EHR Requirements

Electronic
Health Record Requirements

for Public Health Agencies
PublicHealthInformaticsInstitute
Table of Contents
Overview......................................................................................................................................................................................1
Purpose........................................................................................................................................................................................1
AbouttheProject.........................................................................................................................................................................2
ExpertPanel.............................................................................................................................................................................2
Workgroups.................................................................................................................................................................................3
CaseManagement...................................................................................................................................................................3
ClinicalServices........................................................................................................................................................................4
BusinessProcessMatrices...........................................................................................................................................................6
Recruitment/Outreach............................................................................................................................................................7
Screening.................................................................................................................................................................................8
Intake.......................................................................................................................................................................................9
Assessment............................................................................................................................................................................10
CloseCase..............................................................................................................................................................................11
ReferClient............................................................................................................................................................................12
ProvideEducation..................................................................................................................................................................13
ProvideCounseling................................................................................................................................................................14
CoordinateCare.....................................................................................................................................................................15
PatientRegistration...............................................................................................................................................................16
ClinicVisit...............................................................................................................................................................................17
PatientFollowup...................................................................................................................................................................18
ProcessLabOrder..................................................................................................................................................................19
ReviewLabResults................................................................................................................................................................20
DirectlyObservedTherapy....................................................................................................................................................21
BusinessProcessTaskFlows......................................................................................................................................................22
BusinessProcessRequirements................................................................................................................................................41
BusinessProcess#1:Recruitment/Outreach.........................................................................................................................41
BusinessProcess#2:Screening/EligibilityDetermination.....................................................................................................42

BusinessProcess#3:Intake...................................................................................................................................................43
BusinessProcess#4:Assessment..........................................................................................................................................44
BusinessProcess#5:CloseCase............................................................................................................................................47
BusinessProcess#6:ReferClient..........................................................................................................................................49
BusinessProcess#7:ProvideEducation................................................................................................................................50
BusinessProcess#8:ProvideCounseling..............................................................................................................................51
BusinessProcess#9:CoordinateCare...................................................................................................................................52
BusinessProcess#10:PatientRegistration...........................................................................................................................53
BusinessProcess#11:ClinicVisit...........................................................................................................................................55
BusinessProcess#12:PatientFollowup...............................................................................................................................59
BusinessProcess#13:ProcessLabOrder..............................................................................................................................60
BusinessProcess#14:ReviewLabResults.............................................................................................................................62
GeneralSystemRequirements..................................................................................................................................................65
GeneralCharacteristics..........................................................................................................................................................65
DataCapture..........................................................................................................................................................................65
Integration.............................................................................................................................................................................65
Reporting...............................................................................................................................................................................66
Security/Privacy.....................................................................................................................................................................66
SystemAdministration...........................................................................................................................................................67
TechnicalDesign....................................................................................................................................................................67
SystemAccessandNavigation...............................................................................................................................................67
ReliabilityandRecovery.........................................................................................................................................................67
AppendixA:GlossaryofBusinessProcessTerms......................................................................................................................69

