INITIAL DRAFT – Alignment of Transitions of Care Use Case Assumptions, Pre and
Post Conditions with Common Requirements and Actions of Use Case Simplification
11 May 2011
Assumptions
Common
Common
Requirement Action(s)
A provider is either an individual clinician in a care delivery setting
or a provider organization.
The Transferring or Referring provider or Provider Organization
has an EHR system capable of producing a structured summary
document using C32/CCD and/or CCR standards and properly
coded data elements; and can be exchanged to another EHR
system or PHR system.
The EHR system is capable of ensuring that content of the
Summary Record (as exchanged) maintains its fidelity to source,
as well as assured identity, provenance, completeness,
audit/traceability, full context, along with permissions and
qualifications
Established network and policy infrastructure to enable
consistent, appropriate, and accurate information exchange
across clinician systems, data repositories and locator services.
This includes, but is not limited to:
 Methods to identify and authenticate users;
 Methods to identify and determine providers of care;
 Methods to enforce data access authorization policies;
Security and privacy policies, procedures and practices are
commonly implemented to support acceptable levels of patient
privacy and security; i.e. HIPAA, HITECH and EHR certification
criteria.
The Patient has and uses a PHR.
The transmission of data may occur via Health Information
Exchanges as data may be transmitted to multiple HIEs and
providers.
R8-11
N/A
R1-14
Summary
Record Actions:
A.REC.1-3
A.XFER.1-2
A.ACCESS.2
A.ID.x
A.TIME.1
A.REC.x
A.AUDIT.1
R1-15
R8-15
A.ID.x
A.ACCESS.x
A.REC.x
A.AUDIT.1
R2, R7-9, R15
A.ID.x
A.ACCESS.x
A.AUDIT.1
NSR
New Req’t?
N/A
N/A
To ensure the Summary Record maintains its fidelity to source,
assured identity, provenance, completeness, audit/traceability, full
context, along with permissions and qualifications-both as a precondition of transmittal/disclosure (source/sending EHRs/PHRs)
and of receipt (receiving EHRs/PHRs).
PHR and EHR systems are in place.
The Patient is registered in all systems.
R1-14
A.ID.x
A.ACCESS.x
A.REC.x
A.AUDIT.1
NSR
R3-4
The Provider has treated the Patient.
NSR
N/A
A.ID.1-2
A.REG.1
N/A
Pre-Conditions
Relevant clinical information will be exchanged in the proposed
Clinical Summary format; labs, medications, problem list, etc;
 There are methods to ensure the veracity of data.
R1-13
Clinicians securely access clinical information through an EHR
system.
R7-9, R15
Patients securely access clinical information through a PHR
system.
R3-7, R15
Appropriate standards protocols; patient identification
methodology; consent; privacy and security procedures; coding,
vocabulary and normalization standards have been agreed to by
all relevant participants.
 Legal and governance issues regarding data access
authorizations, data ownership, and data use are in effect
R2-7, R15
A.ID.x
A.XFER.x
A.REC.x
A.AUDIT.1
A.ID.3
A.ACCESS.x
A.AUDIT.1
A.ID.1
A.ACCESS.x
A.AUDIT.1
A.ID.x
A.ACCESS.x
A.REC.x
A.AUDIT.1
Post-Conditions



Clinical Information is successfully reported and electronically
transmitted between Sending Provider to Receiving Provider or
Patient PHR and (1) is accessible through an EHR/PHR system
and (2) is displayed in a human readable format.
Clinical Information is accessible by the Electronic Health Record
application.
R1, R7, R13,
R15
A.ID.5
A.XFER.x
A.ACCESS.x
R1, R13, R15
Clinical Information is accessible by the Personal Health Record
application.
R1, R13, R15
A.ID.x
A.ACCESS.x
A.AUDIT.1
A.ID.x
A.ACCESS.x
A.AUDIT.1
Security Assumptions
Audit Logging
Authentication (Person)
Authentication (System)
Data Integrity Checking
Error Handling
HIPAA De-Identification
Holding Messages
Non-repudiation
Pseudonymize and Re-Identify
Secure Transport
Transmit Disambiguated Identities
User Login
NSR = Non-System Requirement
A.AUDIT.1
A.ID.1
A.ID.3
A.ID.5
R14
A.ID.x
R2, R11-13
A.TIME.1
A.REC.x
Not applicable to ToC Use Case
A.REC.6
R16
Not applicable to ToC Use Case
A.ID.x
R11, R14-16
A.TIME.1
A.REC.x
A.REC.6-7
R16-17
A.XFER.x
R2.1
A.ID.x
R3-11, R14
A.XFER.X
A.ID.1
R15
R12-13
R3-11