Interview patient Perform Physician; Nursing; Medical Assistant Take history Document 7.1(Document a progress note for each encounter)

Transcription

1 Reference Workflow Taonomy Patient centric Outpatient encounter 1 Intake and Nurse assessment Clinician* assessment Check in Document 1.16 (Access patient demographic data), 7.6 (Document date of birth), (Document ethnicity, gender, growth chart, height), 7.14 (Document insurance type), 7.25 (Document preferred language), 7.28 (Document race), 7.34(Document smoking status), 7.8(Document Measure, record vital signs Document 7.40(document vital signs); 7.41(document weight) Med review Review (Access mediation allergy history, medication history, active medication list ) Handoff Notify 2.2(acknowledge receipt of clinical 19.5(transmit clinical 12.13(receive patient summary allergy record from other providers) Review charts Review (Access - all information in medical record) (Review quality measure results) Registration Clerk ; Nursing ; Nursing ; Nursing; Physician Physician Interview patient Physician; Nursing; Take history Document 7.1(Document a progress note for each Physician; Nursing; Diagnose and plan Physician Review prior test ( review all information for a lab results test report, clinical lab tests received with LOINC codes) lab test 10.4(order lab study) Physician 1 (1) Tetbook: Fundamentals of clinical practice (2nd Edition) by Mark B. Mengel, Warren L. Holleman and Scott A. Fields, 2002; (2) Apply direct observation to model workflow and assess adoption, Kim M. Unertl BS et al., AMIA * Douglas Bell: Note, we use clinician to mean any practitioner authorized to create orders: MD, DO, NP, PA, etc. 1

2 Reference Workflow Taonomy Patient centric Outpatient encounter 1 Clinician* assessment Prescribe 10.1( medication), Physician ( medication generic-, new), 19.6 (transmit prescription) Make a referral ( provider referral) Physician Emergency room encounter Check out Patient arrival for emergency care (High intensity care)** Patient arrival for unscheduled urgent care / Safety net care (Low intensity care) Treatment Physician; Nursing Patient counseling Physician; Nursing Give out Document 2.1(Acknowledge education receipt) ; instructions Nursing Schedule net appointment Create (Remind patient per patient preference for follow-up, rm ambulance Notify 12.13(Receive patient summary record from other providers), 2.2(Acknowledge receipt of clinical 19.5(Transmit clinical summary) Measure, record vital signs Document 7.40(document vital signs); 7.41(document weight) Registration Clerk Nursing EMS paramedics Handoff Document 7.1(Document a progress note for each Nursing Interview patient Physician; Nursing Take history Document 7.1(Document a progress note for each Physician Interview patient Physician; Nursing (1) Tetbook: Fundamentals of clinical practice (2nd Edition) by Mark B. Mengel, Warren L. Holleman and Scott A. Fields, 2002; (2) Apply direct observation to model workflow and assess adoption, Kim M. Unertl BS et al., AMIA * Douglas Bell: Note, we use clinician to mean any practitioner authorized to create orders: MD, DO, NP, PA, etc. ** Seriously ill and injured pts; referral of pts with emergency 2

3 Reference Workflow Taonomy Patient centric Emergency room encounter Patient arrival for unscheduled urgent care / Safety net care (Low intensity care) ED treatment (Clinician assessment) Take history Document 7.1(Document a progress note for each Physician Referral 10.10( provider referral) Physician Document transfer Transmit 12.13(Receive patient summary record from other providers), 2.2(Acknowledge receipt of clinical 19.5(Transmit clinical summary) Review of referral Review 2.2(Acknowledge receipt of clinical summary) lab tests 10.4( lab study), 10.2(diagnostic imaging procedure), 10.8(procedure), 12.2(Receive clinical lab test result), 17.2(Review clinical lab tests received with LOINC codes), 20.13(Update patients record based on lab test result) Diagnosis Document 7.1(Document a progress note for each Prescribe Review, ( medication), 13.1(Recommend care modifications based on clinical decision support rules), 19.6 (Transmit electronic permissible medication order (prescription)) Nursing; Medical Physician; Nursing Physician Physician Physician 3

4 Reference Workflow Taonomy Patient centric Emergency room encounter (Ambulatory) surgical procedure 2 Patient disposition (Medical assistant) Pre-operative phase Disposition patients 9.1-2(Notify patients for follow-up care and, 10.10( provider referral) Registration Document 1.16(Access patient demographic data), 7.6(Document date of birth), (Document ethnicity, gender, growth chart), 7.14(Document insurance type), 7.25(Document preferred language), 7.28(Document race), 7.34(Document smoking status) Measure, record vital signs Match patient to procedure Nursing preop assessment/eam Document, 7.40(Document vital signs); 7.41(Document weight) Premedication ( medication), 13.1(Recommend care modications based on clinical decision support rules), 17.9(Review education provided) Transport to OR Notify area Handoff Notify 2.2(Acknowledge receipt of clinical 19.5(Transmit clinical 12.13(receive patient summary allergy record from other providers) Nursing; Medical Registration Clerk ; Nursing ; Nursing; Physician Nursing; Medical Physician Nursing; Medical Nursing; Medical 2 Surgical workflow: Clinical epectations to the research field, Leonard Berliner,TIBM 2009 VL Surgical Workflow 4

