WORKFLOWFORAPRIMARYCARECLINICWITHAPAPERMEDICALRECORDThetypicalworkflow

forapatientvisitatthisprimarycareclinicbeginswiththepatientintakeportionwhichincludestherequest

forappointment,patientregistration,historytakingandbeginningtheclinicalexam.Thepatientcontactsthe

clinicforanappointmentviaphonecallorinpersonforawalkinappointment,takenasavailable.Inboth

instances,thereceptionistcollectsdemographicdatafromthepatient,includingdateofbirth,age,address,

socialsecuritynumber,emergencycontactsandinsuranceproviderinformation.Thisinformationisentered

intothedemographicandinsurancecomponentoftheclinicselectronicregistrationsystem.Newpatients

arescheduledforafortyfiveminuteappointmentandreceiveauniquepatientidentificationnumber(ptID).

Thisnumberremainsthesameforthelifeofthepatientattheclinic.Areturningpatientsinformationis

retrieved,includingtheptID,andisscheduledforatwentyminuteappointment.Afterthepatientis

scheduledandregistrationiscomplete,anewpaperchartisdevelopedbythefileclerkandtheregistration

informationisprintedandplacedinthechart.Ifthepatientisareturningpatientthefileclerkpullsthe

existingpaperrecordfromthefileroom,updatesthedemographicinformationandthenplacesthechartin

thependingchartsbin.Thedaybeforethepatientarrivesfortheirappointment,thefileclerkplacesthe

paperchartatthefrontdesksothatitisavailablewhenthepatientarrivesfortheirappointment.Uponthe

patientsarrival,thereceptionistqueriesthepatientssocialsecuritynumberandverifiesthepatients

identitywiththeirlastandfirstname.Demographicinformationisvalidatedorupdatedintheregistration

system.Thepatientthenreceivesapaperencounterform,requestinginformationonpastmedicalhistory,

currenthealthconcernsandreasonsforvisit,tobecompletedwhilewaitingtobeplacedinanexamroom.

Inthemeantime,thenurseisalertedthatthepatienthasarrivedandwhenavailable,roomsthepatientinan

examroomintheclinic.Thesecondportionoftheworkflowincludes:thephysiciansphysicalexam,patient

laboratory,radiologicandothertesting,andpatientdischarge.Oncethepatientisintheexamroom,the

nursereviewsthecompletedencounterform,obtainsthepatientsvitalsignsandentersthepatientschief

complaintandotherrelevantdataintothepaperrecord.Afterthenursecompletesthesetasks,the

physicianbeginshisencounterwiththepatientandcompletestheexam.Thephysiciandocumentsthe

examandwritesorders,includingmedications,lab,radiologyandreferralsinthechartaftertheencounteris

completed.Ifthephysicianwritesanorderformedication,sheprovidesawrittenprescriptiontothepatient

beforetheyleavetheexamroom.Thephysicianthenflagsthechart(toindicatethatthecharthasorders)

andthenreturnsittothenurse.Uponcompletionofthevisitthepatientstopsattheclinicfrontdeskand

schedulesanyreturnvisit.Thenursethenexecutestheorders(facilitatesschedulingoflab,radiology,

medicationprescriptionsandsoforth).Whenlabandradiologyresultsareready,theyareprintedtothe

clinicsprinterandthenursethenplacestheprintedresultsintothechart.Patientsarecalledwithany

abnormallabandradiologyresultsorsentaletterstatingresultsarewithinnormallimits.Whenpatients

needprescriptionsrefilled,theycontactthereceptionistwhothenplacesahandwrittennoteatthenurses

stationintheclinic.Thenursethenplacesthenoteinthepatientschartandplacesitinabinforthe

physiciantoreviewattheendoftheday.Oncethephysicianwritestherefillprescription,sheplacesthe

chartinthebinandthenursecontactsboththepharmacyandpatient.