Interoperability Case Study

I heard a story from a friend at another firm in another city that I thought highlighted the impact of interoperability on patient safety and, in this instance, the defense of medical negligence cases. I fudged things a little so as not to reveal the actual (pending) case.

The plaintiff/patient underwent an operation at a hospital. Over the next few weeks she returned twice for signs/symptoms of a surgical site infection, and underwent multiple clean-out procedures. There was evidence that the infection had become systemic, including possible endocarditis. Her condition worsened to the point where she was discharged to a long-term care facility instead of home.

The LTC facility received a very limited set of medical records from the hospital, and essentially only knew that the woman was being admitted for a post-op infection, and was suffering from some measure of motor dysfunction and altered mental status. Her condition was variable at the LTC facility with no clear baseline.

A day or two later, the woman began experiencing right hand and arm numbness, which resolved the next day. The after that the LTC staff noted that the woman had glassy eyes. The LTC medical director ordered the woman transferred to the hospital, where she was diagnosed with a CVA.

Virtually everyone involved in this woman's care was named as a defendant. Rather than this just being a case about a patient allegedly acquiring and needing to recover from a nosocomial infection, it was transformed into a case about a patient that suffered an allegedly debilitating neurological insult. 

WHAT IF: The hospital, the neurosurgeon's office and the LTC facility all had interoperable EMRs? 

The LTC facility would have at least had access to the history of possible endocarditis (a possible cause of the CVA), and a better idea of its resident's baseline condition. If so, the LTC facility would arguably have been in a better position to understand the significance of the onset of arm and hand numbness.

The neurosurgeon would have had access to the LTC chart showing potential changes in condition (i.e. the onset of hand and arm numbness). Being a highly trained specialist, she could have recognized these symptoms as significant and ordered the patient transferred to the hospital immediately. Thus, the CVA could have, in theory, been prevented or treated much sooner.

This access could have created another whole set of medical-legal issues, but it could also have, in theory, changed the outcome for the patient and made the malpractice case significantly less valuable/potentially easier to defend. Interoperability is a patient safety and economic issue for providers and payors, and must be a focus of the informatics community.