A man is at home and maintains a personal health record (PHR). He notices that he feels winded and fatigue easily with activities. He
prepares an export of his PHR, saves it to a portable USB drive (or sends it to his RHIO). He calls his primary care physician, Dr. Paul
Primary, for an appointment.
In his office, Dr. Primary imports his PHR information into his electronic medical record (EMR). He examines the man and decides that
a cardiologist, Dr. Henry Heartly, should see him. Dr. Primary prepares a referral note and uploads it to his RHIO. Lab results are also
sent to the RHIO using a structured lab document.
The man’s health plan confirms his eligibility to see Dr. Heartly. Dr. Heartly sees the referral from Dr. Primary and has the option to
import this data into his record. Unfortunately, as the man is seeing Dr. Heartly, he develops more chest pain.
Dr. Heartly refers him to the emergency room (ER) for a more urgent evaluation. He prepares the appropriate referral, including ER
specific data. In the emergency room, Dr. Eric Rescue, the physician on call, views the emergency referral. The man’s care is expedited.
Dr. Rescue, the ER physician, orders a chest x-ray. In the radiology department, the radiology technician, Xana Rais, gets the order and
schedules the views to be taken. Ms. Rais uses a DR system to capture the images. The DR system automatically updates and stores the
images to the PACS. The images are made available to the RHIO for future reference.
Later, in his office, Dr. Primary views the x-rays. In the ER, the man’s vital signs are recorded. The man’s chest pain continues, and
initial laboratory tests and EKGs suggest a heart attack. The man is admitted to the intensive care unit (ICU).
Dr. C. Care, the intensivist in the ICU, examines his vitals taken in the ER on the ICU clinical information system (CIS) before his
arrival. In the ICU, he is placed on a monitor. The monitor information is sent to the ICU CIS. He is started on IV fluids and medications.
The nurse uses the pump to compare the patient identification bar code on his wristband to the bar code on the medication container, in
order to confirm that the medication will be delivered to the right patient. Monitored physiological parameters, along with infusion pump
parameters, are shown on the ICU CIS. The CIS permits visual integration of medication delivery and patient condition.
The man has a cardiac arrest in the ICU. He is intubated and has additional catheters placed for continuous arterial blood pressure
monitoring. The man is rushed to the operating room (OR) where he is placed under anesthesia. The patient monitor and anesthesia
system are integrated and analyzed in the OR charting system. The patient monitor and anesthesia system values are sent to the OR
dashboard for the anesthesiologist to view. The patient monitor and anesthesia system values are also sent to the OR information system
for the surgeons and others to see.
In the hospital, serial EKGs are obtained, showing an acute myocardial infarction, along with improvement after his CABG. EKGs are
also stored with the RHIO’s data repository. EKGs are viewed throughout the hospital.
The man is discharged from the hospital. Dr. C.V. Surg, the cardiovascular surgeon, creates a discharge summary and sends it off to the
RHIO’s data repository. He recommends routine follow-up with Dr. Heartly (the cardiologist), and home blood pressure monitoring.
Images are also made available to the RHIO’s data repository. At home, the man checks his blood pressure. Results are sent to the RHIO.
He follows up with Dr. Heartly. He views the discharge summary, home blood pressure checks, and EKGs. Dr. Heartly also views his
radiological images.
At the follow-up appointment, the man’s spouse mentions his difficulties in regaining his strength, gait disturbances, and personal
hygiene. Dr. Heartly and the man decide that physical and occupational therapy would be of benefit to the man. Dr. Heartly refers the
man to the ABC Home Health Agency.
ABC Home Health Agency then retrieves the man’s PHR from the RHIO, confirms his eligibility for home health services, and the
admission case manager develops an initial plan of care based on his profile. The admission case manager visits him and determines that
therapy is indeed indicated, completes the initial government-mandated patient assessment, and updates his plan of care.
The physical and occupational therapists review his PHR and plan of care and make the first visit. Weekly progress notes are completed
by the therapists in his record documenting the man’s progress towards the care plan goals. Six weeks later, at the next follow-up
appointment, Dr. Heartly reviews the man’s PHR and progress with physical and occupational therapy. They both agree that the therapy
was successful and can be discontinued.
ABC Home Health staff writes discharge orders and a discharge summary and submits the information back to the RHIO.
Dr. Heartly updates the man’s PHR and transmits it back to his primary physician and the RHIO as well as uploading the PHR to his
personal device.