A 60-year-old woman falls in her home and injures her knee. She and her husband determine together that she does not need an ambulance, but they are worried about the underlying injury.

This graphic demonstrates how health IT of the future will support decision making for the patient, her husband and their medical team and simplify their financial experience with the health care delivery system.

For a better understanding of the HIMSS Revenue Cycle Task Force’s vision for the Patient Financial Experience of the Future, visit himss.org/rci.

Patient Financial Experience of the Future
- A Continuing Journey
The husband enters information about the incident and the health plan’s web site offers him the option of accessing a 24-hour HELP line to discuss his wife’s current medical situation or going straight to looking for a provider. Together he and his wife decide to look for a provider and the website provides three options. The husband and wife elect to go to the nearest urgent care clinic.
A pre-populated pre-visit registration form specific to injuries appears on the screen. The husband confirms the pre-populated information, which has been completed based on information contained in the patient’s EHR and includes the patient’s name, address, health insurance coverage information, current prescription medications and any known on-going medical issues. He adds information about the reason for the current appointment, including place of injury, how the injury occurred and whether the injury was work-related. He indicates that the form is being completed by the patient’s representative and gives permission for his wife’s medical records to be shared.
Upon submitting the registration form the husband receives an electronic estimated billing statement indicating the patient’s anticipated financial responsibility for the scheduled visit, based on information provided about the reason for the visit and information contained in the health insurer’s databases, such as deductible, co-insurance or co-payment requirements and the amount of money already paid towards the patient’s and family’s out-of-pocket maximum limit.

The urgent care clinic receives an electronic notification that the patient is on her way, which includes a link to the patient’s completed registration form, EHR and estimated billing statement.
Retail Healthcare Clinic
Electronic Health Record (EHR)
Blood Pressure:
130/75 mm Hg
Heart Rate:
71 bpm
205 lbs (92.98 kg)
Vascular disease:
Pain when walking:
Family history of adult-onset Type II diabetes
NP, PCP, Vascular Surgeon
Initial Visit
Orthopedic Surgery
Follow Up Care
Patient receives surgery without complications and no worsening of her vascular disease. She spends two nights in the hospital. Prior to discharge, hospital staff meet with patient and her husband to review her post-discharge treatment plan, schedule post-acute care and arrange a visit with her PCP to conduct a diabetes screening.

