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Unsolicited but Greatly Appreciated Testimonial Mike Anderson, MD, FAAP
EncounterPRO Pediatric EMR Workflow System



Pediatric EMR Chart in 37 Seconds
Pediatric EMR

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FASTEST PRESCRIBER
IN THE WEST
WANNA SEE A DEMO?
WANNA SEE IT AGAIN?



E-PRESCRIBING IS BETTER
ON AN EMR WORKFLOW SYSTEM

We don't send our e-prescriptions through someone else's e-prescribing application, because we are certified to directly connect to the SureScripts Electronic Prescribing Network. The end result? Fewer clicks, faster transmission (OK, perhaps only milliseconds faster), and a higher volume of prescriptions sent electronically. Our favorite testimonials so far? A tie between "Brilliant" and "Best thing since sliced bread." (both from Dr. Rogu, RBK Pediatrics)

As Bruce Lee put it, "Simplicity is the key to brilliance.” Our philosophy is somewhere between the US military's fire-and-forget and Jean-Luc Picard's "Make it so!" The EncounterPRO Pediatric EMR Workflow System takes care of the time consuming side of e-prescribing so you can concentrate on medicine.

 

WHO IS THE E-PRESCRIBING WORKFLOW ENGINE? YOU OR THE COMPUTER?

As a knowledgeable source (who must remain anonymous) put it, "I've seen many integrations between the SureScripts Electronic Prescribing Network and both stand-alone e-prescribing systems and comprehensive EMRs, and you guys have by far the best workflow."

We were both gladdened and puzzled by the compliment. What is it about our e-prescribing workflow that is better than the alternatives? In fact, in order to obtain SureScripts certification we had to add one whole extra click for the prescribing physician (we're as obsessed with minimizing clicks in our workflow almost as much as Google is with minimizing words on its homepage.) And then the light bulb went off. We have great *e-prescribing* workflow because we have great *prescribing* workflow.

Since EncounterPRO is a pediatric EMR workflow system, previous to our integration with SureScripts, we set up workflow process definitions to consult default values and a dose calculator to automatically populate dose amount and frequency, duration, packaging, total dispense, number of refills etc. If, for example, you diagnosis otitis media on the Assessments screen, the next screen is Treatments. If you select Amoxicillin, the next screen displays the default values for that medication. If they are OK, click "OK" and move on. Fire and forget. Make it so. If the workflow process definition (being executed by the workflow engine) has a default to print at the printer near the door, the prescription automatically prints at the printer near the door. This extra stuff happens automatically while the pediatrician is seeing another patient.

When we added e-prescribing functionality, nothing changed from the point of view of the pediatrician. All you, the pediatrician, need to know is that someone or something is going to take over and make sure the right tasks are accomplished in the right order with respect to the right staff and patient and not require any further thought or action (*unless* something goes wrong, the patient doesn't pick up the prescription, the staff member is out sick, the pharmacy doesn't get the electronic prescription, and so on, in which case there is a closed loop mechanism to track the prescription to its final disposition and take further action if necessary).

From the point of view of the prescribing pediatrician, the addition of e-prescribing functionality didn't change your workflow, except for the status screen that SureScripts made us add to restate what is about to be sent to the pharmacy.

THREE CLICKS (WELL, FOUR), LARGE BUTTONS...

Answering a refill request is just as simple. You get a request to approve a refill request on your task list.

  1. Click the To-Do item.
  2. Click one of:
    • Approve the refill request "as is"
    • Deny the request
    • Approve the request with modified prescription
    • Approve the request with change in medication
  3. Click the big "Finished" Button.
  4. Click through that extra SureScripts screen.

Four clicks. The buttons are big and always in the same place. The tenth time you click them, you'll be like the gunfighter who is so fast folks will need slow motion video to see what you're doing.

...VERSUS NINE CLICKS, SMALL BUTTONS

Compare the above workflow with these actual instructions for a straight-forward request for approval of a refill on a non-EMR workflow system (the actual verbiage has been lightly edited to protect the highly un-usable):

  1. Click the renewal item
  2. Click "Append"
  3. Click "Click Here to Perform a Complete Update"
  4. Select the encounter type and click "OK" (A warning appears here that the prescriber must confirm that the medication listed does indeed appear on the patient's medication list. In an EMR workflow system the problem would have gone to the Error Handler role and be handled by someone else besides the pediatrician.)
  5. Click "OK"
  6. Click "Save" (A warning appears here that if you don't "save to chart" the pharmacy will get a new prescription instead of a refill approval. What's that about? We haven't a clue.)
  7. Click "Close"
  8. Click "End"
  9. Click "Sign"

Nine clicks! Heavens! (There's even an anecdotal report in a blog out there of an EMR that requires 25 clicks to renew a refill.) Plus it doesn't even do all the other stuff that a workflow engine executing a process definition can do for you: automatically printing someplace, automatically tasking someone to print it, checking later whether it got printed, got sent, got picked up, etc.

