1. MedLifeCard in real-life scenarios Cost Saving Improved Patient Care

2. MedLifeCard Demonstrations The following scenarios are based upon actual patients seen in the ER. Each clinical course is described as it occurred (without a MedLifeCard), then contrasted with the difference a MedLifeCard would have made. Direct cost comparison using figures provided by Medical Management Specialists, PC. Photographs are used with the consent of the subjects.

3. Case # 2- Arthur V. Arthur V., a 74 year old retired steel worker from Pittsburgh, is reluctantly brought to the ER by his wife after he mentions to her that he felt “a little pressure” in his lower chest while attending his granddaughter’s wedding reception in Michigan.

4. (Arthur V. without MedLifeCard, continued) His discomfort was completely relieved after a glass of milk and a belch and he attributes the episode to “heartburn” from too many deviled eggs. By the time he arrives in the ER he is pain- free and would like to return to the reception but his wife is still concerned. She states her husband has had “heart trouble” in the past, although she is vague on details. He is also on several medications but does not remember the names. He has never smoked and only drinks alcohol occasionally.

5. (Arthur V. without MedLifeCard, continued) Arthur’s physical exam shows normal vital signs, some early signs of emphysema, and a mild heart murmur. More concerning to the ER physician is his EKG which is quite abnormal.

6. (Arthur V. without MedLifeCard, continued) Arthur’s chest X-rays are also abnormal, although it is difficult to tell if the changes are recent or chronic scarring.

7. (Arthur V. without MedLifeCard, continued) After all his labs are complete, the physician discusses the findings with Arthur and his wife. “Sir, your labs all look quite good. But your EKG is much more concerning. You have a heart block and abnormal cardiac axis. I can’t tell if this is new or old. The fact that your pain resolved after just a burp may be a good sign but we can’t rely on that. Also, your chest X-ray is abnormal. There seems to be a lot of scarring as well as what appears to be a bleb on your right lung. I wish we had old medical records for you to see if these are new or old but there’s no way to access your records at your physician’s office in Pennsylvania.”

8. (Arthur V. without MedLifeCard, continued) He continues, “Given these abnormalities as well as the potentially life-threatening nature of some conditions that present in this manner, I have to recommend we admit you to a telemetry bed for observation and probably a stress test in the morning. We’ll get a CT scan of your thorax also.” Arthur protests but is over-ruled by his wife and is admitted to the hospital. He misses the rest of the wedding reception.

9. (Arthur V. without MedLifeCard, continued) The following day he undergoes a stress test that shows no signs of cardiovascular disease. His CT scan demonstrates a moderate-sized right pleural bleb as well as diffuse scarring of both lungs. These changes are judged to be pre-existing and of little significance. He is discharged later in the afternoon after being started on a medication for gastritis, a.k.a. “heartburn”.

10. How might this have been better managed with the MedLifeCard?

11. Arthur V with the MedLifeCard As Arthur is being initially evaluated by the Emergency Physician, his wife produces their MedLifeCard and presents it to the nurse. As Arthur’s EKG, chest X-ray, and labs are being done his MedLifeCard medical file is accessed and printed.

12. Arthur V with the MedLifeCard Arthur’s MedLifeCard file has a digitized copy of his most recent EKG. Comparing this to his ER EKG demonstrates no change. His heart block and abnormal cardiac axis are pre-existing and thus, although not ‘normal’, they are normal for him. New EKG EKG from MedLifeCard file

13. Arthur V with the MedLifeCard  The MedLifeCard file also has a radiology report from his most recent chest X-ray six months ago: “Chronic scarring noted bilateral lungs, greater at the bases. Chronic right pleural bleb unchanged from previous exam of 8/12/91.” Thus, the abnormal chest X-ray is seen in a different light. Again, although not ‘normal’, it is normal for him.  His file also notes that he has mitral stenosis, accounting for the heart murmur.

14. Arthur V with the MedLifeCard  The Emergency Physician is able to find Arthur’s primary physician’s phone number in Pittsburgh in the MedLifeCard file and calls him to advise him of Arthur’s symptoms and findings. Both physicians are comfortable with Arthur being discharged from the ER to follow up with his physician when he gets home.  He is then discharged with a medication prescription for gastritis, a.k.a. “heartburn”.  He returns to the wedding in time to dance with his granddaughter.

15. Direct Cost Comparison for Arthur V Without MedLifeCard ER visit: $ 740 Hospitalization in telemetry ward: $ 1250 Cardiac stress test: $ 650 CT thorax: $850 Medication for gastritis: $35 With MedLifeCard ER visit: $ 740 Medication for gastritis: $35 Total: $ 3,525 Total: $ 775 Direct cost comparison using figures provided by Medical Management Specialists, PC

16. Further Benefits of MedLifeCard for Arthur V.  Unnecessary, costly, and time-consuming procedures are avoided.  Follow up and continuity of care is facilitated.  Timely and safe return to important activities of life is possible.