10/21/11 version 1.0 workflow redesign templates provided by: the national learning consortium (nlc)...
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10/21/11 • Version 1.0
Workflow Redesign TemplatesProvided By:The National Learning Consortium (NLC)
Developed By:Health Information Technology Research Center (HITRC) Practice and Workflow Redesign Community of Practice
10/21/11 • Version 1.0www.HealthIT.gov
Template Instructions:Mapping an Existing Workflow• To use these templates, first identify the current type of workflow you want to
redesign, and then identify the staff responsible for the activities in the workflow.
• In collaboration with the implementation team, they should review the workflow and adjust it as necessary to match the typical scenario in their office.
• Assign a note taker/recorder to enter the steps into the boxes and arrows on the PowerPoint slide. The note taker/recorder can move the PowerPoint boxes and arrows to reflect how the staff order the interactions.
• In the workflow templates, boxes indicate steps in the process. Blue diamonds indicate “yes or no” decision points and lead to appropriate next steps depending on the “yes or no” decision. Staff can indicate decision point steps by turning a sticky note sideways 45 degrees or by drawing a diamond on the box.
Note: Double-click workflow diagrams to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Patient Check-In Paper Process
Pa
tie
nt
Fro
nt
De
sk
Re
ce
pti
on
ist
Signs in at Front Desk
Marks Patient Arrival
Patient Check-in Paper Process
Patient Arrives
New Patient?
Give Pt. Forms to fill out, collect & copy insurance
card
Pull Paper Chart (from staging
area)
Patient Completes Forms
Does PtInfo need
to be updated?
Does co-pay need
to be collected?
Collect Payment & generate record of payment for billing
department
Record updates in paper chart,
collect & copy insurance card if
needed
Collect and file forms in newly created chart
Put chart & flowsheet in bin indicating patient is
ready for rooming
Yes
Generate Flowsheet
Yes
Yes
Yes
No
No
No
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Patient Check-In Process:EHR without Integration/Interface with Practice Management System (PMS)
Pat
ient
Fro
nt D
esk
Rec
eptio
nist
Signs in at Front Desk
Marks Patient Arrival into
PMS and/or EHR
Patient Check-in Process – EHR without Integration/Interface with Practice Management System (PMS)
Patient Arrives
MU Objective:Record Pt
Demographics as Structured Data
New Patient?
Give Pt. Forms to fill out, collect &
copy or scan insurance card
Select Patient from PMS
and/or EHR
Patient Completes
Forms
Does PtInfo need
to be updated?
Does co-pay need
to be collected?
Collect Payment & record into
PMS
Record updates in PMS and/or EHR,
collect & copy insurance card if
needed
Collect and enter information into
PMS and/or EHR
Mark “pt is ready” for rooming into PMS and/or
EHR
No
Yes
Yes
Yes
No
No
No
Note: Double-click workflow diagram to make edits
4
10/21/11 • Version 1.0www.HealthIT.gov
Patient Check-In Process:EHR is Fully Integrated/Interfaced with Practice Management System (PMS)
Pat
ient
Fro
nt D
esk
Rec
eptio
nist
Signs in at Front Desk
Marks Patient
Arrival on EHR
Patient Check-in Process – EHR is Fully Integrated/Interfaced with Practice Management System (PMS)
Patient Arrives
MU Objective:Record Pt
Demographics as Structured Data
New Patient?
Give Pt. Forms to fill out, collect & scan insurance
card
Select Patient from EHR
Patient Completes Forms
Does PtInfo need
to be updated?
Does co-pay need
to be collected?
Collect Payment & record into
EHR
Record updates in EHR, collect & scan insurance card if needed
Collect and enter information in
EHR
Mark “pt is ready” for rooming into EHR
Yes
Yes
Yes
Yes
No
No
No
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Office Visit Workflow Template
Pa
tie
nt
Nu
rse
/Su
pp
ort
Pro
vid
er
Views EHR schedule &
patient “arrived” status
Greets patient and escorts to
clinic area
MU Objective:Record and chart changes in vital
signs
Offi ce Vis it Workfl ow Template
Arrives & checks in
Obtains patient’s
weight, height, blood pressure,
temp., etc.