We've seen user manuals for traditional EMRs that run to hundreds of pages of chapters about workflow. These chapters tell a human user what to click, in what order, and in what circumstances in order to perform a variety of tasks, much like the immediately previous example. In contrast, if you look at chapters about workflow for a pediatric EMR workflow system, you will see that they are about editing workflow process definitions so that these tasks happen automatically after a user just clicks the button and “fires and forgets.”

When you look at a pediatric EMR and wonder whether or not it is a pediatric workflow system, ask yourself this question: Who or what is the workflow engine? If the answer is “who”, this is bad, because “who” is a person, a potentially expensive professional who should not be wasting their time searching for the right button to click. If the answer is “what”, this is good, because “what” is a much less expensive inanimate object, the computer. If the computer can accomplish non-value-added activities and help coordinate value-added activities, then workflow is likely being automated by a true pediatric EMR workflow system.

I hope we've made out point clear. We and the workflow system have taken care of the time consuming side of e-prescribing so you can concentrate on medicine.

WHAT KIND OF PRESCRIPTIONS CAN BE SENT ELECTRONICALLY?

New prescriptions and refills can be sent to participating pharmacies (76 percent of community pharmacies in 2008). However controlled substances still require a paper subscription. Controlled substances are currently not permitted to be filled electronically per DEA regulations.

WHO CAN USE E-PRESCRIBING?

The ordering provider must be a registered SureScripts user. The EncounterPRO EMR Workflow System determines the effective ordered-by provider using the following logic:

  • The last provider to order a refill will be the ordered-by provider.
  • If no refills have been ordered then the last provider to sign for the prescription will be the ordered-by provider.
  • If no one has signed for the prescription, then the provider who originally ordered the prescription will be the ordered-by provider.
  • In cases where a staff member is RX-certified, he or she can register as a SureScripts user and send prescriptions electronically.
  • In cases where the clinical staff is accustomed to ordering the refill and calling that into the pharmacy, either the provider will need to order the refill and the clinical staffer can send the prescription or the clinical staffer can 'scribe' for the provider and order the refill on behalf of the provider.

Providers and RX-certified users can register themselves from the EncounterPRO User Definition screen.

HOW DOES E-PRESCRIBING WORK IN EncounterPRO?

The provider orders a prescription medication from treatment screen. If this is the first time a prescription is ordered for this patient a screen allows the user (who does not need to be the provider) to select and to set the following information (subsequent prescriptions will rely on these defaults in order to effect the three-click example of workflow presented earlier.)

  • The user selects a preferred pharmacy from a list of SureScripts-enabled pharmacies.
  • The user selects SureScripts as the preferred route by which the prescription will be delivered to the preferred pharmacy.
  • The next time a new e-prescription is generated for this patient, the pharmacy and route to the pharmacy (SureScripts) rely on these default values.
  • When SureScripts has sent the prescription electronically, a status message is sent back to EncounterPRO and the document status is updated to confirmed.
  • If the transmission fails the ordering provider gets an error status message.

WHERE DO THE PHARMACIES COME FROM?

The EncounterPRO Health Information Exchange (EPHIE) downloads the list of SureScripts-enabled pharmacies nightly so that your practice has the most up-to-date list possible. The pharmacy list can be searched by name or one or more zip codes.

HOW ARE ELECTRONIC REFILL REQUESTS HANDLED?

To elaborate an earlier example, which focused on click-by-click workflow:

Pharmacies can send refill requests directly and securely to EncounterPRO without time consuming phone calls and faxes. EncounterPRO matches these requests with the right patient and initial prescription, and sends an authorization for a refill task to the ordering provider. Typically your practice will begin receiving refill requests electronically four to six weeks after you begin sending new prescriptions via the SureScripts Electronic Prescribing Network.

"Farm out" your e-prescribing workflow.

Children's artwork courtesy of A Child's Night Out.