ElectronicHealthRecordRequirementsforPublicHealthAgencies
Overview
Publichealthagencieshavelongrecognizedtheneedtomoreeffectivelyintegrateandexchangedatawiththeir
communitypartners,andrecenthealthfederallegislativeinitiativeshavemadethisintegrationapriority.Thereis
astrongpushamongpublichealthpartners,suchascliniciansoffices,hospitals,etc.,toimplementElectronic
HealthRecord(EHR)systems,andmanypublichealthagenciesareinvestigatingwhethertheytooshouldmovein
thatdirectionasawaytosupportdataexchange.Oneissuethatmustbeconsidered,however,iswhetherEHRs
cansupportthewiderangeofservicesthatpublichealthagenciesdeliverbothinsideandoutsideofaclinical
setting.
TounderstandthefunctionalitypublichealthagenciesneedfromanEHR,thePublicHealthInformaticsInstitute
(theInstitute)initiatedtheElectronicHealthRecordsforPublicHealthAgenciesprojectinAprilof2011.The
projectwasdesignedtodevelopEHRrequirementsforpublichealthagencies,focusingprimarilyonpersoncentric
services.1
TheElectronicHealthRecordsforPublicHealthAgenciesprojectwasfundedthroughacooperativeagreement
betweenPublicHealthInformaticsInstitute(theInstitute)andCentersforDiseaseControl(CDC).TheInstitutealso
partneredwiththeNationalAssociationofCountyandCityHealthOfficials(NACCHO)andtheAssociationofState
andTerritorialHealthOfficials(ASTHO),whichallowedtheInstitutetogatherinsightfromthoseonthefrontlines
ofpublichealth,ensuringthatwillbereadilyusablebyorganizationsacrossjurisdictions.
Purpose
Thisdocumentprovidespublichealthagencieswithasetofinformationsystemrequirementsneededtosupport
electronichealthrecords(EHR)forcasemanagementandclinicalservices.TheseEHRrequirementsaredesigned
tobegeneral,givingpublichealthagenciesastartingpointforcreatingmorespecificonesbasedontheir
organizationsneeds.
Weencouragepublichealthagenciestoreviewthisdocumenttobetterunderstandhowtheserequirements
supportcasemanagementandclinicalservicesbusinessprocesses.Agenciesshouldthenidentifyvariances
betweentheirspecificoperationsandtheprocessesoutlinedhere.Thesevarianceswillprovidethebasisfor
customizingsystemrequirements,whichcanthenbeusedindiscussionswithvendors,aspartofaRequestfor
Proposal(RFP),orusedasatooltoperformamarketanalysisofavailablesystems.
ThedefinitionofpersoncentricserviceswasofferedintheElectronicHealthRecordsExpertPanelinanattempttodistinguish
betweenservicesanindividualreceivesfromapublichealthagency(eligibilitydetermination,clinical,socialorpreventativecare)
fromothertypesofpublichealthservicessuchasenvironmentalservices,communityneedsassessment,regulatoryservices,
etc.
1|P a g e

About the Project

TheElectronicHealthRecordsforPublicHealthAgenciesprojectwasbrokenintotwophases,theexpertpaneland
theworkgroups.Botharedefinedbelow.
ExpertPanel
Representativesfromstateandlocalpublichealthagencies,associations,andotherpartnerorganizationsmetin
Denver,ColoradoonApril2627tohelpdefinethescopeofthisproject.Theexpertpanelgeneratedalistof
targetedpersoncentricprocessesthatarespecifictostateandlocalhealthdepartmentsandprioritizedasubset
ofcasemanagementprocesses.Thepaneldeterminedthatbecauseclinicalserviceprocesseswerewell
documented,thefocusshouldfirstbeonthenonclinicalcasemanagementprocesses.Theexpertpanelalso
recommendedparticipantsforthesubsequentworkgroups.
ExpertPanelParticipants
DeborahAnderson
KayHenry
ChicagoDepartmentofPublicHealth
MississippiStateDepartmentofHealth
CentralOffice
MarcusCheatham
JimKirkwood
InghamCountyHealthDepartment,Lansing,
MI
eHealthASTHO
ValerieCochran
ShawnMessick
AlabamaDepartmentofPublicHealth
MultnomahCountyHealthDepartment
KathyCook
PhredPilkington
LincolnLancasterCountyHealthDepartment
PublicHealthAuthorityofCabarrusCounty
ShandyDearth
ValerieRogers
MarionCountyPublicHealthDepartment
NACCHO
SethFoldy
JoeSchreurs
PublicHealthInformaticsProgramOffice,
CDC
LarimerCounty(CO)Dept.ofHealthand
Environment
2|P a g e

