Final PresentationMMI-402GROUP #3:

William Marella

Lena Matternas

Rishi Ohri

Daniel Runt

Introduction

Clinical scenario (before) Role of technology in facilitating clinical

encounters Clinical scenario (after) Implications

Clinical Scenario (before) 45 year-old male patient presents with chief complaint of pain in right hand

of 2 weeks’ duration History of lumbar disc compression but no subsequent history of

neurological problems No family history of neurological problems Other standing items on his problem list include: seasonal allergies and

insomnia Employed, married, ex-smoker

Clinical Scenario (before) Physical exam shows normal color, temperature, no perspiration. No sign of acute injury or trauma Unilateral symptoms Symptoms isolated to area innervated by median nerve No pain or paresthesia in arm Weakness also reported, but no atrophy of the thenar eminence

Phalen maneuver

Subsequent clinical course Patient is referred for nerve conduction studies and

electromyography Not hearing results more than a week after testing, David S.

calls the office for results. Dr. Miller reports the results are positive for moderate CTS and recommends surgical consult.

David S. has surgery for carpal tunnel release with resolution of CTS symptoms, but with surgical site infection which resolves after treatment.

Opportunities for improvement Initial visit could have been virtual Nerve conduction and electromyography probably unnecessary

for diagnosis Poor follow-up of test results No conservative treatment tried Complication of treatment: surgical site infection

Physician/Organization Impacts

Remote Visits (Telepresence) Removes geographical conflicts Time savings Cost savings Increase number of patients serviced.

Physician/Organization Impacts

Remote Monitoring Allows for resources to be spent in other places Time savings Cost savings Increase number of patients serviced

Physician/Organization Impacts

Clinical Decision Support Allows for inclusion of most recent evidence based medicine

results Prevents diagnosing errors Improves physician performance Best return on investment

Physician/Organization Impacts

Patient Portal Better communication• Answer questions

• Send lab results

• Appointment reminders

Replaces need for some visits Time savings

Clinical Scenario (after) David S. logs into scheduled video-chat via secure

patient portal Nurse triage via video chat Patient sees documentation entered in real time. Nurse transfers video chat to physician, who conducts

initial discussion as in initial scenario. Physical exam is modified to accommodate technology

limitations.

Clinical Scenario (after) Clinical decision support (CDS) queues algorithm for CTS

evaluation and treatment based on preliminary diagnosis

Information on disease prevalence and etiology CDS estimates probability of disease, with MD over-ride Tests presented showing modified PPV/NPV for different

tests available, with preferred tests prioritized.

Clinical Scenario (after) CDS presents treatment options Conservative treatment recommended, with plan for

escalation if symptoms persist Patient receives visit summary, checklist, and

information Follow-up at scheduled intervals facilitated by system Conservative treatment success verified and adjusted

by mid-level practitioner