Introduction to Informatics

Case Study

Scenario 1: A primary care office practice without functional informatics systems

Scenario 2: A primary care office practice with functional informatics

   A primary care office practice without functional informatics systems

One family physician entered the exam room to see Juana Perz, a 50 year-old female patient. He had provided care for Ms. Perz intermittently for years, so he was not too disturbed when Ms. Perz’s chart could not be located. Her presenting complaint concerned a cough that produced blood. The history indicated that, within the 2 days prior to the visit, she had a morning cough that produced several drops of blood each day. The patient was a non-smoker. After a physical examination of the lungs that was unremarkable, Ms. Perz was sent to the imaging center for a chest X ray. A short while later, the radiologist called the family physician stating, “It looks like widespread lung metastases from the breast cancer we found on the mammogram 2 years ago. We will send the patient back to your office so that you can talk with her about it.”

The family physician was shocked – he had never received the results of the mammogram, and he had not seen the patient in two years. The patient had never been told, by either the physician or the radiologist, about the positive screening mammogram, and she had received no treatment. Now, at the current visit, it appeared that metastatic disease was present. The patient returned to the physician office. As her physician explained the situation, her demeanor changed, from one of disbelief to one of extreme anger. After screaming, at the physician, she stormed out of the office.

Ms. Perz expired, at age 51, from metastatic breast cancer several months later. Her family has filed a malpractice suit for delay in diagnosis of cancer against both the family practitioner and the radiologist, after the authorities denied attempts to have the physicians arrested on a criminal charge of murder.

   Scenario 2: A primary care office practice with functional informatics

The middle-age family physician entered the exam room and sat down with Ms. Doner, her 47-year-old female patient. Using the networked personal computer in the exam room, she opened the patient’s electronic medical record. A quick review of the electronic problem list reminded the physician that the patient was being treated for breast cancer. The physician also noted that she had received in her electronic basket several important pieces of clinical data on the patient from other electronic sources. Using the mouse to click in the “inbox” icon, she noted that some of the data were from her hospital laboratory. Another click on the lab icon revealed that the patient had a normal complete blood count, electrolytes, and creatinine-test that had been run because the patient was receiving chemotherapy for breast cancer. The inbox also indicated that an imaging study had been completed and that the results had been returned to the chart.

At the end of the visit, Ms. Doner asked if she continue with the same oncologist, using the same medicines, or if she should consider switching to a new protocol she had heard about on a television talk show. Uncertain about the new protocol, the physician agree to check in the National Library of Medicine the advantages and disadvantages of the new protocol, and email the results to the patient. Just as she was living, the patient asked the physician trusted the confidentiality of e-mailing personal information to her, and the physician briefly offered her opinions.