Reviewing the processes of tracking patient care and workflow and Comparison of Paper

Chart Environment with Electronic Chart Environment

Comparison of Paper Chart Environment with Electronic Chart Environment

Paper Chart Environment
Scheduling an Appointment: The
patient calls the medical offi ce to
schedule an appointment.
Preparing Charts and Verifying
Insurance Coverage: At the medical
clinic, paper charts are located and
pulled the night before and organized by
provider and appointment time slots. A
staff member calls the insurance
company of each patient and verifi es
insurance eligibility over the phone.
Checking in the Patient: The patient
arrives at the medical offi ce and
verifi es personal demographics and
insurance information.

Verifying Patients Identifi cation: For

new patients, photocopies of the
patients ID and insurance card are
made and placed in the paper chart.
Collecting Patient Healthcare
Information: A clipboard with forms to
complete is given to the patient so that
personal healthcare history, family
medical history, problem list, and
routine medications can be updated
and documented.
Signing Offi cial Forms: New patients
sign a privacy notice and medical

Electronic Chart Environment

Patient Setup
Patient Setup
The patient accesses the Internet from home
and logs on to the clinics website. The patient
enters a patient portal and requests an
appointment date on the online calendar.
No charts need to be located, pulled, or
organized. Electronic charts are available
immediately in the EHR. The night prior to the
appointment, the medical offi ce computer
automatically interfaces with insurance
companies across the country to verify
eligibility for patients scheduled the following
day. An eligibility report is available the
following day.
An existing patient verifi es and updates
personal demographics and insurance
information via the patient portal on the clinics
website prior to arriving for an appointment.
Front-offi ce personnel check the
patient in on the electronic schedule upon
arrival and enter the patients name into a
patient tracking module.
A digital photo is taken of the patient using a
digital camera or webcam and stored in the
EHR. The patients insurance card is placed in
a device that scans both sides of the card and
stores the image in the patients chart.
A new patient is escorted to a private area of
the waiting room and instructed how to use the
patient kiosk, a computer on which the patient
will complete an electronic-guided
questionnaire regarding personal and family
healthcare history, problem list, routine
medications, and so on.
Patient signs his or her digital signature on an
electronic pad after reading the privacy notice

release authorization. All forms are

placed in the paper chart.

and medical release authorization. The digital

signature is stored in the patients EHR.
Initial Clinical Encounter
Recording Vital Signs and Chief
Front-offi ce personnel change patient status to
Complaint: When front-offi ce personnel
ready in the patient tracking program. A
communicate that the patient is ready
clinical staff member observes this change on
and a clinical staff member calls the
the computer, calls the patient, and escorts him
patient from the waiting room, the
or her to the nurse station. The patients chief
patients chief complaint and vital signs
complaint and vital signs are transmitted
are recorded and placed in the front of
wirelessly from the measuring devices directly
the paper chart. The patient is escorted
into the patients EHR. Body mass index is
to an open exam room.
calculated automatically. The patient is escorted
to an open exam room.
Reviewing Patients Healthcare
A clinician reviews the patients healthcare
Information: A clinician reviews the
information, which was entered by the patient
patients completed healthcare
at the kiosk in the waiting room or via the
questionnaire and makes additional
electronic patient portal on the clinics website.
handwritten notations based on input
Modifi cations can be keyed in by the clinician
from the patient.
based on input from the patient.
Checking Status of Wellness
The clinician clicks a button in the EHR to
Screenings: The patient is asked if he/
conduct a chart evaluation. A window is
she is up-to-date on screening tests
displayed immediately, indicating whether the
and other procedures. The clinician
patient is behind in specific wellness
fl ips through the patients chart looking
screenings. The clinician talks with the
for diagnoses and other indicators that
patient about when and how to take care of
may help fl ag the need for any
necessary screenings and indicates the patients
wellness screenings or tests.
response in the electronic chart note.
Readying Patient for Physician
The clinician updates the patient tracking
Examination: The paper chart is
module on the computer to indicate the patient
typically placed outside the exam room
is now ready for the physician.
in a wall mount.
PatientPhysician Encounter
Reviewing Clinicians Notes: The
The physician opens the electronic chart and
physician enters the exam room, greets
reads the clinicians notes, including chief
the patient, and then reads the
complaint and vital signs, on a workstation
clinicians notes in the patients chart.
computer before entering the exam room.
Documenting Physical Examination:
The physician reviews the patients body
The physician reviews the patients
systems with the patient, conducts a physical
body systems with the patient, conducts
exam, and documents the completed evaluation
a physical exam, and documents all
and plan in the EHR using templates and pick
fi ndings on a paper chart note.
lists.
Ordering In-House Tests: If tests or
If tests or procedures that can be performed in
procedures that can be performed in
the offi ce are required, the physician selects
the offi ce are required, the physician
the test(s) in the electronic chart and signals the
will document the order for the
assistance of a clinician via the electronic
required test or procedure in the chart
patient tracker. The clinical staff member

note and assign a clinician to perform

the test. The clinical staff member
performs the test, records the test
results, and places the documentation
in the front of the paper chart.
Processing Prescriptions: If a
prescription is required, the physician
notes this on the offi ce visit report,
handwrites the prescription on a
prescription pad, and gives it to the
patient. Medical offi ce staff may also
call the prescription in to the patients
pharmacy of choice.

performs the test, records the results in a

pending test area of the EHR, and then
transmits the results into the offi ce visit note
for the physicians viewing.

