Question

Healthcare Delivery Systems

Real-World Case 2.1

The American healthcare system is a patchwork of not-for-profit and for-profit entities that provide comprehensive diagnostics and treatment services. Marsha, the supervising coder at her local hospital, became a veteran of this system after she noticed neuropathy in her right arm. She first noticed a tingling in her right shoulder and elbow in February and by July the discomfort had increased so that the tingling had become painful throughout the entire length of the arm to such a degree that the arm was almost unusable and she had to take time off from work. She set up an appointment with her family practitioner and was seen seven days later. He ordered x-rays of the arm as well as a cervical MRI. While the x-rays did not show any involvement in the affected joints, the MRI indicated cervical stenosis at the C4–C6 levels. Her physician prescribed pain medication and recommended that she see a neurologist. Her physician ordered a neurological consult, which took place three weeks later. The neurologist performed an assessment, looked over the MRI results, and referred her to a neurosurgeon at another hospital in a major city to the east to have her neck evaluated and fused. Four weeks later she was seen by a neurosurgeon who wanted her to have a cervical CT scan with contrast. The CT confirmed the cervical stenosis. Surgery was set for November 1. The surgery was successful and after six weeks of convalescence she was able to go back to work. Marsha was convinced that she had the best possible care, though the cost was extremely expensive. During the process she was involved with six medical doctors (her family physician, the neurologist, a radiologist to read the MRI scans, the neurosurgeon, another radiologist to evaluate the CT scans, and an anesthesiologist who was present during surgery) and five different facilities (her family physician office, the hospital where the x-rays and MRI were done, the neurologist’s office, the neurosurgeon’s office, and the hospital where the CT scans and the surgery on her cervical spine were conducted). Throughout the entire process Marsha was required to carry her medical record from one facility to another as the family physician and neurologist were not part of the EHR with the local hospital where she worked, nor was her hospital able to electronically share her information with the hospital where the neurosurgeon practiced. She also made sure to check her patient portal at each hospital to verify appointments and to ensure that the correct information was being entered for each of her visits.

Real-World Case Discussion Questions

1.How could the length of time from diagnosis to surgery have been reduced for Marsha?

2.What are ways that Marsha could have shared her information between all of the facilities?

3.What could her providers have done to make the sharing of information easier for Marsha?

Answer 1

1. ANS: She would have been able to have the surgery at less cost and more quickly, if Marsha’s PCP had referred her to see a Neurosurgeon instead of a neurologist.

2. ANS: If the facilities that she had gone to used the same EHR systems that allowed sharing of records between facilities (like EPIC) that would have been the easiest way to share information. Another way that she could have shared information between all facilities is participating in a system like Health Info Net which created one EHR for a patient that includes information from many different facilities. A third way that she could share the information is to make sure that she had a copy to bring to each facility like the case said that she did.

3. ANS: If Marsha’s providers all participated in a standard EHR system that shared information across all facilities for one patient that would have made sharing her information so much easier for her.