Patient Journey #1:
When a person is involved a car crash and breaks his leg, he is seen in the emergency department, the facility’s
imaging department, and an orthopedist office for follow up. Eventually the patient will be back in his primary care
provider’s office. While each of these providers uses a different clinical information system, in this use case you will
witness first-hand how a health information exchange allows a the patient continuum of care to share complete
information with each provider at every point of care.
Care Setting
CareWare
Centricity RIS/PACS
Hospital EMR
Tour Stop Description
Patient presents to the Emergency Department after their auto
accident with much pain in their leg. CareWare, the ED EMR
system correlates the local patient ID with the national patient
identification system.
(PIX and PDQ)
Emergency
Department
The Emergency Department physician sends an order for x-ray
of the leg to the imaging department.
(SWF)
Imaging
Department
In the imaging department, the radiologist views the image in the
PACS and makes a diagnosis of a broken leg. The radiologist
generates a report and sends it into the HIE.
(SWF, XDS-I, XDS.b, DICOM)
Prior to entering the patient room the orthopedist reviews the
images from the hospital.
Orthopedic Follow
Up Visit
He orders new images to check the patient’s progress.
(XDS-I, ORU, DICOM)
RIS/PACS
EMR/
HIE Infrastructure
Orthopedist
The orthopedist is using the Alert EMR and documents the
patient’s increased pain. He generates a clinical summary which
then goes into the HIE.
(XDS.b)
Health Information
Exchange
Infrastructure
Oracle has provided the standards-based infrastructure that
allows the patient’s health records to flow seamlessly across the
continuum of care.
(PIX, PDQ, XDS)
PCP
Centricity Clinical
Archive
Patient Home
GetReal Health
Patient Portal
When the patient is later visited in their primary care office the
physician will be able to view the images from both of the
studies that were taken, as well as the documents that have
been collected along the patient’s health journey.
(XDS/XDS-I DICOM and CDA)
When the patient has questions about their care they are able to
find their entire care history in the Get Real Patient Portal on line
from the privacy of their home.
Patient Journey #2: A common pneumonia case turns into SARS and must be treated extensively and monbitored by
public health officials. Later, when researchers are interested in performing analytics the discrete data is available
because it has all been reported through a standards-based health information exchange.
Care Setting
Hospital ED
Next Gate
Patient Portal
Trakcare
Electronic Medical
Record System
Hospital
ED/HER
National Health
Information
Exchange
Interface Engine
Hospital
Integration
Engine
PCP EMR
Electronic Medical
Record
National Health
Information
Exchange
Infrastructure
Physician Portal
HealthShare
Aggregated
patient record
and clinical
imaging
Public Health
HIE and
Analytics
Tour Stop Description
The patient arrives at the Emergency Department complaining of fever,
chills, soreness, and chest pain. The admission clerk at the hospital
records the patient’s information. Because the hospital is connected to
the national provider directory, the clerk is easily able to locate the
patient’s Primary Care Provider and add him to the patient’s record.
(HPD, PDQ)
The patient is seen at the ED and added to the National Patient Index.
The patient has his vitals and complaints recorded, receives lab tests,
and has a chest xray performed. The patient is diagnosed with Influenza
and Pneumonia and admitted for observation. After a day, the patient is
discharged. The Hospital sends a patient summary document to the
national HIE. Later, after the lab results confirm that the strain of
influenza was SARS, the lab summary document is sent to the national
HIE.
(XDS.b, XPHR, HL7)
The Document Repository receives the IHE XDS.b Provide and Register
Request from the HER system. The Repository stores the document and
forwards the IHE XDS.b Register Request to the national document
registry.
(XDS.b)
Meanwhile, additional data on the patient arrives via a legacy HL7v2
feed into the hospital’s interface engine (Infor). The interface engine
converts the clinical data in the HL7v2 document into a HL7 CDA
document (XD?) and then sends the document via IHE XDS.b to the
National document repository (Oracle)
(CDS,HL7, XDS.b)
After discharge, the patient visits his Primary Care Provider for a followup visit. The doctor prescribes some medications to the patient for the
symptoms related to his pneumonia. The doctor refers the patient’s case
to an infectious disease specialist. The PCP’s EMR then creates a
clinical summary.
(XDS.b, XDS-MS)
The National HIE’s Document Registry has been keeping track of all the
clinical documents being generated for the patient. The HIE processes
the referral from the PCP to the specialist. Additionally, the HIE has been
sending messages the Ministry of Health notifying them of new clinical
data for the patient.
(XDW, DSUB, XDS-MS, LDAP, XDS.b)
The infectious disease specialist reviews the patient's case within
HealthShare. The specialist is also able to retrieve the patient's chest
Xrays from the ED visit. This provides the clinician with a single view of
all the patient's medical data including imaging.
(XDS.b, XCA-I, XDS-I)
The discrete data has been incorporated into the patient's clinical record
and pushed into the national analytics system for surveillance. A public
health researcher at the ministry of health has been monitoring influenza
and SARS diagnoses across the country and is able to see this patient
as part of the entire population and help track the outbreak.
(XDS.b, XPHR, XDS-MS, XDLAB)