Escorts patient to
exam room & logs into
EHR
Select & open patient’s
electronic record
Enters vitals & chief
complaint
Secures workstation and leaves
room
Record history: past medical, social, family,
substance (smoking
history), etc.
Verify & record
allergies & current
medications
MU Objective:Maintain active medication &
medication allergy list
MU Objective:Record smoking status for patients 13 years old
or older
Performs chart review before entering exam
room
Enters the room, greets patient, and logs onto
workstation
Consults with patient and records HPI
Performs physical exam
Documents review of
systems & physical exam
into EHR
Updates problem list & triggers CDS rules
if needed
Provides patient with instructions/
materials
MU Objective:Maintain problem list of current and active
diagnoses & implement relevant
CDS rules
Assigns Level of Service (LOS)
Places orders as necessary
(see Orders workflow)
Closes the encounter in
EHR
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
e-Prescribing Workflow Template:During Office Visit
Pat
ien
tC
lerk
/Tec
h/
Nu
rse
Pha
rmac
yeP
resc
rib
ing
Ne
twor
kP
resc
ribe
r
Interviews patient for Rx details of
current medications and allergies
Asks patient for pharmacy information
Prescriber sees patient and
identifies need for Rx(s)
Reviews and updates Rx History
& allergy list
Print or Fax Rx(s) &/or
Call-in Rx(s)
Select, update, and order Rx(s)
New Rx?
Select Rx(s), check for alerts, & order
Rx(s)
Can Rx(s) be ePrescribed?
Rx transmittedCheck patients Rx benefit information
Notifies patient that Rx(s) filled & ready for
pick-up
Rx(s) filledReceives
Rx(s)
Patient drops-off Rx(s) at
pharmacy or sends mail order
MU Objectives:Maintain active
medication and allergy lists
Verify patient pharmacy information
MU Objectives:Implement drug-drug, drug-
allergy, drug-formulary checks
MU Objective:Use CPOE
MU Objective:Implement drug-formulary checks
No Yes
No
Yes
ePrescribing Workflow Template – During Office Visit
Patient arrives
Patient picks up Rx(s)
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
e-Prescribing Workflow Template:Medication Refill
Pat
ient
Cle
rk/T
ech/
N
urse
Pha
rmac
yeP
resc
ribi
ngN
etw
ork
Pre
scri
ber
Interviews patient for RX details of
current medications and allergies
Asks patient for pharmacy
information & sends request to
prescriber
Receives Rx refill request
Reviews and updates Rx History
& allergy list
Print or Fax Rx(s) &/or
Call-in Rx(s)
Select, update, and order Rx(s)
New Rx?
Select new Rx(s), check for alerts, & order Rx(s)
Can Rx(s) be ePrescribed?
Rx transmitted
Check patients Rx benefit information
Notifies patient that Rx(s) filled
& ready for pick-up
Rx(s) filled Receives Rx(s)
Patient drops-off Rx(s) at pharmacy or sends
mail order
MU Objectives:Maintain active medication
and allergy lists
Verify patient pharmacy
information
MU Objectives:Implement drug-drug, drug-
allergy, drug-formulary checks
MU Objective:Use CPOE
MU Objective:Implement drug-formulary checks
No Yes
No
Yes
ePrescribing Workflow Template – Medication Refill
Patient picks up Rx(s)
Patient requests
refill
Pharmacy transmits Rx refill request
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Appointment Scheduling Workflow Template
Cle
rk o
r P
rovi
der
Sch
edul
er
Search for patient in system (MRN,
Name, DOB, etc.)
Appointment Scheduling Workflow Template
Patient needs appointment
New Patient?