RolandGamache
TorneySmith
SchoolofMedicineatIndianaUniversity
SpokaneCountyHealthDepartment
NedraGarrett
DianeThorson
InformaticsPractice,Policy&Coordination,
CDC
OtterTailCountyPublicHealth
Workgroups
Theworkgroupsphaseconsistedofthreemeetingswiththreeuniquesetsofparticipants.Thefirsttwoworkgroup
meetingsfocusedoncasemanagementandthelastfocusedonclinicalservices.
CaseManagement
ThefirstcasemanagementworkgroupmetonJune79,2011inAtlanta,Georgiaandfocusedondefiningand
redesigningprocessesaroundcasemanagement.Participantsoutlinedseveralcasemanagementprocessesand
documentedtheobjectives,triggers,businessrules,inputs,outputs,andoutcomes.
Usingtheprocessesdefinedinthefirstworkgroupmeeting,participantsinthesecondworkgroupmeeting,which
washeldJuly2628,2011inChicago,Illinois,developedrequirementstosupporttheoutlinedprocesses.Foreach
task,theworkgroupdevelopedandvettedalistofrequirements.
CaseManagementWorkgroupI:Atlanta,June7 9,2011
JohnAbellera
KimMeyerLee
CentersforDiseaseControlandPrevention
LarimerCounty
MikeAllen
CindyMurphy
InghamCountyHealthDepartment
AlvinAnderson
SusanneMurray
CentersforDiseaseControlandPrevention
LarimerCounty
LisaChambers
LariPeterson
StateofOregon
MichaelColetta
TaiyanRichmond
NACCHO
3|P a g e

KathyCook
MargyRobinson
LincolnLancasterCountyHealthDepartment
TracyLockard
LindaWestby
CabarrusHealthAlliance
RyanMcGhee
CaseManagementWorkgroupII:Chicago,July26 28,2011
LisaChambers
LariPeterson
StateofOregon
MichaelColetta
TaiyanRichmond
NACCHO
RyanMcGhee
MargyRobinson
CindyMurphy
LindaWestby
ClinicalServices
OnNovember1416,theclinicalservicesworkgroupmetinAtlanta,GAtovetasetofstrawmanbusiness
processthatsupportclinicalandlabservicesandtodevelopasetofsystemrequirementstosupportthem.The
workaroundtheseprocessesservedtocompletetheprocessesidentifiedbytheexpertpanelandfinalizeduser
requirementsforelectronichealthrecordsforpublichealthagencies.
ClinicalServicesWorkgroup
DeborahAnderson
JanetKyle
CityofChicago
HamiltonCounty(TN)
4|P a g e

MichaelColetta
AngelaMay
NACCHO
JeffersonCountyDepartmentofHealth
MichaelCrulcich
SeemaSewell
ChicagoDepartmentofPublicHealth
MaricopaCountyDepartmentofPublic
Health(AZ)
MelanieHenricks
SuzanneSmith
HamiltonCounty(TN)
OrangeCountyHealthDepartment(FL)
KarenHerrington
DebbieThompson
MississippiStateDepartmentofHealth
AlabamaDepartmentofPublicHealth,
TallapoosaCo.
SheilaIsbell
DanielVittum
GeorgiaTechResearchInstitute
CityofChicago
KimberlyJasken
MaricopaCountyDepartmentofPublic
Health(AZ)
5|P a g e

Business Process Matrices

ThebusinessprocessesaddressedaspartoftheElectronicHealthRecordsforPublicHealthAgenciesproject2
serveasastartingpointforpublichealthagenciestoevaluatetheirowninternalprocesses.Usingthedetail
providedhereandinthenextsection,publichealthagenciesshouldcomparethetaskflows,inputsandoutputs,
andbusinessrulesinordertoidentifyvariancesbetweentheoutlinedprocessesandhowthesesameservicesare
deliveredintheirownorganization.Foraddedormodifiedtasks,agenciesshoulddetermineiftheyneed
additionalrequirementstosupportthechanges.Ifthetasksdontcurrentlyexist,theagencyshouldconfirmthat
theassociatedrequirementsarenotneedbytheirorganization.
Oncethisprocessiscompleted,theagencywillhaveproducedasetofrequirementsspecifictotheirorganization
thatcanthenbeeasilyincorporatedintoaRequestforProposal(RFP)orusedasatooltoperformamarket
analysisofavailablesystems.Thesecustomizedrequirementswillprovidepublichealthagencieswithabasisto
evaluateorganizationalfitofcommercialofftheshelfEHRsystemsorassistindevelopingcustomsystems.Asa
result,publichealthagenciesandtheirpartnerswillbebetterequippedtomakeinformedbuyorbuilddecisions
abouttheirinformationsystemsandensurethesystemsinteroperabilityandconformancewithnational
standards.
TheProvideTreatmentprocess,originallydocumentedduringtheCaseManagementworkgroups,wasconsolidatedunder
theClinicVisit,Intake,andReferClientprocesses.Taskdetailsandassociatedrequirementswereincorporatedintothe
appropriatetaskstosupportgreatercontinuityinworkgroupdeliverables.
6|P a g e

