Workflow Redesign Templates

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

2


Patient Check-In Paper Process

Pat

ient

Fron

t Des

k R

ecep

tioni

stSigns in at Front Desk

Marks Patient Arrival

Pati ent 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

3


Patient Check-In Process:EHR without Integration/Interface with Practice Management System (PMS)

Patie

ntFr

ont D

esk R

ecep

tioni

st

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


4


Patient Check-In Process:EHR is Fully Integrated/Interfaced with Practice Management System (PMS)

Patie

ntFr

ont D

esk R

ecep

tioni

stSigns 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


5


Office Visit Workflow TemplateP

atie

ntN

urse

/Sup

port

Pro

vide

r

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


6


e-Prescribing Workflow Template:During Office Visit

Pat

ient

Cle

rk/T

ech/

N

urse

Pha

rmac

yeP

resc

ribin

gN

etw

ork

Pre

scrib

er

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 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 – During Office Visit

Patient arrives

Patient picks up Rx(s)


7


e-Prescribing Workflow Template:Medication Refill

Patie

ntC

lerk

/Tec

h/

Nur

sePh

arm

acy

ePre

scrib

ing

Net

work

Pres

crib

er

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


8


Appointment Scheduling Workflow Template

Cle

rk o

r Pr

ovid

erSc

hedu

ler

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


9


Laboratory Order Workflow Template:During Office Visit

Patie

ntLa

bora

tory

Laboratory Order Workflow Template – During Office Visit

Patient Arrives

Order test with appropriate

diagnosis code(s)

MU Objectives:-- Implement CDS Rule

Test needed?

Prov

ider

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

10


Laboratory Results Workflow

MA

or C

lerk

Patie

nt

Laboratory Results Workflow

Lab results received

MU Objective:Incorporate clinical lab test results into certified EHR technology as structured data

Critical lab values?

Prov

ider

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


11


Lab Orders and Results Management

Nur

se, M

A or

Cle

rkPa

tient

Prov

ider

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


12


Referral Generation Workflow TemplatePC

PSp

ecia

lty P

rovid

er O

ffice

Referral Generation Workflow Template

Determines patient needs referral

MU Objective:Provide Summary of Care Record for each transition of care and referral

MA

or C

lerk

Receives referral order

Generates referral order

Generates encounter

documentation

Patie

nt

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


13


Office Discharge Workflow TemplatePa

tient

Offi ce Discharge Workflow Template

Patient exits exam room

Nur

se, M

A, o

r Cle

rical

Sta

ff

Completes encounter

documentation

Prov

ider

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


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Workflow Redesign Templates

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