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, check out these documents.

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. He elects to look for a provider and the web site 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 electronic health record 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 Medical Record (EMR)
Blood Pressure:
130/75 mm Hg
Heart Rate:
71 bpm
Weight:
205 lbs (92.98 kg)
Vascular disease:
No
Pain when walking:
Yes
Obesity:
No
Possible adult-onset diabetes:
Yes
NP, PCP
blood draw results
Type II DIABETES
Send to:
PCP
Saved at:
Electronic medical record (EMR)
Initial Visit
$100
Orthopedic Surgery
$6000
Rehabilitation/
Follow Up Care
$2500
Total
$8600
Patient receives surgery without complications and no worsening of her cardiovascular 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 address her Type II diabetes.
Anesthesiologist
Doctor
outpatient
Therapist

One consolidated bill

Initial Visit
$100
Orthopedic Surgery
$6000
Rehabilitation/Follow Up Care
$2500
Total
$8600
Payment
$2500
Remainder is
$6100
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. Pre-admission clinical staff notice that the patient may have Type II diabetes but has not yet been seen by PCP for confirmation of the diagnosis or development of a treatment plan for this diagnosis.
As the women moves from her kitchen 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 right 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.
When the patient presents at the urgent care clinic the clinician quickly determines and records the relevant facts. On initial observation, the patient’s right 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 electronic health record (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 is pre-diabetic, 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 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 right tibia.
While the clinician and patient wait for the results of the x-ray the clinician suggests that the patient have a blood draw to ensure that she has not become pre-diabetic or diabetic. The patient agrees. Clinician evaluates results and determines that patient may have Type II diabetes. Clinician shares this information with the patient and enters information into the patient’s EHR. She explains to the patient that her doctor will be notified and will follow up with her to confirm findings and suggest options for treatment. Patient’s PCP is automatically sent an electronic notification.
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. Pre-admission clinical staff notice that the patient may have Type II diabetes but has not yet been seen by PCP for confirmation of the diagnosis or development of a treatment plan for this diagnosis.
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. They agree 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 to develop a long term plan for managing her Type II diabetes.
Soon after her last visit with her orthopedist she 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 coordination of care and 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 and her husband choose a surgeon and a hospital within their 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
Orthopedic:
Vascular Surgeon