One consolidated bill

Initial Visit
Orthopedic Surgery
Rehabilitation/Follow Up Care
Remainder is
The end
The patient prefers to have her husband take her to the hospital; the surgeon agrees that if the patient’s leg is splinted and can remain immobilized in the patient’s personal vehicle it is okay for the husband to transport. While the husband is driving the patient to the hospital, the hospital is accessing the patient’s EHR, preparing admission forms and accessing the hospital and orthopedist’s electronic scheduling systems to schedule the patient for surgery. Pre-operative activities are also scheduled.
As the women moves from her office to the living room, she slips and falls forward, landing first on her out-stretched hands and then on all fours. The majority of her weight is displaced onto her knee. She experiences immediate extreme pain, and the area just below the knee begins to swell. She is unable to bear weight on this leg and cannot bend her leg at the knee without pain.
Her husband logs onto their health plan's website to search for the closest and most timely treatment options within the network associated with their health plan, which has an unmet individual deductible of $5,000. Both the husband and his wife have indicated within their individual electronic health records (EHRs) and to their health plan that personal health information may be shared with their spouse. This prior authorization and the use of a secure log-on allow the husband to act as his wife’s advocate on the health plan’s website.
When the patient presents at the urgent care clinic the clinician quickly determines and records the relevant facts. On initial observation, the patient’s knee is extremely tender and swollen. Prior to examination, the patient’s vitals are taken.
The clinician accesses the patient’s medical history through her EHR and reviews with patient to ensure accuracy. Patient has an established relationship with a vascular surgeon who is not part of her network, but who treats her for issues associated with her peripheral vascular disease. Further review of the medical record indicates patient has a family history of adult-onset diabetes, but has not had a recent blood screen. Patient confirms this is accurate.
The clinician recommends the patient have x-rays done at the on-site facility. Patient agrees. The clinician initiates electronic contact with the on-call radiologist and arranges for an immediate reading of the patient’s x-ray. X-rays are taken and transmitted electronically to the radiologist for evaluation.
Radiologist accesses the patient’s EHR and sees that the patient has both a Primary Care Physician (PCP) within the network and a designated vascular surgeon outside the network. She attaches the x-rays and her report of findings to the patient’s EHR and sends an electronic notification to the treating clinician, the patient’s PCP and the patient’s vascular surgeon. Radiologist’s findings indicate fracture of the medial condyle of the tibia.
While the clinician and patient wait for the results of the x-ray, the clinician suggests that the patient schedule an appointment with her PCP for a diabetes screening. The patient agrees. Clinician enters information into the patient’s EHR documenting the conversation and indicates the need to follow up with the patient for scheduling at a later date.
The clinician receives an electronic message from the radiologist stating the nature of the injury, which alerts the clinician that the patient will need to be seen by an orthopedist immediately in an emergency room. The clinician shares these findings with the patient and explains the severity of the injury and the need for immediate medical care, most likely surgery, by an orthopedist.
The patient prefers to have her husband take her to the hospital; the surgeon agrees that if the patient’s leg is splinted and can remain immobilized in the patient’s personal vehicle it is okay for the husband to transport. While the husband is driving the patient to the hospital, the hospital is accessing the patient’s EHR, preparing admission forms and accessing the hospital and orthopedist’s electronic scheduling systems to schedule the patient for surgery. Pre-operative activities are also scheduled.
When the patient and her husband arrive at the hospital they are taken to an admissions area where they complete the admission process, discuss patient financial responsibility for the anticipated episode of care, and make payment arrangements. The patient’s portion is expected to be approximately $8,600. The patient and her husband elect to pay $2,500 now using the patient’s health savings account and make monthly payments for the balance.
Soon after the orthopedist visits the patient and completes a physical exam. She discusses the proposed surgical procedure with the patient and her husband. The patient decides to move forward with the surgery. The patient is prepped for surgery and visited by an anesthesiologist. The anesthesiologist verifies patient medical history, outlines potential complications associated with it and how it will affect the way anesthesia is administered during surgery. While the patient and anesthesiologist are visiting, the orthopedist consults with patient’s vascular surgeon to assess patient’s risk for surgery. Prior to surgery the vascular surgeon conducts a telehealth visit with the patient and confirms that her injury has not complicated her underlying peripheral vascular disease.
Patient completes post-acute care without incident and meets with her PCP. PCP confirms Type II diabetes diagnosis. He and patient discuss and decide on long-term plan of care for managing the disease.
Soon after her last visit with her orthopedist the patient receives a single final bill for the episode of care related to her knee surgery, including the telehealth evaluation by her vascular surgeon. She receives a separate bill from her PCP related to evaluation of her diabetes diagnosis. Each bill includes services received from both in and out-of-network providers, if applicable. The previously agreed upon monthly payment plan for the episode of care involving the patient’s knee is automatically initiated according to the terms of the agreement. Patient elects to submit payment in full for her portion of the episode of care involving her diabetes diagnosis.
Patient resumes her daily activities knowing her financial responsibility has been addressed and this episode of care is behind her.
Together, the clinician and the patient access the patient’s health plan information online and review the list of orthopedic surgeons in the patient’s health plan’s network. They are able to compare the surgeons based on cost, healthcare quality, and patient satisfaction ratings, see where each surgeon has hospital privileges, and whether or not a particular hospital is within the health plan’s network. Based on this information the patient chooses a surgeon and a hospital within her network. The clinician confirms the surgeon’s availability, shares information about the hospital the patient has chosen and discusses transportation options with the surgeon.

Clinician sends electronic notification to the hospital that the patient is being transferred under the orthopedist’s care and should be scheduled for surgery as early as possible.
Orthopedic surgeons list:
Anastasia Doe
Nicole Jones
Jeremy Wise
Vascular Surgeon