A clinician is seeing a patient and considering which health maintenance screenings are appropriate.  The clinician, possibly seeing this patient for the first time, wishes to consider appropriateness by reviewing an up-to-date summary of relevant issues including

1) what sexual organs the patient has (e.g. testicals, ovaries, uterus, cervix, breasts/mammography, osteopenia screening/estrogen status, prostate/PSA/DRE),

2) previously determined screening needs (e.g. determined at the time of gender affirming surgery(s),

3) previously recorded goals and preferences relative to health maintenance screening,

4) appropriateness of using USPHTF screening based on guidelines based on recorded sex or gender at birth,

5) need to update SFCU-specific screening status (e.g. diagnoses and/or surgeries since screening plan.)  

Note: Roles and local workflows will vary.  This is intended to be a basic use case (specific instance; does not cover everything)

People

1. Patient -
   1. whose record indicates the existence of a SFCU-aware, health maintenance screening profile. 
   2. Need for such a screening profile is part of a different use case for classifying the patient.
   3. Profile may simply contain indication that patient does not have factors that require consideration outside of Recorded Sex or Gender at Birth driving selection of health maintenance screening considerations.
2. Clinician
3. Care Manager (reviewing/assuring a panel of patients is up-to-date on their screening)
4. Are other clinical workers involved? Elsewhere referred to as "Intake Personnel" such as registration clerk, person rooming, roles of nurse practitioners, physician assistants, and other personnelle.

System

  EHR record may have current status for eligible screening

  Referral for task of classifying the patient as concurrent or scheduled classification, based on local or plan policy.

  Policy question: who (which roles) are qualified to classify the patient's needs?

• Patient in EHR, being seen in an ambulatory setting.
• Their health maintenance needs
  • have been classified or
  • need to be classified on the current comprehensive visit.
• There is a system of record (EHR). 
• There minimal required health maintenance needs need to be assessed, including needs often not assessed and captured in prior decades.  This is in some ways exactly parallel to SDOH needs but in a GHP content.
• HL7:
  • FHIR: Resource/Elements/Extensions relating to GHP classification reviewed and updated in this example
    • Some organizations will recognize a task and status:  patient has been classified for health maintenance
    • Information necessary for provider to reason over the patient's status could be in FHIR Resources including Patient, Observations, Service Requests, Conditions, Questionnaires, and other resources to a lesser degree (NEEDS TO BE REVIEWED BY CLINICAL AND OPERATIONAL ARCHITECTS)
  • cCDA: Information to classify health maintenance needs will be contained in one or more existing documents, and include all that are relevant to GHP concepts (SFCU factors that drive health maintenance.
  • v2 Messages and GHP-associated segments where relevant to Health Maintenance for all patients, in the genderbread person-aware sense.
• If patient not classified, provider may be scheduled for the classification task.
• Health Maintenance appropriateness assessment MAY be a required step based on local policies for annual health maintenance visit, with local implications beyond this use case.

The clinician and patient involved have determined which health maintenance screening tests are appropriate based on previously captured information which relates the patient to the USPHTF guidelines.

No new Resources and Elements or In-line extensions are populated.  There is no write-back as a result of completing this workflow.