Us Case 5

ED Encounter Resulting in ICU/Inpatient Stay with Follow-up Care by PCP

Care Theme: Transitions of Care

Use Case 8

Interoperability ShowcaseIn collaboration with IHE

Primary Goal: To demonstrate the transition of care between an emergency room, intensive care and Med-Surg units, PCP, and Cardiologist, despite care team members being in different departments, facilities, and communities.

Key Points: The demonstration illustrates how IHE profiles (including PIX, XDS, XDS-I, XCA, XCPD, XCA-I, ATNA, EDPN, MS, SWF, and others), patient care devices, and NHIN Direct protocol to demonstrate how a patient’s medical history, including device readings and images, are shared across multiple providers in multiple communities. The demonstration has a special focus on Patient Care Devices (PCD), used by the ED’s clinical staff to gather initial readings and continuous bedside readings throughout the patient’s encounter. The demonstration also highlights a new profile, Scheduled Workflow (SWF), which defines a framework for coordinating care in a typical imaging encounter.

This scenario begins with a patient visiting her PCP for a general feeling of fatigue and shortness of breath, after which the patient is sent to the local ED for evaluation. At the ED, the nursing staff monitors the patient through a sophisticated set of medical devices that includes a vital signs monitor, a physiologic monitor, a ventilator, infusion pump, and others. After being treated by both the intensive care and Med-Surg units, the patient is discharged, seen by her primary care physician, and ultimately her cardiologist for specialty care. Meaningful Use Relevance (MU Objectives):

• Improving quality, safety, efficiency, and reducing health disparities• Improve care coordination• Ensure adequate privacy and security protections for personal health information

 Clinical Workflow: A patient visits her PCP due to a general feeling of fatigue and occasional shortness of breath. After conducting an initial exam, the PCP refers the patient to the local Emergency Department for detailed evaluation. At the ED, the nursing staff takes patient’s vital signs while the attending physician reviews the PCP’s referral summary. The patient is moved to a treatment room where the patient is placed on continuous device monitoring. The attending physician orders a DR of the chest, which is performed by the hospital’s imaging department, and then transfers the patient to the ICU for further monitoring. During the night, the patient’s bedside monitor triggers an automated alarm, which requires immediate clinical attention and results in an adjustment of the patient’s medications. Once stabilized, the patient is moved to a med-surg unit for general oversight, and is then discharged. The patient visits her PCP for follow-up care, who after reviewing the patient’s recent encounter history, refers the patient to a Cardiologist for a specialized review.

Care Theme: Transitions of CareUse Case 8: ED Encounter Resulting in ICU/Inpatient Stay with Follow-up Care by PCP

1- The patient visits a PCP using an EHR system

2- The patient is referred to the ED – using an EHR system and various patient care devices

3- The patient moves to the ED Treatment Room, also using an EHR system and various patient care devices

4- The patient is sent to the Imaging Department - using a RIS, Acquisition Modality, and PACS

5- The patient is transferred to the ICU for further monitoring

6- Once stabilized the patient is sent to the Med-Surg Unit - using an EHR system and various patient care devices

7- The patient visits the PCP for a follow-up visit

8- The patient is referred to a Cardiologist using an EHR system

1- PCP 2- ED Intake 3- ED Treatment Room 4- Imaging Dept

5- ICU 6- Med-Surg Unit 7- PCP 8- Cardiologist

Care Theme: Transitions of CareUse Case 8: ED Encounter Resulting in ICU/Inpatient Stay with Follow-up Care by PCP

Clinical Workflow:

HIE1| HIE2

HIE2| HIE1

Domain Profile Actors

IT Infrastructure (ITI)

ATNA Repository, Secure Application

CT Time Client, Time Server

HPD Consumer, Source, Directory

PIX, PIXv3 Manager, Consumer, Identity Source

XCA Initiating Gateway, Responding Gateway

XCA-I Initiating Gateway, Responding Gateway

XCPD Initiating Gateway, Responding Gateway

XDR Source, Recipient

XDS Consumer, Source, Registry, Repository

EDPN Consumer, Creator

Patient Care Coordination (PCC) MS Consumer, Creator

Patient Care Devices (PCD) DEC Consumer, Reporter

Radiology (RAD)SWF

Acquisition Modality, Order Filler, Order Placer, Evidence Creator

XDS-I Consumer, Source, Registry, Repository

Care Theme: Transitions of CareUse Case 8: ED Encounter Resulting in ICU/Inpatient Stay with Follow-up Care by PCP

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