Jane Q. is a 56 year old female who lives in downtown Kansas City, MO. She is divorced, lives alone and has no children. Jane works as an accountant and has been with the same company for 15 years. She is a non-smoker and a social drinker.
Mrs Q. had a routine abdominal exam that found tenderness upon palpation of her right upper quadrant. She does not have a history of gallstones. She was referred for an ultrasound at an outpatient imaging facility that found a 15cm solid mass and has been referred for a biopsy at a surgical center. After her procedure Jane is given a CD in a plastic case with her name, patient ID number and her birthday written on a sticker in black felt tip ink. She is told to give this to her primary care doctor during a follow up visit.
Jane’s imaging study needs the results transmitted to an academic medical center for further follow-up. She brings the CD of images and hands it to the tech before her CT-guided needle biopsy. The tech takes the CD and attempts to load the images into the PACS system for review by the radiologist. As it turns out the disc loads slowly and it takes an extra 10 minutes to open the files. The technologist asks Jane if she wants the CD back after the procedure and Jane declines, saying “it won’t be of any use to me.” The rest of the biopsy is routine and is completed without any issues. The tissue samples are sent to the pathologist for review and classification.
Jane’s type of tumor proves to be complex and rarely seen. It would be a good addition to the teaching files used for radiology residents and might be useful for training the new augmented intelligence model that the bioinformatics group is building. The Institutional Review Board (IRB) needs to be appraised of this idea and how it may impact direct care as well as clinical decision making.
Jane’s primary care doctor would like to import the results of the imaging studies as well as the pathology reports and the oncologist’s recommendations into the practice’s EHR. The primary care office contacts the medical records department of the academic medical center four days after the procedure’s results were interpreted. The practice uses an EHR vendor that is less well-known and has limitations on interoperability. There is no way to direct connect the two systems.
The academic medical center begins building an oncologic clinical data registry. Jane’s case, and many like hers, are very instructive for training purposes. This multidisciplinary effort is led by the Oncology Department and is seen as a way to enhance their institutional reputation as a leader in cancer care, as well as potential revenue stream for vendor participation. They would like to stand this up in 12-16 months.
As it turns out, Jane’s case also includes a rare form of liver cancer. The academic medical center’s Pathology Department wants to confirm the diagnosis with an outside institution. They want to ensure that they are accurate in their understanding of the findings and are able to add to the great corpus of knowledge around the case by writing up the results for the next pathology conference that the medical center hosts annually.
Jane’s primary care physician has submitted many of these diagnostic tests for prior authorization to her insurance company, yet there are rejections of routine studies that must be submitted multiple times before they are approved. This causes delays in her care. Nothing substantial, but it proves to add stress and repetitive work for many of the parties involved.
