Jack visits his internal medicine doctor to follow up on a sinus infection. When Jack made the appointment on the physician's secure website, he also updated his medical file with a description of the symptoms from his persistent sinus problems. He also updated his insurance and address information, and received an electronic message that he will owe a $40 copay for the visit.

After Jack's exam, his doctor determines that he does have a sinus infection and needs an antibiotic. She checks Jack's medication history through the EHR, which alerts her to a potential adverse medication interaction, recommends generic alternatives, and details pharmacy costs for the drug. The physician sends an e-prescription to the pharmacy.

Before leaving the doctor's office, Jack uses a kiosk to schedule a sinus CT scan that evening at the hospital, and receives driving and parking instructions, information about what to expect during the CT scan, and an estimate of the amount he is expected to pay at the time of the CT scan.

When Jack arrives that evening at the hospital to register, the receptionist greets him by name. She recognizes him from her screen, which shows photographs of all patients registered for procedures. The hospital's information system automatically re-verifies his eligibility, benefits for the procedure ordered, deductible status and copay.

After Jack's CT scan, the radiologist checks his notes, which were entered via automated speech recognition software from his dictation as he reviewed Jack's scan. He steps into Jack's room to give him the preliminary results of the scan.  He electronically sends a follow-up note to Jack's physician, and electronically signs the EHR. This action automatically posts real-time transactions to the physician and hospital billing systems and sends electronic insurance claims to Jack's health plan with diagnosis and procedure coding validated as consistent with EHR documentation.

The insurer adjudicates the claims, and within seconds the physician and hospital receive electronic payments. Jack pays his personal liability with a debit card from his HSA. Jack picks up his prescription at the pharmacy on his way home. Jack has had a seamless, great experience - clinically, administratively and financially.  The doctors are happy and the hospital has zero days in accounts receivable.

Return to Breaking the "Wicked" Healthcare Barriers

Publication Date: Tuesday, October 28, 2008