DevelopmentofUserRequirements:ElectronicHealthRecordsforPublicHealthAgencies
Recruitment/Outreach
OBJECTIVES
Toincrease
awarenessof
programsand
servicesand
increase
referralsand
reports
BUSINESS
RULES
Program
criteria
Reporting
rules/statutes
Jurisdictional
oragency
protocols
Funder
requirements
(Grants,
Medicaid,
Medicare,
Insurance)
TRIGGER
Variationin
referrals
Outreach
maintenance
TASKSET
INPUTS
1. Variationin
Dataonreferral
Referrals/
patterns
Reports
2. AnalyzeIssue/
Information
3. Referral/
Recruitment
Needed?
4. Develop
RecruitingPlan
5. ImplementPlan
OUTPUTS
Recruitingplan
Imple
mentat
ion
plan
MEASURA
BLE
OUTCOM
ES
Increasein
referrals/report
sfrom
appropriate
sources
7|P a g e

Screening
OBJECTIVES
BUSINESSRULES
Identifyclients
HIPAA/other
withspecific
privacyand
needs,diseases,
confidentially
and/or
regulations
conditions
Reporting
Connect
standardsand
individualsto
requirements
appropriatecare Serviceprovision
throughtargeted
rules/program
interventions
criteria
TRIGGER
Testresults
Community
incident
Referral
Communityrisk
(specific
population)
TASKSET
1. IdentifyAtRisk
Individual(s)
2. Conduct
Screening
3. MeetCriteria?
4. ReferClient
5. Resources
Availablefor
Case
Management?
6. AcceptCase
Management?
7. InitiateIntake
INPUT
Testresults
Referral
Contacts(STI,
outbreaks)
OUTPUTS
MEASURABLE
OUTCOMES
Education/linkto Case
othercommunity
management
resources
processinitiated
Referral
Clientsare
connectedto
mostappropriate
interventions
Increasein
education/under
standingbyclient
8|P a g e

Intake
OBJECTIVES
Case
determination
andassignment
BUSINESSRULES
TRIGGER
Receivereport
Program
protocols
Receivereferral
Reporting
rules/statutes
Jurisdiction/
agencyprotocols
Funder
requirements
(e.g.,grants,
Medicaid,
Medicare,
insurance)
TASKSET
INPUTS
OUTPUTS
1. Receive
Referralor
Caseassignment
Referral/Report
reportincluding
ordisposition
/CaseFinding
name,reasonfor Caserecord
2. ExistingClient?
referral,contact
initiated
3. CompleteInitial
information,
Documentation
referralsource,
4. Update/
date
Combine
Record
5. Eligible/
Resources
Available?
6. ReferClient
7. AssignCase
MEASURABLE
OUTCOMES
Assignmentor
dispositionof
100%ofreferrals
orreports
accordingto
protocol
100%ofcase
outcomes
documented
9|P a g e

Assessment
OBJECTIVES
Gather
informationto
determineclient
needs/strengths
andeligibilityfor
specificservices
Developa
patientcareplan
BUSINESSRULES
HIPAA
Mandated
reporting
Program
eligibility
Consentand
releaseof
Information
TRIGGER
Screening
outcome
TASKSET
1. Case Assigned
2. ContactClient
3. Client
Reached?
4. CloseCase
5. Schedule
Appointment
6. Encounter/Visit
7. Enrollin
Program?
8. Provide
Education
9. SignConsent
Forms
10. CollectData
11. DevelopGoals
12. DevelopCare
Plan
13. AcceptPlan
14. Document
Impressions/
Notes
INPUTS
Screening
Client
information
Labresults
Agencyor
partner
information
OUTPUTS
Identifystaff
timeforprogram
planning
Connectreferrals
notenrolledin
agencyservices
toresources
Careplan
Counseling
Education
Patientdatafor
reporting/
analysis
MEASURABLE
OUTCOMES
Identificationof
clientneeds
Client
involvementin
settinggoals
Careplanis
created
Clientagreement
Connectingclient
tothemost
appropriate
services
Receivepayment
forassessment(s)
Incidenceof
casesforatime
periodand
jurisdiction
10|P a g e

