BA is a 53-year old woman. Upon her weekly log in to her personal health record (PHR) she notices that the 'health maintenance' label, in the lower corner of the screen, is flashing. BA clicks on it and sees a message that 2 years have passed since her last mammogram and the system recommends her to get a mammogram. BA thinks she has recently had one and is not sure she needs it. She clicks on the message and it changes to a view of all of her mammograms over the past 5 years. It appears the system is correct; she does indeed need a mammogram. By clicking on the message for the new mammogram she is able to send an electronic message to the radiology department at her local hospital and confirm an appointment for her mammo-gram next week. Using her PHRs built-in Google search engine, with its pre-defined medical search algorithm, BA 'Googles' pre-appraised high quality information regarding new methods of diagnosing breast cancer. She is particularly impressed with a short video that shows a world-renowned breast cancer specialist discussing the importance of mammogram and the overall great outcomes for patients with early stage disease. Armed with this information she feels much more a part of her health care experience and she arrives right on time for her mammogram appointment.
On her last visit at her primary care physician's office, BA had given him a passkey to log in to her PHR. Back at his office, BA's primary care provider, Doctor Smith is reviewing results in his electronic health record system. Doctor Smith's office houses no books or patient charts. Patient specific evidence-based medical information and best practices are delivered instantaneously, on request from leading web resources directly to the electronic health record (EHR). Patient medical information, such as records from emergency department visits and hospitalizations appears on Doctor Smith's e-mail inbox and are transferred to the EHR transparently. Doctor Smith gets a quick note from the PHR indicating that BA has accepted a recommendation to get a mammogram and scheduled the test. A week later, Doctor Smith gets a note in the EHR from radiology indicating that BA's study has come back positive. He is able to click on the message and review the latest treatment guidelines and prognosis information for breast cancer and prepare himself for the difficult phone call with BA. Doctor Smith schedules BA for a needle localization biopsy and 2 weeks later, he reviews the results on the phone with a surgeon. BA has cancer, but it is early stage and the prognosis should be very good. Doctor Smith has another difficult phone call with BA, but BA is grateful that the cancer has been diagnosed early and that she stands a very good chance of cure. Doctor Smith suggests that video recordings of patients with a similar diagnosis that can be accessed through the PHR might be helpful for BA. At the end of the phone call, BA has an appointment with an oncologist and scheduling information has been conveyed over the phone and sent to her PHR. Prior to her visit with the oncologist, BA logs onto her PHR and fills out several forms with personal questions about her treatment. She is pleased to see that she is being asked sensitively about her religious beliefs and practices including her approach to blood products and her desire to seek aggressive treatments for her cancer should that be necessary. She submits all of the responses and arrives at the oncologist's office prepared for the discussion that will ensue. She has already read on the PHR about some of the treatments that she will discuss with the oncologist and the visit goes very well. The oncologist and BA decide on a treatment plan that involves radiation, chemotherapy, and surgery. It is an aggressive strategy, but the oncologist explains that this is in part due to a risky genetic profile uncovered in the many blood tests that BA has had so far. He is able to pull up the genetic profile via the EHR in the office, display it and show BA how her risk changes based on the profile. Given the fact that BA has expressed a desire to be very aggressive about her treatment in the electronic forms, the oncologist is able to further support this approach. He even recommends that BA's three sisters have genetic screening and more frequent mammograms. Since two of them are already signed up for the PHR, the oncologist is able to transmit summary recommendations to their profiles based on this information. The oncologist finishes his day by submitting a treatment plan to the inpatient system via the EHR. At one point, he accidentally orders chemotherapy mixed in saline when it should be mixed in dextrose solution. The EHR quickly fires a pop-up window pointing out the error and then goes on to assist him in calculating the best doses of chemotherapy to treat BA's cancer given her genetic risk profile, weight and kidney function. BA is admitted to the hospital exactly five weeks from the moment that she first clicked on the link describing the need to get a mammogram. BA's world is the future. The high quality, rich information and common-sense efficiency inherent in BA's care are all within our grasp. In fact, we have seen similar and even greater transformations in equally complex sectors.9
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