Patient arrives in Emergency Department

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State: Draft


Perspective : ER provider treating patient

Context: Patient arrives in ER critically ill, essential medical information is missing

Story: The ER clerk logs on to the Nationwide Health Information Network, swipes the patient's drivers license and the hospital ID card. NwHIN sends a query to local hospitals, pharmacies and doctors' offices who have made records accessible to NwHIN via the NwHIN-provided web interface. Their EMRs identify records belonging to this patient and export a CCR extract to the NwHIN-provided web interface, which calls back to NwHIN to request web address of the hospital ER. NwHIN responds with the hospital ER's verified web address. NwHIN-provided web interfaces at patient's cardiologist's office, urologist's office, another hospital and two pharmacies connect securely to the NwHIN-provided web interface on the ER's website, send CCR extract of patient's medical record to the NwHIN-provided web interface, which transfers it to the ER's EMR. The ER doctor reviews the patient's drug list and notes the urologist prescribed Cialis, filled at one pharmacy, while the cardiologist prescribed Isordil, filled at another pharmacy. She immediately institutes specific lifesaving treatment.



Identity information
Patient and hospital ER
Web location information
All NwHIN- enabled providers of medical care, maintained by NwHIN
NwHIN Central
Sends query to multiple medical providers that might have treated patient, with patient identifiers and requestor NPI number
NwHIN web gadget on providers' websites
Establishes secure connection to NwHIN, interfaces with EMRs
NwHIN interface to providers' EMRs
Transmits Query to providers' EMRs
NwHIN-enabled providers' EMRs
Queries records for patient, returns CCR record or 'patient not found'
NwHIN interface to providers' EMRs
Accepts CCR record, references known NHIN web address, requests verified web address of requesting entity

NwHIN Central
Supplies verified web address of requesting entity

NwHIN interface to providers' EMRs
Sends data to wNHIN interface at requesting hospital's ER web address
NwHIN interface at requesting hospital's ER web address
Receives CCR record, transfers information to ER EMR
ER doctor
Initiates record request, views CCR records in EMR

Data Exchanged:

Patient identity, requester identity, what information is requested, CCR record, Address of requesting entity. Note that the only web address the local users have to know is that of NwHIN. NwHIN initiates records query, then the entity supplying information checks with NwHIN for the requesting entities' web address. This 'call back' scheme renders spoofing irrelevant. If a bad actor requests records, they can only be sent to a known covered entity, which is equipped and required to protect them. All exchanges are HTTPS. This is a 'must have' scenario.

User Acceptance Tests