Select provider and Open
appointment schedule
Summarize appointment
verbally or give appointment card
Select Reason or Type of
Appointment
Create new record in system
Enter patient information
Search for specific date or next
available appointment
Select appointment
slot(s) and save
Appointment Scheduled
Yes
No
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Laboratory Order Workflow Template:During Office Visit
Pat
ient
Labo
rato
ry
Laboratory Order Workflow Template – During Office Visit
Patient Arrives
Order test with appropriate
diagnosis code(s)
MU Objectives:-- Implement CDS Rule
Test needed?
Pro
vide
r
Yes
No
Office Visit
Patient leavesNo labs needed
Patient leaveswith lab order
Point of Care Test?
Specimen collected?
Test performed?
No
Notify provider
Test results generated &
Sent to provider
See Lab Results
Workflow
No
No
Yes
Yes
YesNote: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Laboratory Results Workflow
MA
or
Cle
rkP
atie
nt
Laboratory Results Workflow
Lab results received
MU Objective:Incorporate clinical lab test results into certified EHR technology as structured data
Critical lab values?
Pro
vide
r
No
Route results to ordering provider
Patient receives notification of lab
results
Provider receives lab results
Alert provider immediately
Provider takes action, if
necessary
Provider signs off on lab results
Notify patient of lab results
MU Objectives:-- Provide patient with electronic
copy of their test results uponrequest
-- Provide patients with timely electronic access to their lab results
Yes
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Lab Orders and Results Management
Nur
se, M
A o
r C
lerk
Pat
ient
Pro
vide
r
Lab Orders and Results Management
Generate list of pending orders
Search for patient and lab results in
EHR
Send message to
provider
MU Objectives:-- Provide patient with electronic
copy of their test results uponrequest
-- Provide patients with timely electronic access to their lab results
Test Performed
Lab results available?
Send reminder or follow-up with patient
Patient calls for lab results
Labo
rato
ry
Test results generated
and sent to provider
Patient receives notification:
reminder or lab results
Provider receives lab
results
Provider signs off on lab results
Notify patient of
lab results, if needed
MU Objective:Incorporate clinical lab test results into certified EHR technology as structured data
Yes
Yes
No
No
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Referral Generation Workflow TemplateP
CP
Spe
cial
ty P
rovi
der
Offi
ce
Referral Generation Workflow Template
Determines patient needs referral
MU Objective:Provide Summary of Care Record for each transition of care and referral
MA
or
Cle
rk
Receives referral order
Generates referral order
Generates encounter
documentation
Pat
ient
Obtains insurance authorization, if
neededGenerates referral
Patient receives referral
Contacts specialty provider for appointment
Generate Summary of Care
Document
Send referral documentation via
eExchange, secure email,
faxing, or printing
Receives referral documentation
Schedules appointment
Provides specialty service(s) to
patient
Generates encounter
documentation
Routes specialty documentation to
PCP
Receives message from
specialty provider
Generate & send Summary of Care Document to PCP
Receives Summary of Care document from
specialty provider
Note: Double-click workflow diagram to make edits
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10/21/11 • Version 1.0www.HealthIT.gov
Office Discharge Workflow TemplateP
atie
ntOffi ce Discharge Workflow Template
Patient exits exam room
Nur
se, M
A, o
r C
leri
cal S
taff
Completes encounter
documentation
Pro
vide
r
Review patient instructions and
orders
Print or send orders to
appropriate recipients
Schedule follow-up appointment(s),
if needed
Print or send summary of care document (including instructions,
patient-specific education materials, and medication list), if needed
Receives orders, instructions,
follow-up appointment, etc.
Patient exits office
MU Objectives:-- Use CPOE-- Generate and transmit
permissible ePrescriptions
Submit data to Immunization Registry, Public health agencies,
quality measures to CMS or States, etc., if needed
MU Objectives:-- Provide clinical summaries-- Provide summary of care record
for transition of care
MU Objectives:-- Capability to submit electronic data to immunization registry-- Capability to submit electronic syndromic surveillance data to
public health agencies
Note: Double-click workflow diagram to make edits
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