Use Case Scenario

A San Diego VA patient with essential hypertension is traveling in the Phoenix area and is involved in a severe car accident that leaves him severely injured and comatose. He is admitted to Mayo's intensive care unit and is being treated, among other things, with IV XXX for hypertension. He is intubated and being supported by a Draeger ventilator. His vital signs and arterial blood pressure are displayed on the bedside Phillips CR Monitor.  Both devices feed data (waveforms, settings, etc.) to an Event Integration Manager that has components for processing different event types. The device data is analyzed by a Complex Event Processor that extracts a variety of features from the event stream and publishes those features (facts) to an HL7 compliant Event Publication and Subscription Service.

One of the subscribers to the Patient Medical Device Topic is a Clinical Decision Support System (CDSS) that monitors the patient's care and advises the clinical staff as they treat the patient for his injuries. The system also subscribes to many other topics that publish clinical data being recorded in the EMR. One of these topics is Medication Administration.

The system detects that with each XXX administration, the patient experiences a transient, but clinically significant (suboptimal) drop in systemic blood pressure.  These dips, however, are still within the Philips Monitor's configured parameters and so no alarm is triggered. Typically, these transient events would result in the CDSS system recommending both a dose and interval adjustment to his XXX order.  However, Mayo is a NwHN participant and the CDSS system makes an automatic request to the VA for pertinent patient information.  The VA replies with a CDA document containing valuable past medical history and his genome profile, both of which are parsed and analyzed by the CDS system.  It determines that the patient is genetically predisposed to unpredictable responses to his XXX medication.  After determining alternative therapies, the system makes a DSS call to an OpenCDS drug-allergy knowledge base that evaluates the possibilities in light of the patient's VA allergies. It then recommends a suitable substitute and generates the corresponding provider recommendation.

The CDS system passes the advice to an HL7 compliant Unified Communication Services that delivers the alert to the EPS Advice topic which is subscribed to by the Mayo's FHIRBase EMR and is visualized in a CDS "Inbox".  The Inbox is a Smart On FHIR component that plugs in to Mayo's CareWeb bedside GUI.  When the provider fails to acknowledge the alert within a mandated period of time, the system escalates the message to the provider's cell phone.  Upon receiving an appropriate HIPAA compliant text, the provider logins in, opens the alert, reviews several InfoButton provided references, and ultimately accepts the recommendation.

The system then retrieves the corresponding orderable from Mayo's HeD compliant Order Catalog  and the provider completes and signs the order.

Later, as the patient is preparing to be discharged, the system prompts the provider to complete a suicide risk assessment as recommended for all former combat veterans. The provider accepts the recommendation and the corresponding Motive HeD Risk Assessment form is displayed. Upon completing the survey, the system evaluates the data and promptly passes the information to a Suicide Risk predictive model that determines that the patient is a high risk.  The corresponding mental health follow-up appointment is made and the VA provider is notified to ensure appropriate transition of care.