Workflow Analysis

Workflow Analysis

An essential & critical step to building the foundation of a successful EMR implementation is to perform an in-depth analysis of the practice. Everyone who is involved in a patient’s flow through the office, from scheduling to the patient’s exam to filing medical records, needs to be interviewed.

By documenting a practice’s current-state and working with staff to develop a standardized future-state, you will provide the practice with improved processes and help to build an efficient EMR environment for the end-user.

The following list is an example of areas to focus on when performing a current-state workflow analysis. This list is only a guide and the questions are meant to be elaborated on. Once your interviews are complete and verified by all key players, you can move forward and create a future-state based on the capabilities of the EMR application being implemented.

• Appointment Preparation
  • When do you verify insurance?
  • When is the chart pulled?
  • What is reviewed prior to visit?

• Check-In
  • What is the process?
  • What type of documentation is brought in by the patient?
  • Are there walk-ins?
  • How are no-shows handled?
  • How is clinical staff notified that patient is ready to be seen?
  • How often is the HIPAA form signed?
  • Is a facesheet printed from PM for patient to verify demographic information?

• Patient Intake & Review
  • What does the clinical support staff document prior to the Provider entering the room?
  • Where does the Provider review this information?
  • Consider using the Patient Worksheet report to have patient's provide medical updates Patient Worksheet Report

• Patient Exam/Note
  • What does the Provider document in the chart?
  • When does the Provider complete documenting the visit?
  • Is dictation used?
  • Where does the chart go after the visit is complete?
  • Is there a need to assign an ad hoc security code to notes?

• Medication Management
  • Is a formulary used?
  • Are samples dispensed?
  • Does the clinic perform shot clinics?

• Orders
  • Is there an in-house lab?
  • Do you have an information system for any of your lab vendors?
  • What orders are placed?
  • Will CareGuides and Patient Education materials be implemented?
  • Does your group have their own radiology? If so, will they use the EHR to modify orders as needed?
  • Do you sell supplies?

• Charges
  • How is E&M coding performed? By whom?
  • Who reviews & submits charges?
  • Will you allow discounts to be reported through the EHR charge module?
  • Will your organization utilize the E/M coder?
  • Will Exploding Sets be used?
  • When a patient has a split visit (part work comp and part commercial, or part self pay and part commercial) do the practices enter the patient on the schedule in the PM twice? Or do they create a second charge encounter in the EHR?

• Check-Out
  • What is the check-out procedure?
  • When are follow-up appointments made?
  • How is payment handled?

• Patient Communication
  • Process for taking messages?
  • How are patients notified of lab results?
  • How are incoming patient calls handled?
    • Medical complaints?
    • Medication refill requests? Pharmacy? Patient?
    • Referral requests?
    • Billing questions?
  • Does the office send out appointment reminders?

• Other visits
  • Nurse only visits?
  • Psych/social work visits?

• Reporting
  • What are the current reporting requirements?

• Surgery and Inpatient
  • Who schedules the surgery with the facility and obtains required authorizations?
  • Where is the authorization information captured? (PMS)
  • Does the provider provide the surgery scheduler/clerk the CPT and ICD9 codes for surgery when scheduled?
  • Does the provider sign and submit their paper charge ticket the same day of surgery?
  • When a patient is seen in the hospital for rounds, does the provider submit the charges the next day or after a report is received in the clinic?
  • Do you intend on having your surgery coordinator or staff queue up the surgery charges for your provider to streamline surgery charge entry?

• Scan
  • Will labels be printed and placed on correspondence or paper forms received by the clinic to be scanned?
  • How will your group store imaging CD's or X-Rays when you no longer use paper charts?
  • Will you have a centralized scan team?
  • Will your group use the File Cabinets (for non-registered new patients)