From detailed guides to online courses – resources are available to provide you with the knowledge necessary to build and integrate EHR applications.

Appendix C: Scenarios

The scenarios below compare what currently happens when a health care client interacts with the health care system with what will happen when the EHR is implemented.

Scenario #1 – Health Care Client Visits a Physician

A health care client’s care involves several providers, each using a different clinical system. 

Steps Current Situation With the EHR
Health care client visits physician with a problem and requires a procedure or treatment
  • Support staff locates client's paper chart
  • Physician reviews information received from procedures or treatments ordered (information from other providers may not be available). Client forgets to mention a relevant visit to another health care facility.
  • Physician documents visit in paper chart; information will be available for review in subsequent visits

Possible outcomes:

  • Probability of errors in data due to manual data entry
  • Probability of errors due to delayed or misplaced information in paper chart
  • Health care client responsible for providing much of full clinical history
  • Unnecessary or redundant procedures and consultations ordered
  • Avoidable costs incurred
  • Physician reviews client’s clinical information in the EMR system. May also access client’s province-wide health information electronically (e.g. using a portal accessing data through a HIAL, or through an EMR connected to a HIAL).
  • Before accessing data created by other providers, physician's identity and access rights are validated and health care client’s instructions regarding use of his/her health information are checked, to make sure he/she has not blocked access (performed through provincial registries, accessed via eHealth Ontario HIAL segment)
  • Physician reviews all client’s procedures and treatments, including information from all data sources and providers across the province
  • Physician documents visit in the EMR. This information will be available for review by all authorized providers across the province (for example, via a clinical document repository).


  • Procedures and consultations not repeated unless required
  • Information available to authorised providers in real time, regardless of location
  • Client does not need to remember full clinical history
Physician identifies need for an intervention / procedure
  • Physician generates paper requisitions for interventions/ procedures such as lab tests or diagnostic images. Physician may not be aware of previous interventions and procedures, since paper reports were either not forwarded or are delayed.
  • Requisition taken by client or sent by fax for processing
  • Copy of requisition added to client's paper chart

Possible outcomes:

  • Data errors with manual/paper-based processes
  • Physician checks in the EHR for previous interventions and procedures
  • Physician reviews results and orders new interventions/ procedures electronically (using OLIS via eHealth Ontario HIAL segment)
  • Physician orders additional interventions/ procedures complementing previous orders
  • Physician may access online references if additional information is required during treatment process (using integrated knowledge resources with information on best treatment practices and medical reference materials


  • Results available online for authorized review in the EHR regardless of who ordered intervention/ procedure and their location
  • Interventions and procedures not duplicated
  • More timely initiation of treatment
Health care client presents for follow-up visit
  • Paper copies of interventions/ procedures are sent to physician and added to paper chart
  • Follow-up visit must account for delays in receiving information
  • Physician reviews information and compares with other information in paper chart

Possible outcomes:

  • Access to information is limited (local) and not available across continuum of care
  • Delays in starting treatments
  • Results of interventions and procedures available for review by physician shortly after being completed (using domain repositories, via e eHealth Ontario HIAL segment)
  • Physician compares results against information collected from other providers


  • Comprehensive picture of client's results
  • Treatments can be started without delay>
Health care client referred to a specialist
  • Referral sent by fax or mail. Office staff or health care client schedules referral with specialist by telephone
  • Copy of information from paper chart sent by fax or mail (only tests and treatments physician is aware of),/li>
  • Additional information sent with client to specialist
  • Fragmentation of information available for specialist to review
  • Available information includes data from local physician’s paper chart

Possible outcomes:

  • Delays in service delivery
  • Duplication of interventions/ procedures
  • Physician office completes online referral (using EHR electronic referral application)
  • Possible dates made available electronically to physician’s staff
  • Specialist reviews information electronically from all sources (all data is integrated through a HIAL)
  • Specialist's identity and access rights are validated, and client's consent directives are checked (using provincial registries via eHealth Ontario HIAL segment)


  • Referral not delayed
  • Information available for specialist to review electronically in timely fashion (may include digital information)
  • Treatment initiated without delay
Health care client treatment plan established and follow-up arranged
  • Treatment plan developed and documented in paper chart and forwarded to primary care physician
  • Client documents some of the treatment plan
  • Paper prescription written by specialist and handed to client

Possible outcomes:

  • Potential adverse drug event if critical medication information from other health providers not available, or if client omits information on medication history
  • Consultation summary sent to primary care physician for client’s paper chart
  • When the pharmacist transcribes the paper prescription, possible error in drug dosage, or refill instructions, which may result in inappropriate dispense
  • Treatment plan when entered is available to authorized providers
  • A copy of plan is printed for client
  • Electronic prescription is created and sent to the pharmacy (using the ePrescription service)
  • Pharmacist checks for potential drug interactions (using the Comprehensive Drug Profile System (CDPS), via the eHealth Ontario HIAL segment)


  • Easier for client to follow printed treatment plan and document personal activities
  • Information is available electronically in timely fashion to all providers subject to confirmation of identity, access rights, and consent directives
  • Treatment initiated without delay
  • Mitigated risk of prescribing inappropriate medications
Throughout the scenario
  • No record of who has accessed the Client's PHI.
  • All accesses to client's PHI in the EHR are logged<


Scenario #2 – Unknown Health Care Client goes to Emergency Department 


Steps Current Situation With the EHR
Health care client presents alone at emergency department requiring urgent acute medical care (client unknown to emergency department)
  • Assessment history obtained during interview with client. If client is incapacitated, critical information may not be available.
  • Limited information about client available
  • Client may not have medications or list of medications
  • Other providers must be contacted to obtain health information

Possible outcomes:


  • Potential for adverse event due to incomplete information
  • Duplication of interventions/ procedures
  • Avoidable costs are incurred
  • Emergency department views client’s health information electronically (information sources are integrated through the EHR)
  • Previous information is available for comparison purposes
  • All accesses to client's PHI logged
  • Drug dispensing history from this encounter is available for any other providers who treat this client in future (using the CDPS, via the eHealth Ontario HIAL segment)


  • Interventions and procedures not duplicated
  • Treatments initiated in timely fashion
  • Mitigated risk of inappropriate treatment
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