Understanding the Key Players and Interactions

When designing a healthcare management system, one of the most effective ways to visualize functionality is through a Use Case Diagram. This diagram maps out how different users (or “actors”) interact with the system to accomplish their goals.

Step 1: Identifying the Key Actors

In a healthcare setting, multiple stakeholders interact with the system. These include:

• Patients – Individuals seeking medical services (e.g., booking appointments, accessing records).
• Doctors – Healthcare providers who diagnose, treat, and prescribe medications.
• Nurses & Receptionists – Staff who manage appointments, patient intake, and administrative tasks.
• Insurance Providers – External entities that handle billing and claims processing.
• Pharmacy Networks – External systems that receive and fulfill prescription orders.

Example Scenario:
A patient logs into a hospital’s portal to book a consultation. The receptionist confirms the slot, the doctor updates the diagnosis, and the system automatically sends a prescription to the pharmacy while filing an insurance claim.

Step 2: Defining the Core Use Cases

Each actor interacts with the system in different ways. Here are some essential functions:

For Patients:

• Book an Appointment – Schedule visits with doctors.
• Access Medical History – View past diagnoses, lab results, and treatment plans.
• Submit Insurance Claims – File reimbursement requests digitally.

For Doctors:

• Review Patient Records – Access full medical histories before consultations.
• Update Treatment Plans – Add new diagnoses or modify prescriptions.
• Issue e-Prescriptions – Send medication orders directly to pharmacies.

For Receptionists:

• Manage Appointments – Handle scheduling, cancellations, and reminders.
• Verify Patient Details – Confirm insurance eligibility and personal information.

For External Systems:

• Process Insurance Claims – Approve or deny reimbursement requests.
• Fulfill Prescriptions – Receive and dispense medication orders.

Step 3: Constructing the Use Case Diagram

Now, let’s visualize these interactions:

1. Draw the System Boundary – Label it as “Healthcare Management System.”
2. Place Actors Outside the Boundary – Patients, doctors, receptionists, insurers, and pharmacies.
3. List Use Cases Inside the Boundary – Connect each actor to relevant functions using lines.

Example Connections:

• Patient → Book Appointment, Access Records, Submit Claim
• Doctor → Review Records, Update Treatments, Send Prescriptions
• Pharmacy → Receive Prescriptions, Confirm Dispensing

Step 4: Clarifying Relationships

To enhance clarity, you can add:

• <<Include>> – If one use case depends on another (e.g., “Submit Claim” requires “Verify Insurance”).
• <<Extend>> – For optional steps (e.g., “Send Follow-Up Reminder” extends “Book Appointment”).

Why This Diagram Matters

1. Clear Scope Definition – Shows what’s inside the system vs. external interactions.
2. Stakeholder Alignment – Helps developers, doctors, and administrators understand workflows.
3. Requirement Validation – Ensures no critical functions are overlooked.
4. User-Centric Design – Focuses on real-world needs (e.g., seamless appointment booking).

Final Touches: Annotations & Refinements

• Add brief notes to explain complex interactions.
• Use color-coding for different actor types (e.g., green for patients, blue for doctors).
• Highlight high-priority use cases (e.g., emergency access for medical staff).

Conclusion

A well-structured Use Case Diagram transforms abstract healthcare workflows into a clear, actionable blueprint. By mapping out how patients, doctors, and external systems interact, development teams can build a system that’s intuitive, efficient, and aligned with real-world needs.

Whether you’re designing a hospital management tool or a telehealth platform, this approach ensures nothing falls through the cracks—leading to better patient care and smoother operations.