Use Case 15

Use Case 15
Care Theme: Transitions of Care, Medical Device Integration
Use Case: Ensuring Safe, Timely Patient Care With Medical Devices and Transition to Follow-up Care by a PCP
Primary Goal: To demonstrate the ability to provide efficient and accurate ICU care, formally close the ICU event with the
patient’s PCP, and show interoperability of patient data across MD offices and hospital. Medication is ordered and administered
through the EHR. Medical device information triggers alerts about a patient’s status. Patient data is sent from the hospital to the
PCP when the patient is discharged.
Key Points:
• When the patient is admitted to the ICU, all bedside patient care devices (physiologic monitor, programmable infusion pump,
and “smart bed”) are linked to the hospital EHR, so that data is readily available to hospital staff.
• Ordered medications are electronically filled and programmed into the infusion pump with the status updated in the EHR.
• Patient care device alarms are electronically linked to hospital staff’s smart phones to speed alarm response and enhance
patient safety.
• Patient data moves seamlessly between hospital departments and PCP office, each of which uses a different EHR system.
Meaningful Use Relevance: Coordination of Care as evidenced by movement of patient data between separate hospital
departments and PCP. Device data is continuous added to the patients chart recording vitals signs.
IHE Profiles & Actors
IT Infrastructure (ITI)
Patient Care
Coordination (PCC)
Patient Care Device
Optum Insite
ICA Care Exchange
Manager, Consumer, Identity Source, Repository
Content Creator, Content Consumer
Allscripts Professional
Content Consumer
GE, iSirona, Carefusion,
WelchAllyn, Covidien
Device Obs. Consumer, Device Obs. Reporter
Cerner, Carefusion
Infusion Order Programmer, Infusion Order Consumer
Alarm Reporter, Alarm Manager, Alarm Communicator
GE, Omnicell
Prescription Placer, Medication Dispenser, Med. Admin
Care Theme: Transitions of Care, Medical Device Integration
Use Case 15: Ensuring Safe, Timely Patient Care With Medical Devices and Transition to Follow-up Care by a PCP
Clinical Workflow:
1 – ICU Monitoring Devices
4 – Rx Infusion Pump
2 – Hospital EMR
5 – PulseOx Monitoring
3 – Rx Dispensing
6 – PulseOx
7 – PCP
1. A male patient has been admitted to the SICU following surgical repair from multiple gunshot wounds. The patient is
currently being monitored in the SICU on a physiological monitor.
2. The hospital EMR is receiving information from the monitoring devices. The patient becomes hypotensive following the
operation and is ordered to begin a vasopressor drip to maintain the blood pressure. An appropriate medication is
ordered from the inpatient pharmacy.
3. The medication dispensing is completed with the medication being retrieved from the SICU department’s local
dispensing unit and the order status was updated accordingly.
4. At the bedside, the medication is added to the patients care program. The infusion pump management is engaged to
ensure that the vasopressor is administered correctly. Monitoring of the patient and vital signs continues.
5. The patient’s condition improves and is finally able to transfer to the Surgical Step-down unit. The patient remains on
patient controlled analgesia (PCA) to treat his pain. Vital signs, including pulse oximetry are monitored on the floor.
6. The PCA is too high for the patient. As a result, he begins taking slow and shallow respirations. The PulseOx reading
drops, triggering an alarm. The patient’s nurse is notified of the issue and the patient is administered oxygen through a
nasal cannula and the PCA dose decreased.
7. The patient continues to recover from his operation and is well enough to go home. The patient is discharged from the
hospital. The patient visits his PCP for follow-up from the incident.
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