3. Case Study
One of the biggest challenges in medicine is inaccessible medical records for acutely ill patients unable to verbalize or recall their personal information. For example, a patient was admitted from the emergency room because of an acute respiratory failure. He could not verbalize his medical history, because all of his focus and efforts were upon getting enough air. In terms of his medical history, his medical team was flying blind.
The patient was a 48 year old long haul truck driver from out of town. No family was at the bedside and no medical records were available. What medications was he on? What allergies did he have? Given all of the unknowns, the patient received the generic, one size fits all treatment for acute hypoxic respiratory failure.
Over the next several hours, his heart rate gradually increased into the 130’s. Most likely, he was developing sepsis from an acute infection which was the cause of his initial breathing difficulties. In response, he was given antibiotics and intravenous fluids, again the generic treatment for what was the most likely cause of his condition. But it turns out his symptoms were due to something else entirely, that would not have been missed if old medical records had been available.
The patient just had a severe exacerbation of his chronic obstructive pulmonary disease. He didn’t have sepsis at all. His increased heart rate was due to beta blocker withdrawal from not getting his routine nightly dose of metoprolol. He was eventually discharged from the hospital in good condition, back at his baseline. His hospitalization, however, was prolonged by a full day and he received unnecessary antibiotics all because nobody knew he was on a beta blocker. His old medical records were in Oklahoma, locked up safe and secure in an electronic database. We, however, were in Oregon. While his medical records were secure in Oklahoma, they were not useful. His home clinic’s database had no interoperability with the clinical database at the hospital in Oregon. The result was not fatal, however, his hospitalization was prolonged and his diagnosis delayed due to poor computer database to computer database communication.