If a prescription is required, the physician

selects the medication from the drug database
within the electronic chart. The medication(s) is
transmitted to a national clearinghouse, where
drug and allergy checking is conducted. The
physician is alerted to any contraindications or
drug interactions. An
electronic comparison is also automatically
made with the patients insurance company to
ensure coverage. The prescription is then
transmitted to the patients pharmacy of choice.
Completing Physicians Note: The
The physician creates the offi ce visit note in
physician completes the examination
real time with the patient using templates and
report, usually from memory, and may
text selected in the electronic chart. The
dictate the examination, assessment,
physician electronically signs the encounter
and plan in a private area after the
note, which locks the report so modifi cations
encounter. The transcription of the report
cannot be made. Addenda can be added at a
may take several days to complete. It is
later time if necessary. When the patient leaves
then returned to the clinic, where it is
the exam room, the physician has completed
proofread, signed by the physician, and
the electronic examination report. No
fi led into the patients chart.
transcription services are needed.
Patient Referral Documentation
Ordering Outside Tests: Order forms
Diagnostic tests and procedures that need to be
are completed for diagnostic tests and
conducted at other facilities are selected from a
procedures that need to be conducted
database within the electronic offi ce visit note.
at other facilities. A copy is given to
Physician orders are created for these tests and
the patient, a copy is placed in the
automatically populated with the clinics
paper chart, and clerical staff may call
information, patient demographics, procedure
the testing facility on behalf of the
and diagnosis codes, insurance information,
patient to schedule the test.
and other appropriate data. The physicians
order is printed out and given to the patient.
Clerical staff may call the testing facility on
behalf of the patient to schedule the test or
transmit information electronically via the
EHR.
Patient Checkout
Completing the Superbill: The
When the physician closes the electronic offi ce
physician notes the diagnosis(es),
visit note, a superbill/routing slip window is
procedures, tests, and other billable
displayed, which automatically captures all
items on the paper superbill/routing
billable items from the offi ce visit note, along
slip; selects the evaluation and
with the appropriate procedure and diagnosis

management code; and notates the

time for a follow-up visit.

Distributing Patient Education

Material: The patient is escorted to the
checkout desk, where a staff member
provides the patient with educational
material and medication instructions,
as necessary.
Checking Out the Patient: The
clinician carries the routing slip and
paper chart to the checkout desk. The
superbill/routing slip is used to
determine the patient charges for the
encounter. The checkout receptionist
manually searches through the
schedule book to locate open time
slots for the patients return visit.
Entering Billing Data: The paper chart
is fi led, and the routing slip is passed
to the billing clerk for insurance and/or
patient billing. The billing clerk enters
the charges and other necessary data
into the billing program.

codes. The physician selects the evaluation and

management code recommended by the EHR
program. The electronic superbill is transmitted
to the practice management software for
billing.
During the physicians examination, the
selection of a diagnosis in the electronic chart
triggers the display of patient education
material. The physician can select the
appropriate education material on-screen and
print it to the checkout desk printer to be
collected later.
A staff member at the checkout desk opens the
electronic encounter in the EHR and views the
charges for the days visit, which have been
automatically calculated. An electronic note
sent from the physician is displayed on the
checkout desk computer screen, indicating the
time necessary for a follow-up visit.

The billing clerk receives the billable charges

from the electronic encounter in the practice
management system (PMS) portion of the EHR
program. The billing clerk is able to access any
necessary documents from the patients
electronic chart to send to the insurance
company, if necessary.
Patient Follow-up Care
Processing Lab and Medical Test
Results from the patients lab tests and other
Results: Results from the patients lab
medical tests and procedures are sent to the
tests and other medical tests and
clinic via a secure Internet interface. The
procedures are sent to the clinic by
electronic results are stored automatically in a
either fax or mail. The patients chart is
staging area of the EHR program, awaiting
pulled, the test results are fi led in the
review by the physician or another qualifi ed
chart, and the chart is sent to the
clinician and then electronically stored in the
physician or another qualifi ed clinician
patients chart.
for review.
Sending Healthcare Records to Other
Via the patient portal on the clinics website,
Physicians: The medical clinic receives
the patient requests that certain documents be
a request from a patient to send
sent to another physician or medical facility. A
records from his or her chart to
clinic staff member receives the request, opens
another physician or medical facility. A
the patients electronic chart, and checks the
clinic staff member retrieves the paper
selection box beside various items in the
chart, finds the appropriate healthcare
patients chart. An electronic letter autodocuments, photocopies the documents,
populates with the patients demographics, the

places the originals back into the

chart, refiles the chart, and mails or
faxes the documents to the medical
facility or gives the copied documents
to the patient.

clinics information, and a copy of the selected

items from the patients chart. The letter and
other documents are then transmitted
elctronically from the EHR program to the
waiting physician or medical facility.