Example of Clinic Flowchart Format
Appointment Scheduling Workflow Template
Clerk or Provider
Patient needs appointment
Create new record in system
Search for patient in system (MRN, Name, DOB, etc.)
Enter patient information
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Select provider and Open appointment schedule
Summarize appointment verbally or give appointment card
Select Reason or Type of Appointment
Search for specific date or next available appointment
Select appointment slot(s) and save
Office Visit Workflow Template
Views EHR schedule & patient “arrived” status
Greets patient and escorts to clinic area
Obtains patient’s weight, height, blood pressure, temp., etc.
Escorts patient to exam room & logs into EHR
Secures workstation and leaves room
Select & open patient’s electronic record
Record history: past medical, social, family, substance (smoking history), etc.
Enters vitals MU Objective:
& chief Record and chart
complaint changes in vital signs
Verify & MU Objective:
record Maintain active
allergies & medication &
current medication allergy list
MU Objective: Record smoking status for patients 13 years old
Performs chart review before entering exam room
Closes the encounter in EHR
Enters the room, greets patient, and logs onto workstation
Consults with patient and records HPI
Provides patient with instructions/ materials
Performs physical exam
Assigns Level of Service (LOS)
Documents review of systems & physical exam into EHR
Places orders as necessary (see Orders workflow)
Updates problem list & triggers CDS rules if needed
MU Objective: Maintain problem list of current and active diagnoses & implement relevant CDS rules
WORKFLOW FOR A PRIMARY CARE CLINIC
WITH A PAPER MEDICAL RECORD
The typical workflow for a patient visit at this primary care clinic begins with the patient intake portion which includes the request for appointment, patient registration, history taking and beginning the clinical exam. The patient contacts the clinic for an appointment via phone call or in-person for a walk-in appointment, taken as available. In both instances, the receptionist collects demographic data from the patient, including date of birth, age, address, social security number, emergency contacts and insurance
provider information. This information is entered into the demographic and insurance component of the clinic’s electronic registration system.
New patients are scheduled for a forty-five minute appointment and receive a unique patient identification number (ptID). This number remains the same for the life of the patient at the clinic. A returning patient’s information is retrieved, including the ptID, and is scheduled for a twenty minute appointment.
After the patient is scheduled and registration is complete, a new paper chart is developed by the file clerk and the registration information is printed and placed in the chart. If the patient is a returning patient the file clerk pulls the existing paper record from the file room, updates the demographic information and then places the chart in the pending charts bin. The day before the patient arrives for their appointment, the file clerk places the paper chart at the front desk so that it is available when the patient arrives for their appointment.
Upon the patient’s arrival, the receptionist queries the patient’s social security number and verifies the patient’s identity with their last and first name. Demographic information is validated or updated in the registration system. The patient then receives a paper encounter form, requesting information on past medical history, current health concerns and reasons for visit, to be completed while waiting to be placed in an exam room. In the meantime, the nurse is alerted that the patient has arrived and when available, rooms the patient in an exam room in the clinic.
The second portion of the workflow includes: the physician’s physical exam, patient laboratory, radiologic and other testing, and patient discharge. Once the patient is in the exam room, the nurse reviews the completed encounter form, obtains the
patient’s vital signs and enters the patient’s chief complaint and other relevant data into the paper record. After the nurse completes these tasks, the physician begins his encounter with the patient and completes the exam. The physician documents the exam and writes orders, including medications, lab, radiology and referrals in the chart after the encounter is completed. If the physician writes an order for medication, she provides a written prescription to the patient before they leave the exam room. The physician then flags the chart (to indicate that the chart has orders) and then returns it to the nurse. Upon completion of the visit the patient stops at the clinic front desk and schedules any return visit. The nurse then executes the orders (facilitates scheduling of lab, radiology, medication prescriptions and so forth).
When lab and radiology results are ready, they are printed to the clinics printer and the nurse then places the printed results into the chart. Patients are called with any abnormal lab and radiology results or sent a letter stating results are within normal limits. When patients need prescriptions refilled, they contact the receptionist who then places a hand written note at the nurse’s station in the clinic. The nurse then places the note in the patients chart and places it in a bin for the physician to review at the end of the day. Once the physician writes the refill prescription, she places the chart in the bin and the nurse contacts both the pharmacy and patient.
Key Workflow Problems
1. Patients frequently complain about having to fill out and update the registration forms and health history in the waiting room when they first arrive at the clinic for their appointment.
2. Paper charts occasionally become lost and staff spend a substantial amount of time searching for them.
3. Nurses complain that it is difficult to read the physicians handwriting and have made errors in transcribing orders.
4. It takes considerable time to sort through printed lab and radiology reports and place them in patients charts for the physician to review. It would be much easier to have all lab, radiology and other ready to go for each patient the day before.
5. Nurses complain that they spend an enormous amount of time checking patient’s drug allergies and validating correct dosages on medication orders. They often use Google to look up drug information.
6. Patients frequently lose their paper prescriptions written at the office and nurses spend a considerable amount of time having to call the pharmacy to validate them.
7. Patients often ask for information regarding their disease condition and nurses spend a considerable amount of time searching for reliable information on the Web to educate them. Evidence based guidelines are changing all the time and it is difficult to keep up with best practices.
8. Clinic physicians complain that there is not a good system of informing them if one of their patients has been admitted to the emergency room or admitted to the hospital. Emergency room staff complain that they do not have access to outpatient records and the patients past medical history when they are seen in the emergency room.
9. Clinic physicians and nurses complain that it is difficult to piece together the “patients story” in the paper chart. Much of the information is fragmented and caregivers need to see key metrics (trended lab, weight, BMI, and other data) in one place.
10. Patients would like to become more engaged in wellness and make less visits to the clinic for routine health monitoring such as tracking their weight, blood sugar, exercise program, adherence to a diet and so forth. Many also would like to become involved in various support groups but cannot leave their homes. And they would also like access to their own medical record so that they can review it at home.