George has diabetes mellitus and high blood pressure for 7 years and has a private family doctor to whom he addresses for his usual health problems. His family doctor uses an Electronic Medical Records software for the Electronic Prescriptions and the results of the exams of George. In fact, George often sends to his family doctor also the results of the examinations ordered by other doctors, in order to have an archive point of his examinations results.
Twice a year, George visits his diabetologist at the state hospital near his home. His diabetologist is informed about the changes in his health by George’s narration and can also see his exam orders/medication prescriptions. George brings with him also the printed results from the tests he has done during the last six months, but usually the diabetologist asks him to do additional tests, that they should be prescribed in the National E-Prescribing system by his family doctor, before his next visit.
Last month, his family doctor requested from him to visit a cardiologist because of a suspicious sign in the ECG. Thus, he visited the private cardiologist that his brother also visits. He provided him with the printed ECG from his family doctor, but the cardiologist could not explain his doctor’s reason for referring to him. The cardiologist, regardless of the specific issue, suggested him to do a proper check because he is diabetic and older than 50 years of age. So, he performed a heart ultrasound and a new ECG which also showed a suspicious sign. The cardiologist did a cardiac stress test that was positive-abnormal. His cardiologist ordered a coronary computer tomography and explained to George the procedure. George remembered that he had undergone such an examination last year and it was normal. He said that last year he had a chest pain and he was examined by a cardiologist in the emergencies that proposed to him to do a coronary computer tomography. His family doctor prescribed this examination, but George had forgotten to show the results to his family doctor or to any other doctor. George was sure that the report of the exam did not mention any abnormal situation. The cardiologist proposed a new appointment after one month, so George will bring the result of the coronary CT and to undergo some more examinations that he prescribed to him.
Two weeks ago, George felt a stomachache and started vomiting. Because it was a Saturday afternoon, he went to the emergencies of the on-duty hospital on the other side of town. There, after a physical examination and while he was waiting for the blood tests’ results, he suddenly lost consciousness. Myocardial infarction was diagnosed, he was admitted in the ICU and the doctors tried to find examinations’ results that George had undergone in the past. Fortunately, they could get the results from the local hospital in the town, but these were practically only his diabetologist’s periodic exams. George’s brother searched in George’s home and return the next day with the examination results he found at his home. Four days ago, George was discharged. The cardiologist in the clinic prescribed him new cardiac medications. As the cardiologist was still waiting for a couple of results, he gave him some printed urgent info to provide to his family doctor and said to George that the medical discharge note will be sent to him by mail.
George returns home with instructions for reduced physical activity and while he is at home alone, he discovers that it is difficult for him to carry the groceries from the supermarket, and he has breathing difficulties. He calls his family doctor and his doctor promises to inform the Municipality’s “Support at home” team to visit him. During the phone call, George tries to explain to his doctor what happened and the doctor suggests to have an appointment in 3 weeks to evaluate the situation with the final medical discharge note.
George’s appointment at the hospital with the diabetologist is next week and George finds it is difficult to contact him on the phone and inform him that he cannot attend. George requests from his family doctor if he can contact the diabetologist. The family doctor tells him that he cannot help and it is better to book a new one in the future. George is anxious about his new health status and the consequences for his job. A sick certificate for his work was prescribed by the cardiologist in the hospital and sent to his email but his employer asks to receive a printed sick certificate with the doctor’s stamp as requested by the local social security organization store.
Measuring his blood sugar after leaving the hospital, he sees that it has very increased and sends a photo with the values to his family doctor’s cell phone via Viber. His doctor suggests increasing the dose of a medication he is taking. Because the blood sugar is still high in most measurements, he decides to take a taxi the day of his appointment to the diabetologist and visit the hospital. He is carrying the blood sugar measurements, the medications he is taking now and a heavy bag with all the exam results of last year. The diabetologist discovers that George, having misunderstood, has stopped taking a medicine for diabetes while taking at the same time two similar medicines for blood pressure. As he leaves the hospital looking for a taxi, he again feels a chest pain and his vision is blurred. He is readmitted to the hospital.
Possible areas to simulate:
- Visualisation of lab reports, discharge letters and medical imaging reports based on the European Electronic Health Record Exchange Format
- Foster the use of the EEHRxF in the context of cross border healthcare
- Exchange/access examination results between health professionals
- Referral process from a health professional and its documentation
- Inform his family doctor about hospital discharge and status
- Electronic availability of the contents of hospital discharge
- Postponed orders to be undergone in the future
- Sick certificate uses
- Continuous telemedicine follow-up
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