Cascading Failure vs Coordinated Care Success - an (imaginary, but possible) case study

This case study illustrate the pivotal role of coordinated care and interoperability in healthcare outcomes. While failures in communication and fragmented approaches can lead to prolonged suffering and unnecessary procedures, integrated systems that facilitate seamless information sharing among healthcare providers can result in accurate diagnoses, effective treatments, and improved patient satisfaction.

Initial Scenario

1. Patient Karen Splintright is a 36-year-old graphic designer who has been experiencing severe headaches for several months. The headaches are often accompanied by visual disturbances and nausea, significantly impacting her ability to work and enjoy daily activities. Seeking relief, Karen makes an appointment with her primary care provider, Dr. W. Overbord. “Dr. O” conducts a thorough history and physical examination and decides to refer Karen for an MRI of the brain, suspecting migraines or another neurological issue. The referral is placed through the health system’s Heroic EMR software.

2. Karen goes to the imaging center for her MRI, which reveals a small, non-enhancing lesion in the right frontal lobe and signs of chronic sinusitis. The radiologist recommends clinical correlation and possibly a referral to a neurologist for further evaluation. Dr. O reviews the MRI results and decides to refer Karen to a neurologist within the health system, Dr. Neura Lis.

3. Several weeks later, Karen sees Dr. Lis, who unfortunately cannot access the MRI images directly, only the radiologist’s report. Dr. Lis conducts a detailed neurological examination and decides that a more detailed MRI with contrast is necessary to understand the nature of the lesion better. Karen undergoes the second MRI, which confirms the presence of the lesion but raises concerns about a possible vascular anomaly. Dr. Lis recommends a referral to a neurovascular specialist for further evaluation.

4. Feeling frustrated with the lack of clear answers and the repeated imaging, Karen decides to seek a second opinion from an outside neurologist, Dr. C. I. Care. Dr. Care requests all of Karen’s previous imaging studies, but due to poor interoperability between the health system’s Heroic EMR and Dr. Care’s different EMR system, accessing the images is cumbersome and incomplete. Dr. Care decides to order yet another MRI, this time with a different imaging protocol.

This fourth MRI confirms the previous findings but also suggests chronic changes in Karen’s sinuses that might be contributing to her headaches. Dr. Care refers Karen to an ENT specialist, Dr. Sina Sol, for further evaluation of her sinus issues. Dr. Sol, unable to access the latest MRI images, orders a CT scan of Karen’s sinuses to get a clearer picture of the chronic sinusitis. The CT scan reveals significant inflammation and nasal polyps.

Overwhelmed by the number of tests and lack of coordinated care, Karen expresses her frustration to Dr. O. Dr. O reviews all the reports and tries to piece together a cohesive plan. He recommends starting with treating the sinusitis conservatively with medications and a referral to a headache specialist for the migraines. Karen follows this plan, but her symptoms persist, and she feels no closer to a resolution.

Throughout this process, repeated imaging studies, lack of interoperability between different EMR systems, and poor communication among specialists resulted in delayed diagnosis, increased healthcare costs, and significant frustration for Karen. Disjointed care led to overlapping and sometimes contradictory recommendations, leaving Karen feeling unsupported and uncertain about her health.

Ultimately, Karen continues to struggle with her headaches and visual disturbances. She decides to take a break from seeking further medical opinions and focuses on managing her symptoms through lifestyle changes and alternative therapies. 

Alternative Scenario:

1. Patient Karen Splintright is a 36-year-old graphic designer who has been experiencing severe headaches for several months. The headaches are often accompanied by visual disturbances and nausea, significantly impacting her ability to work and enjoy daily activities. Seeking relief, Karen makes an appointment with her primary care provider, Dr. W. Overbord. “Dr. O” conducts a thorough history and physical examination and decides to refer Karen for an MRI of the brain, suspecting migraines or another neurological issue. The referral is placed through the health system’s Heroic EMR software, which ensures seamless communication and data sharing.

2. Karen promptly schedules her MRI at the imaging center. The results reveal a small, non-enhancing lesion in the right frontal lobe, along with signs of chronic sinusitis. The radiologist’s report suggests clinical correlation and potentially a referral to a neurologist. Dr. O reviews the MRI results and decides to refer Karen to a neurologist within the health system, Dr. Neura Lis, ensuring that all imaging and reports are readily accessible through the integrated Heroic EMR.

3. Karen sees Dr. Lis within a week. Dr. Lis has already reviewed the MRI images and report through the Heroic EMR system, which allows for efficient and comprehensive understanding of Karen’s condition. Dr. Lis conducts a detailed neurological examination and discusses the MRI findings with Karen. She explains that the lesion appears to be benign but warrants further evaluation. To better understand the lesion’s nature, Dr. Lis orders a follow-up MRI with contrast, seamlessly scheduling it through the EMR system.

3. The follow-up MRI with contrast confirms the presence of the lesion and provides clearer details, suggesting it is a small cavernous hemangioma. Dr. Lis also notes chronic sinusitis that could be contributing to Karen’s headaches. Dr. Lis discusses the findings with Karen in detail, explaining that the lesion is likely benign and does not require immediate intervention. She refers Karen to an ENT specialist, Dr. Sina Sol, for evaluation of her sinus issues, with all imaging and notes shared through the Heroic EMR.

4. Dr. Sol reviews the MRI images and notes through the EMR system before Karen’s visit. During the consultation, Dr. Sol conducts a thorough examination and explains that Karen’s chronic sinusitis and nasal polyps could be exacerbating her headaches. Dr. Sol recommends a conservative treatment plan including nasal corticosteroids and saline rinses, and schedules a follow-up visit to monitor her progress.

Meanwhile, Dr. Lis refers Karen to a headache specialist, Dr. C. I. Care, to address her migraines. Dr. Care has access to all of Karen’s medical history, imaging, and specialist notes through the Heroic EMR system. During the consultation, Dr. Care conducts a comprehensive evaluation and tailors a treatment plan specifically for Karen’s migraines, including medication adjustments, lifestyle modifications, and a potential trial of a new migraine-specific medication.

Over the next few months, Karen diligently follows the treatment plans prescribed by Dr. Sol and Dr. Care. Her sinus symptoms improve significantly, leading to a reduction in the frequency and severity of her headaches. The migraine treatment plan prescribed by Dr. Care also helps manage her symptoms effectively. Regular follow-up visits with her healthcare team ensure that her progress is monitored and her treatment plans are adjusted as needed.

Throughout this process, the coordinated care and seamless interoperability provided by the Heroic EMR system result in accurate diagnosis, efficient communication among specialists, and effective treatment plans. Karen feels well-supported by her healthcare team and experiences significant relief from her symptoms.

With her headaches under control, Karen is able to return to her work and daily activities with renewed confidence. She appreciates the collaborative approach taken by her healthcare providers and the advanced technology that facilitated her care. The successful coordination and interoperability of her medical care lead to a positive outcome, improving Karen’s quality of life and restoring her trust in the healthcare system.

 

About the author - Andra Bria

Andra Bria is a marketing manager at Medicai. She is interested in health equity, patient experience and value-driven care pathways. She believes in interoperability and collaboration for a more connected healthcare industry.