What is a Storyboard?

A Storyboard is a concrete example of the practical applicability and utility of Patient Summary and ePrescription services in the epSOS context. While the intention of Use Cases is to give a rather broad view of the scope of the eHealth services to be defined, Storyboards illustrate how the epSOS cross-border Patient Summary and ePrescription services could work in specific, day-to-day situations and improve the quality of the delivered health care.

Patient Summary Storyboards

Storyboard No. 1:  A 44-year-old woman from Sweden develops a lower respiratory tract infection during her holidays in Greece. She reports about an allergy against an antibiotic, but cannot recall the name.

Possible answer from PS: A specific antibiotic (Sulphonamide) may not be administered.

Storyboard No. 2: A 66-year-old retiree from Germany is a known insulin-dependent diabetes mellitus patient. While on vacation in Italy, the patient loses his antidiabetic medication. He reports to a nearby hospital to request a new insulin prescription.

Possible answer from PS: The emergency room doctor refers to the Patient Summary to receive information on the appropriate insulin type and dosage, and issues a prescription for the corresponding brand names available on the Italian market.

Storyboard No. 3: A 55-year-old chronic dialysis patient from Germany travels to Paris every year for a trimester. He would require several planned dialysis sessions during the 3-month-stay. Prior to his travel, details of his condition have been clarified with the receiving dialysis unit in Paris by the German physician. Due to flooding, his journey is delayed in Reims. Here his overall condition deteriorates, probably due to dehydration and travel stress, and hospital treatment is unavoidable.

Possible answer from PS: The physicians in Reims receive information on his condition and medication.

Storyboard No. 4: A 62-year-old archaeologist from Amsterdam, who is scheduled to hold a lecture in Paris, is found disoriented and sweating in his hotel accommodation. He is admitted to a nearby hospital’s emergency room.

Possible answer from PS: The consultation of his Patient Summary excludes previous major health problems. His blood glucose level is highly abnormal (530 mg/ml) and insulin treatment is started. After his condition stabilized he is discharged from hospital and advised to report to his own GP as soon as he returns to Amsterdam for an appropriate check-up.

Storyboard No. 5: On his visit to Sweden, a 72-year-old Spaniard, who is accompanied by his wife, reports to the Stockholm South General Hospital’s emergency room due to repeated fainting episodes. Unfortunately, the couple has a very limited knowledge of English and Swedish. They are therefore only able to supply general information on preceding cardiac problems, but no details. The emergency room doctors therefore consult his Patient Summary.

Possible answer from PS: The Patient Summary includes a history of hypertension and severe cardiac disrhythmia, which required a recent pacemaker implantation. A routine ECG reveals the malfunction of the pacemaker. Fortunately the implanted device is similar to the ones available in Stockholm and the reprogramming of the pacemaker is successfully performed. After a short observation period, the patient is discharged and advised to contact his cardiologist in Spain.

ePrescription Storyboards

Storyboard No. 1: A patient from Andalusia (Spain) is spending a one-month vacation in Denmark. He suffers from a chronic illness and receives long-term treatment. However, according to regulations in Andalusia, he cannot collect, with certain exceptions, more than one box of the same medicine at a time. After three weeks in Denmark, he runs out of the medicine and goes to a pharmacy to purchase a new box. The dispenser consults the information from Spain to find out whether a prescription for the medication is currently available.

Answer from ePrescription: The prescription is available - the patient receives the medicine. Information about the dispensed medicine is sent to Andalusia to update the related prescription (eDispensation).

Storyboard No. 2: The patient from Andalusia (Spain) who is visiting Denmark and suffers from a chronic illness loses his nearly full box of medicine on the second day of his stay. This time, there is no prescription available, because a new prescription would only be available in about three weeks, when it is estimated that the previous box of medicine has been consumed. This situation can arise either because a) the patient has lost a package of medicine (like in this case), b) if he has forgotten the package in Andalusia or c) if he took a larger quantity than prescribed.

Answer from ePrescription: Two possible situations could happen at this point, depending on the legal situation in Country A (in this case Andalusia):
Legal Situation 1: In Andalusia, pharmacists are not allowed to access the Medication Summary; they may only access the ‘available’ prescriptions. Thus, the current prescriptions of the patient in Andalusia will not be available for the pharmacist in Denmark. The pharmacist will decide, according to his legislation, if he is able to dispense the medicine and if not, offer advice to the patient for the necessary steps to attain a new prescription.
Legal Situation 2: In Andalusia pharmacists are allowed to access available prescriptions as well as the Medication Summary. Thus, the current prescriptions will be sent to the pharmacy in Denmark together with a list of available prescriptions (in this case, however, there are none). The pharmacist will then need to decide, based on the attainable information (in this case, only on the current prescriptions) and according to legislation, if he is able to dispense the medicine or not. If not, he has to advise the patient on the necessary steps to attain a new prescription.
In both situations, no information on the dispensed medicine is sent to Andalusia, as the dispensing is not based on an available and valid ePrescription that can be updated with eDispensation information.