Case Study - Eastgate Health Co-Op Ltd Administrative System Eastgate Health Co-Op Ltd is a not-for-profit, member owned co- operative that provides affordable medical and healthca re services to the communities where it operates. Eastgate Health Co-Op hosts a number of doctors {GPs and specialists} and nurses that look after patients. For administrative purposes, Eastgate Health needs an IT system that processes patient administration records [not actual medical records). Each patient has a record . with his or her name, gender, date of birth, date of first visit, and date of last visit. Patient records are grouped together under a household. A household has attributes such as name of head of household, telephone number, and address. Each household is also associated with an insurance carrier record, containing name of insurance company, address, billing contact person, and telephone number. At Eastgate Heaith Co-op, each medical staff person also has a record that tracks who works with a patient {doctor, nurse, medical technician}. Because the system focuses on patient administration records, only minimal information is kept about each medical staff person, such as name, address, and telephone number. Information is maintained about ea ch office visit, such as date, insurance copay amount {amount paid by the patient}, paid code, and amount actually paid. Each visit is for a single patient, but, of course, a patient will have many ofce visits in the system. During each visit, more than one medical staff person may be involved by doing a procedure. For example, the medical technician, doctor, and nurse may all be involved on a single visit. In fact, some doctors are specialists in certain medicai fields; even multiple doctors may be involved with a patient. For each staff person that does a procedure in a visit combination {many-to-many], detailed information is kept about the procedure. This information includes the type of procedure, a description, the copay amount, the total charge, the amount paid, and the amount the insurance company denied. Another domain that the system will need to keep track of relates to invoicing. There are two types of invoices: invoices to insurance companies and invoices to heads of household. Both types of invoices are fairly similar, listing each visit, the procedures involved, the patient copay amount, and the total due. Obviously, the totals for the insurance company are different from the patient amounts owed. Even though an invoice is a report (when printed], it also maintains some information such as date sent, total amount, amount already paid, amount due and the total received, date received, and total denied. The latter is relevant because insurance companies do not always pay the full amount they were billed for. Information about patient and head-ofhousehold information, will be entered and kept up to date in the system by the receptionist. The receptionist will also keep track of ofce visits by the patients. Patient information is also entered and maintained by the ofce business manager. In addition, the business manager maintains the information about the medical staff. Another responsibility of the business manager is to print the invoices. Patient invoices are printed monthly and sent to the head of household. Insurance invoices are printed weekly. When the invoices are printed, the business manager double-checks a few invoices against information in the system to make sure it is being aggregated correctly. When payment is received, she also enters this information in the system. Medical staff are responsible for entering information about the medical procedures they perform. The business manager also prints an overdue invoice report that shows heads of household who are behind on their payments. Sometimes doctors like to see a list of the procedures they performed during a week or month, and they can request that report. 3) At the end of the month, patient invoices are printed. The billing clerk manually checks to see that all procedures have been collected. The clerk spot-checks, using the written records to make sure procedures have been entered by viewing them with the system. The clerk also makes sure all payments have been entered. Finally, s/he prints the invoice reports. An invoice is sent to each patient. - Draw an Activity Diagram for the Print patient invoices use case. Event Type Use case Receptionist Entering patient External Create patient record data Receptionist Updating patient External Update patient record data Receptionist Entering insurance External Create insurance record information Receptionist Visiting office External Record office visit + Office Business Manager External Print invoice printing invoice Office Business Manager External Print insurance claim Printing insurance claim Office Business Manager External Maintain staff information edits medical staff information Office Business Manager External Record payment invoice record payment information Office Business Manager Internal Verify payment invoice verifies invoice payment Office Business Manager Internal Generate overdue invoice generate overdue invoice information Medical staff enters medical External Record medical procedure procedure Doctor requesting medical Internal Generate medical procedure procedure detail detail Doctor requesting report of past Internal Generate past medical medical procedure procedure report