5 Reference Workflow Taonomy Patient centric (Ambulatory) surgical procedure 2 Inpatient hospitalization 3 Operating room phase (Surgeon, anesthesiologist, nurses) Postop Period (Medical assistant) Admit (Nurse assessment) Set up instruments & devices Identify patient Acknowledge Anesthesia procedures Operate Create surgical Create 7.1(Document a progress note for each Physician record Write orders (--all types) Physician Handoff Notify 12.13(Receive patient summary record from other providers), 2.2(Acknowledge receipt of clinical 19.5(Transmit clinical summary) Nursing; Medical Transport to Notify recovery area Post-op labs/tests 10.4( lab study), 10.8( order set), 10.9( procedure) Pain management Discharge from recovery area Measure, record vital signs Transport the patient Create Document Notify 9.1-2(Notify patient for follow-up care and, 10.10( provider referral), 2.1(Acknowledge education receipt) 7.40(Document vital signs), 7.41(Document weight) ; Nursing; Physician ; Nursing 2 Surgical workflow: Clinical epectations to the research field, Leonard Berliner, TIBM 2009 VL Surgical Workflow 3 An ontological knowledge framework for adaptive medical workflow, Jiangbo Dang et al., Journal of biomedical informatics 41 (2008)

6 Reference Workflow Taonomy Patient centric Inpatient hospitalization 3 Admit (Nurse assessment) Handoff Notify 12.13(Receive patient summary record from other providers), 2.2(Acknowledge receipt of clinical 19.5(Transmit clinical summary) Detect & Treat History / Physical Review (Access--all information in medical record) Interview patient Take history Document 7.1(Document a progress note for each ; Nursing; Physician Physician Physician; Nursing; lab tests 10.4( lab study) Physician Imaging 10.2( diagnostic imaging procedure) Physician Review results Review 2.3(Acknowledge receipt of diagnostic test Physician; Nursing results from other providers), 12.2(Receive clinical lab test result), (Review lab results electronically in human readable format, incorporated as codified data) Diagnose Prescribe Review, ( medication, as generic, new Physician medication), 13.1(Recommend care modifications based on clinical decision support rules) Treat Administer medication Handoff Notify 12.13(Receive patient summary record from other providers), 2.2(Acknowledge receipt of clinical 19.5(Transmit clinical summary) ; Nursing; Physician 3 An ontological knowledge framework for adaptive medical workflow, Jiangbo Dang et al., Journal of biomedical informatics 41 (2008)

7 Reference Workflow Taonomy Patient centric Inpatient hospitalization 3 Transfer (Medical assistant) Transfer to ICU or higher care unit Notify Handoff Notify 12.13(Receive patient summary record from other providers), 2.2(Acknowledge receipt of clinical 19.5(Transmit clinical summary) ; Nursing; Physician Discharge (medical assistant) Give out discharge instructions Create 2.1(Acknowledge education receipt), 9.1-2(Notify patients for follow-up care and ; Nursing Transport the patient Notify Inpatient surgical procedure See ambulatory surgical procedure 3 An ontological knowledge framework for adaptive medical workflow, Jiangbo Dang et al., Journal of biomedical informatics 41 (2008)

8 Reference Workflow Taonomy Message centric Patient request for appointment Emergency room information flow 6 Pharmacy message handling, patient request for renewal Check patient eligibility pre-visit tests Review 1.16 (Access patient demographic data), 17.3 (Review of patients insurance eligibility) Registration Clerk 10.4(order lab study) Physician Make appointment Registration Clerk Refer patient to ( provider referral) Physician another provider Refer to telephone consultation or secure messaging Physician, nursing Notify ED of Notify EMS Paramedics Incoming arrival Transfers notes Create 7.1(Document a progress note on each Nurse onto ambulance run sheet Verbally reports Notify EMS Paramedics case to ER Quick registration Create 7.8(Document Nurse and verify patient identity Writes report Create 7.40(document vital signs); EMS Paramedics 7.41(document weight) Transfer report to Transmit 19.5(Transmit clinical summary) EMS Paramedics ER providers Intake Take message Registration Clerk 6 Improving access to clinical information in an Emergency Department: a Qualitative Study, Boonchai Kijsanayotin and et al. 8

9 Reference Workflow Taonomy Message centric Pharmacy message handling, patient request for renewal Intake Routing to prescriber Check R Review (Access medication allergy history over multiple visit, history over multiple visits, active medication list and supplements, medication order, nonmedication allergy history over multiple visits), 10.10( provider referral), ( Update medication allergy, medication list, medication order,nonmedication allergy, order for medication), (Review of patients insurance eligibility, received clinical lab test results for user interface, changes in diastolic blood pressure/height/ systolic blood pressure/weight, education provided) Check formulary Review 17.10(Review electronically formulary or preferred drug list) Prior authorization Check Review (Transmit insurance eligibility check to private/public payers, eligibility queries to private/public payers) Check DDI Review 3.2(Alert for drug-drug contraindications(real time)) Change medication Create 10.1((prescribe) medication), ( medication as generic, new medication), 20.6(Update medication list) Change instruction Document 7.1(Document a progress note for each Obtain prior authorization Receive (Receive insurance eligibility check electronically from private payers/public payers) Nursing; Medical Nursing; Medical Physician Nursing; Physician Physician Nursing Nursing; Medical 9