Demo EncounterPRO Pediatric EMR Workflow System

TESTIMONIALS

"Waiting times have been dramatically reduced every step of the way—not just the waiting room time. Parents are happier because going to the doctor no longer takes two hours out of their already overcrowded schedule. I can see more kids per hour with an actual increase in preventive services like screenings and vaccines—thus improving healthcare and increasing revenue at the same time." Jeffrey D. Cooper MD Pediatrician EncounterPRO User Since 1995 (and HIMSS Davies Award Winner)

"It has allowed our physicians to increase the number of patients they see in a day...And it has given the physicians that were already high-volume the opportunity to spend a little more time with their patients and be more personable." Dee McGee, Pediatric Practice Manager EncounterPRO User Since 1995
"It's really helped my lifestyle. I'm working three and a half days a week, I used to work seven days a week. So it's really made life much easier, and the staff love it!" Armand Gonzalzles MD Pediatrician EncounterPRO User Since 1999 (and HIMSS Davies Award Winner)
"At a time when physicians are being squeezed by cost constraints of record proportions while trying to continue to provide quality care, it is absolutely imperative that you look for a system that delivers security, cost efficiencies, and unparalleled quality of care in a new way—EncounterPro is that system." John Ivan Sutter MD Pediatrician EncounterPRO User Since 2000
"One Monday in the winter we had only two of our five doctors in the office. Then my partner was stuck at the hospital and I was left by myself. At the end of a long day I had seen 79 patients! I wasn’t even frazzled." Karen Kamachi MD Pediatrician, EncounterPRO User Since 2000
"My office went live 2 days ago and it's unbelievable! For the first time in my nearly 15 years in pediatric practice I left my office with all my charts and notations completed for the day...Thank you so much for giving me a life again!" Angela D. Hunt MD Pediatrician EncounterPRO User Since 2001
"When I selected EncounterPRO, the biggest motivating factor was the concept of having an office screen that displays the necessary patient activities. This is similar to the ER board that many of us are familiar with that lists where each patient is and what procedure needs to be done next. In a procedure-oriented practice like ophthalmology, the efficiency from this tool is tremendous. The idea of telling staff what to do silently without disruption took me over the top. Features like this can eliminate the need for signaling lights or flags on exam room doors. The final big feature is workflow. Essentially, the program automatically sequences through your documentation depending upon the type of exam you have chosen." Phelgar Washington MD Ophthalmology EncounterPRO User Since 2001
"We have seen a dramatic impact in lower cost, higher quality and increased speed of healthcare services. Parent satisfaction has dramatically increased as a result of the improved quality and timesavings of our healthcare services." Charles Gregg Pediatric Office Manager EncounterPRO User Since 2002
"EncounterPRO has reduced the amount of time it takes to produce medical records. The system promotes more teamwork and greater staff efficiency." Linda Hall Office Coordinator Pediatrics EncounterPRO User Since 2002
"The EMR user interface is akin to the touch screen-oriented systems in restaurants: one screen at a time, with only the most relevant data displayed and options presented (although, of course, a user can always jump out of a particular screen sequence to accomplish an arbitrary task), and the sequences can be tweaked through the workflow management to make such occurrences infrequent...The workflow plans are tailored for each type of patient seen in the office (obstetrics, gynecologic, annual exams, family practice) assuring that key elements of the present illness, history and physical are addressed and documented. Work plans contain required laboratory tests for specific conditions, assuring that key tests are not forgotten." Jeffrey Harris MD Obstetrics Gynecology and Family Practice EncounterPRO User Since 2003 (and HIMSS Davies Award Winner)
"Benefits I have noticed personally included: decreased turnaround time for telephone messages, decreased turnaround time for prescription refills, decreased turnaround time for referrals, improved efficiency of office procedures such as immunizations and tests, decreased time spent at the end of the day returning phone calls, writing refills, and completing charts." William Long MD Pediatrician EncounterPRO User Since 2004
"Many pediatricians operate with narrow profit margins. Reducing costs, capturing charges correctly, and increasing the number of encounters can increase profit. If a pediatrician cannot chart a routine otitis media encounter from start to finish in 30 seconds, the EHR will slow him or her down and reduce profit. The EncounterPRO EHR’s workflow engine essentially pushes tasks to users as fast as they can accomplish them. However, pediatric offices accomplish tasks in many different orders, so the workflow definitions can be changed to accommodate a specific pediatric group preference." Michael Blum, DO, Pediatrician EncounterPRO User Since 2004
"EncounterPRO has made our workflow very smooth. We see 30-40 patients daily and we are almost always finished with all work by 4:30 in the afternoon. No need to stay late and file charts." Stephen Dentler MD Pediatrician EncounterPRO User Since 2004
"In the height of the physical season, from the minute the patient walks in the door for a kindergarten physical, gets all the preliminary screening test (vision, hearing OAE VEP), heights, weights, BP plotting, physical exam blood work and immunizations, we are getting folks out the door in under an hour and that is decreasing. This is unheard of." George Rogu MD Pediatrician, EncounterPRO User Since 2008
 
