Clinical examples of the effectiveness of a health information exchange are the best ways to illustrate the impact SandlotConnect® is having on improving the quality of patient care.
SandlotConnect's integrated clinical information provides physicians, hospitals and other healthcare organizations access to over 1.8 million patient records to aid physicians in developing the right plan of care in the least amount of time with the added the benefit of clinical decision support and other business intelligence tools.
Read more about the clinical results of physicians who are integrating SandlotConnect in their practices.
"Patient is a liver transplant patient who presented for routine office follow-up…"
The patient described admission to Hospital A several months prior for severe abdominal pain and fever which were an adverse reaction to a medication. He could not recall the name of the medication, but it had been prescribed by his transplant program Hospital System B which was not connected to the HIE. Therefore, the medication of concern was not included in the HIE medication list. Fortunately, Hospital A was connected with the HIE, and the hospital discharge summary was quickly available at the time of care. This summary identified the medication as azathioprine. The symptoms of abdominal pain, fever, and chills are typical of an unusual idiosyncratic severe reaction to that medication.
Results: Advising the patient of the medication will help assure that he can avoid serious injury in the future by avoidance of azathioprine.
"Patient is a woman referred for evaluation of esophageal reflux symptoms…"
The patient is a diabetic with poor glycemic control and suspected diabetic gastroparesis contributing to her GERD symptoms. The patient denied known liver problems. However, the physician was able to see clinical information from the HIE on his EMR system. The clinical information contained a diagnosis code indicating abnormal liver enzymes. Review of the HIE data revealed that abnormal liver test were present since 2008. The patient was not aware of this finding as the primary reason for referral.
Results: The availability of this pertinent clinical information allowed for a more complete consultation accomplished more efficiently for the office staff and at a lower total cost.
"One evening just before closing, a primary care physician received a call from the daughter of one of his patients…"
The patient, who had not seen in the office for some time, was being discharged from a nearby hospital and she was requesting assistance in managing her care at home. She reported that the woman had been on a ventilator and now had a tracheostomy. She had also had radical surgery for a recurrence of her laryngeal cancer.
All of this was new to the primary care physician as he had not seen the patient in quite some time. None of her specialists had communicated any of these problems. In addition because the PCP was not on staff at the hospital he was unable to access the hospital records online.
Results: However with only her name and birth date the PCP was able to securely access her medical history and clinical information in the HIE. He was able to reassure the patient’s daughter that continuity of care could be maintained for her mother.
Based on the current information, the PCP was able to help the daughter reconcile discharge medications with her mother’s routine medications.
"Patient is an 82 year old woman who was seen by a nurse practitioner for evaluation of abdominal pain…"
The patient was confused and unable to provide important clinical history. Her daughter who accompanied her also had a limited capacity to recall her mother’s history and prior evaluation. The HIE was easily accessed and provided detailed clinical information including: a problem list including 16 diagnoses; a provider list including 9 physicians who had seen E.W. in the previous months; list of diagnostic procedures including endoscopy, colonoscopy, cardiac ultrasound, and fecal disimpaction; medication list of 8 medications; recent laboratory and X-ray results including CBC, chemistry panel, Abdominal series, Abdominal CT scan, Urinalysis, and a series of other laboratory studies from the previous 12 months.
Results: From this breadth and depth of clinical information it was possible to confidently determine that the patient’s abdominal pain was most likely related to obstipation and IBS. Duplication of expensive laboratory, X-ray, and endoscopic tests was avoided. Symptomatic treatment was promptly begun without delay and at minimal cost. The patient was served by faster relief of her symptoms without the inconvenience and cost of further diagnostic testing.
"Patient is a 76 year old woman seen in follow-up to hospital admission for pancreatitis…"
No records accompanied the patient's visit. Upon accessing the HIE, the following vital clinical information was obtained: Hospital discharge summary including discharge medications and diagnoses. The report from her admission ABD CT scan was retrieved. These records revealed that the patient was admitted with diverticulitis documented on the ABD CT scan and did not have “pancreatitis” as reported by the patient. In addition, the important finding of anemia was documented during her admission.