10 Reference Workflow Taonomy Message centric Pharmacy message handling, patient request for renewal Messaging with other clinicians Preop phase of surgery Routing back Contact pharmacy Notify 19.6(Transmit electronic permissible medication order(prescription)) Contact patient Notify 9.1-2(Notify patients for follow-up care and Transmit prescription Msg. intake or outreach to other clinician Negotiate on patient s case Make an agreement Remind patient of surgery beforehand Transmit Transmit (Transmit to other provider diagnostic test results/immunizations/ medication allergy list/medication list/ problem list/procedures performed, transmit to patient summary record from other providers) (Transmit to other provider diagnostic test results/immunizations/ medication allergy list/medication list/ problem list/procedures performed, transmit to patient summary record from other providers), Nursing, Physician Physician, Nursing Physician, Nursing Physician, Nursing Document Remind 7.1(Document a progress note for each 9.1-2(Notify patients for follow-up care and Physician, Nursing Physician, Nursing 10

11 Reference Workflow Taonomy Message centric Pre-op phase of surgery Scheduling procedures Schedule an appointment/ surgery Contact nursing group Contact anesthesia group Confirmatory phone call Notify Notify Notify (Transmit to other provider diagnostic test results/immunizations/ medication allergy list/medication list/ problem list/procedures performed, transmit to patient summary record from other providers) (Transmit to other provider diagnostic test results/immunizations/ medication allergy list/medication list/ problem list/procedures performed, transmit to patient summary record from other providers) (Transmit to other provider diagnostic test results/immunizations/ medication allergy list/medication list/ problem list/procedures performed, transmit to patient summary record from other providers) Contact Surgeon Notify (Transmit to other provider diagnostic test results/immunizations/ medication allergy list/medication list/ problem list/procedures performed, transmit to patient summary record from other providers) Answer phone call from pt Physician, Nursing Physician, Nursing Physician, Nursing Physician, Nursing Nursing, Medical Check available Review Registration Clerk slot Confirm with pt Create 9.1-2(Notify patients for follow-up care and Registration Clerk 11

12 Reference Workflow Taonomy Message centric Scheduling procedures Schedule an appointment/ surgery Schedule staff Remind before schedule Review historical patient visits Check staff s availability Assign time schedule Remind Review Review Document 9.1-2(Notify patients for follow-up care and Registration Clerk 12

13 Reference Workflow Taonomy Population management Clinician review of feedback report Case management session 7 Case finding Review report Review (Review ed changes in diastolic blood pressure, height, systolic blood pressure, weight, education provided, electronically formulary or preferred drug list, lab results electronically in human readable format, lab results incorporated as codified data, quality measure results) Track Review Analyze & Stratify (Stratify notifications by patient preference, patients by condition, reports by demographic information, by provider type, by provider role) Report Report 17.13(Review quality measure results) Alert Alert 13.1(Recommend care modifications based on clinical decision support rules) Educate patients Recommend Follow up Notify 9.1-2(Notify patients for follow-up care and Contact patient (may include order, ask patient to come in for appointment) Review report to identify potential eligible people Review 17.13(Review quality measure results) 7 Case management in health care, Health and Social work, 13:3(1988: Summer) p.219, Loomis, James F. 13

14 Reference Workflow Taonomy Population management Case management session 7 Case finding Screen Registration Document 7.26(Document problem on problem list) Assessment Interview clients Determine needs Document 7.24(Document performance result) Goal setting and service planning Collaborative decision making with patients Document 7.22(Document patient preference) Epert consultation support Transmit 19.5(Transmit clinical summary) Guidelines institutionalization and prompts 7.2(Document advanced directive), 7.3(Document alert provided to clients) Provider Education Care plan implementation Educate patient Patient activation/ psychological support Guidelines available to patients Notify 9.1-2(Notify patients for follow-up care and 7 Case management in health care, Health and Social work, 13:3(1988: Summer) p.219, Loomis, James F. 14

15 Reference Workflow Taonomy Population management Case management session 7 Care plan implementation Monitoring and evaluation Implement the plans Reviewing services delivered Feedback of performance data Remind Review Review (Remind patients per patient preference for follow-up care and 17.9(Review education provided) 17.13(Review quality measure results) (Review ed changes in diastolic blood pressure, height, systolic blood pressure, weight, education provided, electronically formulary or preferred drug list, lab results electronically in human readable format, lab results incorporated as codified data, quality measure results) 7 Case management in health care, Health and Social work, 13:3(1988: Summer) p.219, Loomis, James F. 15