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EncounterPRO Pediatric EMR Workflow System



Pediatric EMR Chart in 37 Seconds
Pediatric EMR

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WORKFLOW MANAGEMENT: MODELS, METHODS, AND SYSTEMS

THIS IS YOUR EMR,
THIS IS YOUR EMR ON WORKFLOW

The best and most authoritative explanation of workflow management systems ideas and technologies is Wil van der Aalst and Kees van Hee's Workflow Management: Models, Methods, and Systems (MIT Press, 2002).

You don't need to be a workflow expert to benefit from the EncounterPRO Pediatric EMR Workflow System (just as you don't have to be an automotive engineer to drive a car). However, if you are so interested, here is a quick cheat sheet about workflow management concepts and terminology.

The three most important workflow ideas that EncounterPRO Pediatric Workflow System implements are:

  • A workflow engine saves you and your staff time and effort by executing process definitions.
  • Process definitions ("workplans" in EncounterPRO) are customizable sequences of screens with large buttons that mirror sets of task steps. Different encounter types (well versus sick versus newborn versus vaccination), roles and users (physicians versus nurses, Dr. Smith versus Dr. Jones, orders (developmental testing versus education), and data (such as doing something automatically with a scanned in document).
  • A "radar view" (called Office View in EncounterPRO) allows all staff members to see whose tasks for which patients have been waiting for how long and in what exam room (like a view from an airport control tower, except patients instead of planes). EncounterPRO's Office View is an important (though not only) part of EncounterPRO's clinical groupware functionality. It helps users to see what each other are doing (and not doing), moment by moment, to facilitate teamwork and care coordination.

The EncounterPRO Pediatric EMR Workflow System is based on mature, robust technology (workflow management, groupware, and business process management systems) that is prevalent in many other industries, but which has not yet become widespread in healthcare. If you'd like more information please visit our blog at Electronic Health Record Workflow Management Systems.

 

EMR WORKFLOW SYSTEMS 101

The combination of EHR and EMR workflow management, workflow systems, clinical groupware, and business process management (BPM) is such a BHAI (Big Hairy Audacious Idea) that it is sometimes difficult to separate the extraneous from the essential. As a marketing consultant put it: "Cat, Dog, Tree!" To which we replied, what do you mean? To which she replied "Cat, Dog, Tree!" All very Zen... but we think we got it. What is the absolute minimum number of ideas that we can present that only go together in one way (a dog chasing a cat up the tree) and thereby illustrate the difference between a traditional "hunt-and-peck" EMR and the "anticipatory" EncounterPRO EMR Workflow System. This is what we came up with:

CAT, DOG, TREE!

The EncounterPRO EHR Workflow Management System includes a large number of optional data review and entry and order entry tasks. For example, Figure 1 shows the Chief Complaint screen.

chief complaint

Figure 1: Typical EncounterPRO Pediatric Workflow System Screen
(Chief Complaint)

A subset of these tasks is selected to create a workflow process definition, or “workplan” in EncounterPRO speak. In this example (Figure 2) the workplan is a pediatric workplan for “Standard Encounter Child Well Visit New Patient.” The Chief Complaint screen occurs as the third step in this workplan. A collection of pediatric-specific workplans configures an EncounterPRO Pediatric EMR Workflow System.

process definition

Figure 2: A Process Definition (”Workplan”) Controls
Presentation of Screens to Users

During workplan execution the Chief Complaint task time is automatically and continually updated in the Office View (Figure 3). It can be seen as the pick item in the upper left. It has been languishing (in this demo situation) for 29 minutes. Touching the task bar brings up the Chief Complaint screen in order to complete it (back to Figure 1).

office view

Figure 3: EncounterPRO Pediatric EMR Workflow System Office View

By automatically pushing the pediatric task screens to the right users (on their To-Do lists) and by indicating their status in real time on the office view where all staff can see them, tasks are accomplished quickly and the occasional ignored task is ignored only briefly. EMR workflow systems are clinical groupware. However, there are two kinds of clinical groupware. There is the workflow-engine variety (pushes clinical tasks to users and tracks their status) and there is the keep-all-the-users-aware-of-the-status-of-all-relevant-clinical-tasks-all-the-time variety (using shared displays such as radar views). The EncounterPRO Pediatric EMR combines both kinds of clinical groupware--to achieve levels of usability and productivity that traditional EMRs cannot. Because they are not clinical groupware.

By the way, notice that these screenshot have been reduced to about 380 by 540 pixels, and they're still readable! That's because just a few big buttons on each screen (made possible by spreading the buttons across screens) is so much more easily and accurately "hit" in quick succession than traditional "hunt-and-peck" EMR user interfaces.

If we've whet your appetite (in keeping with the Cat, Dog, Tree metaphor) here's some more to chew on.

EMR WORKFLOW SYSTEM GLOSSARY

Phrase Definition Medical Example
Work item Task to perform Vitals signs awaiting performance during a patient encounter
Workflow Definition Description of a process detailed enough to drive
EMR behavior
Get the Patient, Take Vitals and a Chief Complaint, Review Allergies, Review Medications, Review of Systems, Examination Screen, Evaluation and Management, Billing Approval
Worklist List of tasks to perform A nurse's To-Do list
Case   A particular patient's encounter managed by a workflow management system
Process Order of tasks to be performed and resource
requirements
A Well Child pediatric visit
Resource Something that
accomplishes tasks (usually a user)
A physician, nurse, technician
Role Set of related skills accomplished by a resource The role of nurse or physician
Routing Types of routing include sequential, parallel, conditional, or iterative task execution
Routing a recording to a transcriptionist and the report back to the physician
Task Unit of work carried out by a resource Obtain vital signs
Trigger An event that changes a work item into an activity Starting to accomplish the task of responding to a phone message by selecting a To-Do list item
Workflow A process and its cases, resources, and triggers The tasks and people involved in accomplishing a patient encounter
Workflow Definition Editor User application or interface for creating workflow definitions An ordered picklist representing Get the Patient, Take Vitals and a Chief Complaint, Review Allergies, Review Medications, Review of Systems, Examination Screen, Evaluation and Management, Billing Approval
Activity Performance of a task Obtain vital signs within a patient encounter


Artwork Courtesy of A Child's Night Out
(Cat? Dog? Cat-Dog? Dog-Rabbit?)

Pediatric EMR Demo

 
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)
"The payroll savings and increase in collections repaid our total investment in 18 months." Allen R. Carter Jr., Business Manager, Family Medicine EncounterPRO User Since 2000
"We have seen incredible results as to the increase in patient volume we can handle." Patricia Hernandez, Clinic Administrator, OB/GYN Practice EncounterPRO User Since 2000
"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
 
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)
 
Usability

 

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

 
Usability
 

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.

Additional Instruction

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