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.