Quote of the Day:  
Recent Blog Post: ACM, Clinical Groupware, and Routine vs. Non-Routine Workflow in Pediatric Practice
EncounterPRO EMR Customer in the Spotlight: Cooper Pediatrics (Winner of the HIMSS Davies Award)
 
Blog

 

EncounterPRO Pediatric EMR WORKFLOW SYSTEM SITEMAP

Home

THE HIGH-USABILITY ENCOUNTERPRO PEDIATRIC EMR WORKFLOW SYSTEM
WHAT KIND OF EMR WOULD A PEDIATRICIAN, JET PILOT, AND COMPUTER SCIENTIST DESIGN?
HOW TO CHART A PEDIATRIC ENCOUNTER IN 37 SECONDS (VIDEO)
INTEGRATED OR BEST-OF-BREED EMR/PMS APPROACHES
HIE / INTERFACES: LABS, REGISTRIES, DEVICES, PMSs
DIRECT INTERFACE TO SURESCRIPTS ELECTRONIC PRESCRIBING NETWORK
FAMILY MEDICINE, OB/GYN, AND OTHER SPECIALTIES
EncounterPRO PEDIATRIC EMR ROLLOUT & GO-LIVE SYSTEM ("LIVE IN FIVE!")
WHY TRADITIONAL EMRS ARE INADEQUATE AND A FUNDAMENTALLY NEW DESIGN IS REQUIRED
"WHY DO YOUR SCREENS LOOK SO DIFFERENT?"
USABLE WORKFLOW: NATURAL, CONSISTENT, RELEVANT, SUPPORTIVE, AND FLEXIBLE
MORE NATIONAL AWARDS THAN ANY OTHER PEDIATRIC EMR
OUR MANAGEMENT TEAM (And a Short Editorial)

Pediatric EMR

PEDIATRIC-SPECIFIC FEATURES OF THE ENCOUNTERPRO EMR WORKFLOW SYSTEM
TOP TEN REASONS PEDIATRICIANS CHOOSE ENCOUNTERPRO
PEDIATRIC-SPECIFIC FEATURES

Other Specialties

IDEAL FOR ANY HIGH-VOLUME, LOW-MARGIN AMBULATORY MEDICAL SPECIALTY
ENCOUNTERPRO FAMILY MEDICINE EMR WORKFLOW SYSTEM
ENCOUNTERPRO OBSTETRICS & GYNECOLOGY EMR WORKFLOW SYSTEM
ENCOUNTERPRO "YOUR SPECIALTY" EMR WORKFLOW SYSTEM

Usability

PEDIATRIC EMR USABILITY
TRADITIONAL EMRS VERSUS EMR WORKFLOW SYSTEMS
THE PRINCIPLE OF NATURAL WORKFLOW
THE PRINCIPLE OF CONSISTENT WORKFLOW
THE PRINCIPLE OF RELEVANT WORKFLOW
THE PRINCIPLE OF SUPPORTIVE WORKFLOW
THE PRINCIPLE OF FLEXIBLE WORKFLOW
THE IDEAL PEDIATRIC EMR (WORKFLOW SYSTEM)

Workflow

THIS IS YOUR EMR, THIS IS YOUR EMR ON WORKFLOW
EMR WORKFLOW SYSTEMS 101
CAT, DOG, TREE!
EMR WORKFLOW SYSTEM GLOSSARY

Chart in 37 Seconds

HOW TO CHART A ROUTINE ENCOUNTER IN 37 SECOND (VIDEO)
SO LET'S CHART A PATIENT

EMR / PMS

INTEGRATED OR BEST-OF-BREED PRACTICE MANAGEMENT SYSTEM
EncounterPRO PEDIATRIC EMR + ENCOUNTERPRO PM
EncounterPRO PM SCHEDULING
EncounterPRO PM BILLING
EncounterPRO PM REPORTING
EncounterPRO PEDIATRIC EMR + YOUR PRACTICE MANAGEMENT SYSTEM

