15 hours into a natural disaster an elderly individual is semi-conscious, dehydrated, and unable to provide first responders any information.

While team is cutting through the roof to extract the patient from the flood waters, the first responder logs into a mobile device app and brings up patient's medical history from the HIE by entering patient's name and address which they retrieved from patient's wallet.

The EHR information is available to view on their mobile device via the HIE which is on a back-up database unaffected by the storm lightning and flooding.

The information gained from using the mHIE including medications and ongoing Problem List provides that the patient has a history of cardiac disease (including heart failure secondary to valve disease), was recently treated, and is taking warfarin. It appears to the paramedic as though there might be an electrolytic imbalance secondary to the dehydration that's causing an arrhythmia, appearing as 2nd degree heart block, and manifestations of heart failure, all of which might prompt the use of amiodarone.

From reviewing the mHIE at the flooded house, however, they know that the patient is taking warfarin, and thus opt not to administer amiodarone, and monitor the patient closely. The paramedic starts an IV, but from the HIE information they know it is imperative that they don't overload the patient with fluids which could potentiate the heart failure risk.

Patient is flown by medevac to hospital ED beyond the impact of the storm.

During the transfer the paramedic contacts the Tulane ED they are heading to and in addition to relaying information over the phone, she sends message with link to patient's HIE information and a brief description of what has transpired.

The ED triage nurse receives the electronic report from the paramedic, and holds a resuscitation room for the incoming patient. He also notifies the nursing supervisor and admissions that the patient will likely require an ICU bed.

The ED attending is notified that the patient is en route, and reviews the paramedic's note and the patient's medical history via the mHIE, allowing him to better anticipate the patient's immediate needs on arrival to the ED.

The dehydrated storm survivor patient arrives in ED, and during the workup, aggregated EHR information from the HIE provides that a mechanical mitral valve replacement had been performed at a different hospital that's attached to the HIE.

The ED physician has a suspicion that changes in the EKG are now indicative of heart failure and not dehydration and patient might be having or had a myocardial infarction. In order to meet the PCI 90-minute benchmark Door-to-Balloon time, cardiac enzyme labs are drawn and the on-call cardiologist, who is out having dinner, is called and consulted with.

The on-call cardiologist consults with ED doc while reviewing patient's info from the HIE using his mobile device . He sees what he needs from the valve procedure, changes the focus to ensure heart failure is ruled out ASAP, and orders a STAT 2-D echocardiogram and a BNP test.

On-call cardiologist checks in on Patient's status from mobile HIE app and sees that the 2-D echocardiogram and BNP test results have come in. After reviewing them contacts ED Physician who informs him things are not improving in spite of rehydration and they are beyond 45 minutes from when patient was wheeled into the room.

The accumulation of the bedside 2-D echo report, the 2nd consultative discussion with ED Physician on lab results, and noted new STEMI indications from ED work up that patient could be at risk for congestive heart failure, make for an emergency heart catheterization.

He activates the on-call catheterization team for a potential angiography to see what's going on and heads in to the hospital to perform the procedure well within the PCI 90-minute benchmark of Door-to-Balloon time.

After stabilization, the patient is transferred from the hospital to a long term acute care facility (LTAC) for three weeks. Then the primary care physician is alerted by iPhone that her patient is being discharged from LTAC.

PCP is at home and uses link in mobile alert to open patient HIE information to review what's been happening. She looks at the most recent in-patient hospital visit and the LTAC discharge summary.

She calls the patient to see if they have any questions and schedules an appointment to follow up.