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Several days later, Patient Eighteen has a positive blood culture, for an organism that is multi-drug resistant. The CDS system sends a recommendation to Dr. Greenhorn recommending an Infectious Disease consult. Dr. Greybeard accepts the advice, and while  filling out the consult request, he is presented with a variety of order (workflow) requirements. He addresses each precondition, completes all details of the order in the Computerized Physician Order Entry (CPOE) system and submits the consult request for fulfillment to the Infectious Disease department.

The Infectious Disease department, upon receiving the consult request, is advised of the “Service Level Agreements” (SLA) that the organization has in place regarding consult review and appointment wait times. Based on the organization’s policy, two previously resulted labs for patient Eighteen (an HIV blood test and a cocaine drug screening) in the patient record are treated as protected content. Given the patient’s consent policy vis-à-vis protected content, these are not visible nor accessible except under emergency conditions. The creatinine lab result and its alert, however, are not so restricted.