Your Rollout

THE EncounterPRO ROLLOUT & GO-LIVE "SYSTEM"
AN INDUSTRIAL ENGINEERING APPROACH TO YOUR EMR ROLLOUT & GO LIVE EXPERIENCE
THE EncounterPRO PEDIATRIC EMR IS DESIGNED TO BE USABLE
THE EncounterPRO PEDIATRIC EMR IS DESIGNED TO BE LEARNABLE
ADDENDUM: EncounterPRO's INDUSTRIAL ENGINEERING FOUNDATIONS

14 National Awards

FOURTEEN NATIONAL AWARDS (PLUS BEST IN GEORGIA)
HIMSS DAVIES AWARDS (2003, 2004, 2005)
MEDICAL RECORDS INSTITUTES AWARDS (TEPR)
MICROSOFT INDUSTRY SOLUTION AWARDS
MICROSOFT HEALTH USERS GROUP AWARDS
HEALTH MANAGEMENT TECHNOLOGY PLUS BEST IN GEORGIA AWARD

Blog (Takes a moment to load.)

WHY WE BLOG ABOUT EHR WORKFLOW MANAGEMENT SYSTEMS
RECENT BLOG POSTS

E-Prescribing

WHY E-PRESCRIBING IS BETTER ON AN EMR WORKFLOW SYSTEM
WHO IS THE E-PRESCRIBING WORKFLOW ENGINE? YOU OR THE COMPUTER?
THREE CLICKS, LARGE BUTTONS...
...VERSUS NINE CLICKS, SMALL BUTTONS
WHAT KIND OF PRESCRIPTIONS CAN BE SENT ELECTRONICALLY?
WHO CAN USE E-PRESCRIBING?
HOW DOES E-PRESCRIBING WORK IN EncounterPRO?
WHERE DO THE PHARMACIES COME FROM?
HOW ARE ELECTRONIC REFILL REQUESTS HANDLED?

HIE / Interfaces

EncounterPRO HEALTH INFORMATION EXCHANGE (EPHIE)
WHAT IS EncounterPRO's CONNECT, COMMUNICATE, AND COORDINATE VISION?
ELECTRONIC LAB RESULT MANAGEMENT WORKFLOW
STATE IMMUNIZATION REGISTRY WORKFLOW
WHAT DO THE NEXT FIVE YEARS HOLD?: THE EHR NETWORK EFFECT
SuresScripts E-PRESCRIBING WORKFLOW
PRACTICE MANAGEMENT WORKFLOW
MEDICAL DEVICES

Screenshots

"WHY DO YOUR SCREENS LOOK SO DIFFERENT?"
EncounterPRO VIDEOS AND SCREENSHOTS
OFFICE VIEW, VITALS, CHIEF COMPLAINT, CURRENT MEDICATIONS, ALLERGIES,
ENCOUNTER SCREEN, PHYSICAL EXAM, ASSESSMENTS, TREATMENTS,
PRESCRIPTIONS, BILLING APPROVAL, WORKPLAN (PROCESS DEFINITION) EDITOR

Management

OUR MANAGEMENT TEAM RESUME
GREGORY D. VACCA, CEO & PRESIDENT
FRANK MARTIN, COO
MARK COPENHAVER, CTO
CHARLES WEBSTER, MD, MSIE, MSIS, CMIO
KATHLEEN ST. JOHN, JD, GENERAL COUNSEL
BETH PATE COPENHAVER, DEAN, EncounterPRO UNIVERSITY

Contact Info

 
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EncounterPRO Healthcare Resources
2000 RiverEdge Parkway
Suite GL 100A
Atlanta, GA 30328
(800) 677-5653

www.encounterPRO.com
info@encounterPRO.com

EncounterPRO Healthcare Resources is a wholly owned subsidiary
of WifiMed Holdings Company, Inc. (OTCBB: WIFM)


The High-Usability EncounterPRO Pediatric EMR Workflow System Website
" Clinical Groupware for Pediatric Practice"
Under the Creative Commons Attribution 3.0 License
© 2009 EncounterPRO Healthcare Resources, Inc.

Use of EMR workflow systems, EMR groupware, clinical groupware, EHR workflow management systems, and EMR/EHR business process management frameworks and technologies will be key to transforming healthcare at the industry, organizational, and professional and personal levels. Subject to the Creative Commons Attribution 3.0 License, feel free to use content from this website and associated blog in educational curricula, industry presentations, websites, blogs, and social media.

Please attribute EncounterPRO Healthcare Resources, Inc. as the creator of this work. Please indicate the title of the Work: The High-Usability EncounterPRO Pediatric EMR Workflow System. Please include this URL for the Work: www.encounterPRO.com.

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