Results: The reports available from the HIE provided the correct diagnosis at the time of service leading to more directed and appropriate subsequent testing and management avoiding delay in diagnosis, unnecessary tests and risks to the patient.
"Patient is an 86 year old woman with longstanding chronic diarrhea who presented to the office for evaluation…"
The HIE provided:
- A Problem List including: Depression, Irritable Bowel Syndrome, Sleep Apnea, and Asthma.
- A Medication List included omeprazole and Zoloft both of which may produce diarrhea as an adverse effect.
- Prior laboratory evaluations included: Normal CBC, chemistry panel, thyroid function, sedimentation rate, and levels of B12, Folate, Vit E, Vit A.
- X-ray studies including Abdominal series, Abdominal and Pelvic CT scan.
Results: These studies and findings contributed immeasurably to the evaluation of the differential diagnosis of diarrhea in an elderly woman by showing no evidence of blood loss, malabsorption, inflammation, or mass lesions. Significant costs, risks, and inconvenience of duplicate tests were avoided allowing symptomatic therapy to promptly be pursued. Rather than adding medications to treat symptoms, medications with adverse effects of diarrhea were discontinued leading to symptom relief.
"Patient is 64 year old woman who is followed in the physician's office for autoimmune hepatitis…"
The patient presented for a follow up visit approximately 3 weeks after an admission to a local hospital. She reported a major bleeding episode with melena for several days because her “blood was too thin” from her Coumadin therapy for atrial fibrillation. She also reported being transfused with 5 units of blood. No records had been forwarded to the physician regarding the hospitalization. By accessing the HIE I was able to determine that she was admitted with a Hgb=6 and INR=9. She was transfused with FFP and PRBCs to a Hgb=9. Upper endoscopy revealed esophagitis and antral ulcerations. The discharge summary included a complete problem list and medications for reconciliation including Prevacid. Her primary care and specialist physicians were also identified so that follow-up outpatient laboratory studies could be obtained. These revealed a Hgb=12, INR=2.3, and normal hepatic enzymes.
Results: No further studies were necessary and clinical management decisions could be made at the time and place of service without the cost of additional laboratory studies and without having to wait for results from further studies. At the completion of her office visit the patient was reassured of her stable clinical status, and the office report, with assessment and plan, was sent to her primary care physician, cardiologist and rheumatologist before the patient left the parking lot.
"Patient was referred to a gastroenterologist for loss of appetite and significant weight loss…"
Results: Review of the problem list from the HIE revealed a diagnosis of polymyalgia rheumatica. Further history revealed episodic loss of vision, jaw pain, and other symptoms consistent with temporal arteritis. The patient could not recall the name of his rheumatologist. This information was available in the HIE allowing a prompt phone consultation, immediate institution of correct therapy and the avoidance of significant vision loss. All of the patient’s presenting symptoms were dramatically improved within 24 hours.
"Patient presented for an office follow-up of anemia and reported a hospital admission two weeks prior for shortness of breath and a new cardiac arrhythmia…"
The HIE provided a discharge summary and the names of attending specialists. It was noted that he had not had a follow-up visit with his cardiologist.
Results: By facilitating a prompt follow-up visit and more efficient care transition, a hospital readmission was avoided as well as other potential adverse events.
"Patient presented for colonoscopy to remove a large polyp…"
The patient brought a list of her medications that were reviewed and documented. The medication list from the HIE included warfarin. When the patient was questioned it became apparent that she had forgotten to add warfarin to her list when it was prescribed a few weeks before.
Results: This single piece of information precluded a serious bleeding complication during her procedure, almost certainly avoiding hospital admission, transfusion, and repeat colonoscopy to control the bleeding.
