, then that document is automatically accessible from the patient portal).
Meducation transactions increment the Patient Ed Numerator for MU
When Meducation materials are printed out for the patient, or a video demonstration is played, the numerator for Meaningful Use needs to be incremented. This will help hospitals meet their MU requirements for "patient education" .
Pediatric Growth Chart Write Back of Z-Score
When a clinician sees a pediatric patient and views the pediatric growth chart, the clinician documents Z% score to be stored as part of the patients longitudinal record inside the EHR using the Pediatric Growth Chart Application.
Bilirubin Chart Writes a Transcutaneous Bilirubin Observations
To assess the risk of hyperbilirubinemia in new borns, a clinician uses a transcutaneous bilirubinometer to read the serum bilirubin levels. The clinician then documents the reading to be stored as part of the patients longitudinal record inside the EHR using the Bilirubin Chart Application.
Bilirubin Monitor Writes an Alert/Notification
When the Bilirubin Monitor sees that a bilirubin observation has not been stored for a new born within a certain amount of time after birth, it needs to raise an alert to relevant clinicians reminding them to do a serum bilirubin reading.
When the Bilirubin Monitor sees a bilirubin observation with serum bilirubin levels that exceed a certain threshold, it needs to raise an alert to relevant clinicians providing advice on how to intervene and treat the patient along with a link so the Bilirubin Chart Application can be opened directly from the Alert/Notification.
Ideally, the Bilirubin Monitor would raise alerts inside of the EHR in the way that is standard for that EHR. The goal being that alerts generated by the Bilirubin Monitor are treated the way all alerts generated by EHR are treated.
Eventing Use Cases
Bilirubin Monitor Responds to 'Baby Born' & Bilirubin Observations
When a baby's birth is documented in the EHR, the Bilirubin Monitor is notified by the EHR with an event containing enough relevant information so that the Bilirubin Monitor can query the EHR through it's FHIR services to collect relevant details about the patient.
When ever a serum bilirubin is stored in the EHR, the Bilirubin Monitor is notified by the EHR. (This could be handled by an implementation of the FHIR Subscription resource).
Work is underway to support this in the HSPC Reference Implementation.
MeducationPMI: User, On-Demand Trigger:
Clinicians can print MeducationPMI sheets (detailed instructions for a medicine) for use at bedside, prior to med reconciliation, to explain meds to patients at the time a medicine is administered – while in the hospital. An important HCAHPS measure is “Percent of patients who reported that staff "Always" explained about medicines before giving it to them.” This will help hospitals improve their performance score.
MeducationPMI: “New Med” Trigger:
When a new medicine is ordered for the patient, MeducationPMI could be automatically generated for the patient.
MeducationRS: “Ready for Discharge” Trigger:
When the patient is flagged as “Ready for Discharge” or “Initiating Patient Discharge”, Meducation should be automatically invoked, the final home-going med list sent to Meducation, and the Meducation screen populated with the discharge medication regimen summary presented to the discharge Nurse.
Backend Service Use Case
Bilirubin Monitor Is Authorized to subscribe to certain clinical event published by the EHR
The Bilirubin Monitor needs to authorized to listen to relevant events happening inside of the EHR. Such as: Baby is born, bilirubin observation written/updated. It also needs to be authorized to read patient demographics, observations, and write alerts/notifications.