A Centralized EMPI system that is connected to the registration screen that you designed in Week 3 Assignment.

• A Diagnoses Record Screen (a new screen for the Emergency department- so now the department has two screens: a patient registration and a diagnoses record). This screen will allow documenting diagnoses for each patient for each of their visits to the Emergency department. Each patient can have multiple diagnoses per visit.
• A Central Diagnoses record system, which is connected to the Diagnoses Record Screen. The diagnoses data are actually stored in this component, and much like the idea behind having a centralized EMPI system, this component allows accessing patient diagnoses data from other locations (other hospitals or departments) once they come on board.

In the picture below, you can see the architecture of this model, including the interconnections of different components. Here is a list of how different components are interconnected:

• (Connection #1) Patient Registration Screen is connected to the Central EMPI:
  • When the registration clerk is registering a patient, the system will send an automated query to the Central EMPI to check if that patient already exists in the EMPI.
  • If the patient exists, their information is retrieved and the registration form is auto-populated (instead of the clerk having to enter everything), but the clerk will still review and confirm (or change, if needed) the information.
  • Changes (if any) will be communicated back to the Central EMPI to update the patient’s record.
  • The Central EMPI system has an error detection system that checks for certain errors or inconsistencies (e.g. if the postal code and address of a patient are from two different cities). If an error is detected, the patient data will not be stored and an error message is sent to the Registration Screen. Otherwise (i.e. when no error is detected) a success message is sent to the Registration Screen.
  • To reduce the chances of sending erroneous data to the EMPI, which would result in an error message (and therefore increased workload on the EMPI system), some of the data checks are also done on the registration screen.
• (Connection #2) Diagnoses Record Screen is also connected to the Central EMPI so that when clinicians want to document a patient’s diagnoses on the Diagnoses Record Screen, the right patient based on the patient identifier and demographic information is retrieved. This will allow clinicians to double check patient information in order to reduce the likelihood of documenting diagnoses of a patient for a different patient.
• (Connection #3) Diagnoses Record Screen is connected to the Central Diagnoses Record so that patients’ diagnoses can be sent to and stored in the Central Diagnoses Record. Similar to what was said about Connection #1, a number of error checks are developed to ensure data quality. For the purposes of this exercise, we will only consider two types of data quality checks. Note that in a real world application, such checks on diagnoses can be much more rigorous.
  • Central Diagnoses Record has a list of valid SNOMED CT diagnoses, and only entries from that list are accepted. In order to reduce the likelihood of errors, the same list is also embedded in the Diagnoses Record Screen in the form of a picklist, and the user can only pick from that list.
  • Gender-diagnosis checks are implemented on the Central Diagnoses Record. For example, “prostate cancer” cannot be documented for a female patient.
• (Connection #4) To check patients’ gender, and also to make sure the patient for which diagnoses are being entered, exist in the Central EMPI system, the Central Diagnoses Record maintains a connection to the Central EMPI.

Your assignment is to complete the table below based on the information given above. I have completed the first row as an example. Be as thorough as you can in your explanations.

Error	In which component can the error occur?	Under what conditions or circumstances will it occur?	Impact of the error	How to prevent or reduce likelihood of error? (this should include constraints and data quality checks before data is stored)	How to detect error if it occurs? (this should include data quality checks after data is stored)	How to remediate error if it occurs?
Duplicate patient entry	Central EMPI	This could happen when different demographic information is entered for a patient at different visits. This is usually due to registering a patient without their ID or Health Care Card. For example, some homeless people frequently visit emergency departments without any ID and sometimes introduce themselves by different names, addresses, etc.	This will result in duplicate entries in EMPI for the same patient. When a patient’s information is being retrieved, the system will not be able to determine the best record; also, not all diagnoses of a patient will be stored under the same patient ID, which will result in errors when reporting or retrieving information.	Although it may not be practical or ethical to enforce requirements for presenting ID and Health Care Card at all times, tighter restrictions and requirements should be implemented so that patient ID and Health Care Card be checked at the time of registration, to the extent possible.	There should be routine (e.g. daily) checks on the EMPI to find and review entries that have several demographic pieces of information that are the same. Especial attention should be given to entries that have been registered without a Health Care Card number.	The two (or more) duplicate records need to be merged. The diagnoses that have been entered for each entry must also be merged.
Incorrect patient demographics
Mismatch between different pieces of “address”; e.g. City is entered as Seattle, while State/Province and country are BC, Canada Or, when Postal Code and address don’t match
Incorrect format of demographic information, e.g. If date of birth is entered as Month/Day/Year, instead of Year-Month-Day
Diagnoses entered for the wrong patient
Duplicate diagnoses entered for a patient for the same visit
One of the diagnoses in the picklist of valid diagnoses is retired in the next release of SNOMED CT (note that SNOMED CT is released every six months and each new release will have a number of added, changed, and retired concepts)
Diagnosis-gender mismatch

Emergency Department Patient Registration Screen Central EMPI Diagnoses Record Screen Central Diagnoses Record