CloseCase
OBJECTIVES
Toclosecase
BUSINESSRULES
TRIGGER
Programor
Clientdecision
jurisdictional
Metclient
requirements
objectivesfor
Clientlegalissues
case
management
HIPAA
Elapsedtime(by
rule)
Lackofresources
Administrative
decision
TASKSET
INPUTS
1. ReviewCarePlan CarePlan
2. CloseCase
Clientstatus/
3. Continue/Revise
circumstances
CarePlan
Administrative
4. Develop
reports
TransitionPlan
5. CreateClosing
Summary
6. SignOff
7. UpdateStatus
8. NotifyReferring
Agency/Partners
9. CreateCase
ClosureLetter
OUTPUTS
MEASURABLE
OUTCOMES
Updatedstaff
caseload
Closing
summary/client
chart
Letter
Durationofcase
andnumberof
contacts
Percentofclients
inwhichprogram
criteriaaremet
Dispositionof
casedocumented
Programcapacity
Program
utilization
Improvementor
clientchanges
11|P a g e

ReferClient
OBJECTIVES
BUSINESSRULES
Accessservices
HIPAA
fortheclient
Programor
Developand
jurisdictional
maintain
requirements
relationshipwith
referralsources
TRIGGER
Clientrequests
referral
Providerassess
needforreferral
Servicesneeded
arenotavailable
withinthe
agency
TASKSET
1. Inquire
Available
Services
2. Provide
Information
3. OfferAvailable
Services
4. Accept/
Interest?
5. UpdateRecord
6. Generate
Referral
7. Provide
Services
8. Followup
INPUTS
Documentation
ofreferralneed
OUTPUTS
MEASURABLE
OUTCOMES
Documented
Awarenessof
referraltosource
availableservices
Clientobtains
services
12|P a g e

ProvideEducation
OBJECTIVES
Increaseclient
knowledgebase
andimprove
healthylifestyle
choices
BUSINESSRULES
Established
evidencebased
guidelines
TRIGGER
Clientrequests
education
Casemanager/
provider
identifies
educationneed
Universal
education
providedby
program,time
interval,etc.
Providerreferral
foreducation
TASKSET
1. AssessNeeds
2. Referral
Needed?
3. ReferClient
4. DevelopGoals
5. Deliver
Education
6. Receive
Education
7. Provide
Feedback
8. Evaluate
Learning
9. Understand/
Comply?
10. UpdateRecord
INPUTS
Documentation
ofclient
educationneeds
Documentation
ofrequestfor
education
OUTPUTS
MEASURABLE
OUTCOMES
Documentation
Percentageof
ofprovisionof
clients
educational
communicating
servicesor
understandingor
resources
demonstrating
compliancewith
Documentation
education
ofclient
understandingor Percentageof
compliance
clientsreceiving
educationand/or
materials
13|P a g e

ProvideCounseling
OBJECTIVES
Improved
problemsolving
skills
BUSINESSRULES
PublicHealth
Service
Guidelines
Professional
standards
Licensure
requirements
Program
requirements
TRIGGER
Providerreferral
Identifiedneed
forcounseling
TASKSET
INPUTS
OUTPUTS
MEASURABLE
OUTCOMES
AssessNeeds
Detailsofreferral Documentation Positivebehavior
Referral
needs
ofbehavioral
changeas
Needed?
changeor
evidencedby
3. ReferClient
improved
meetingspecific
4. DevelopGoals
emotionalstatus
clientgoals
5. ProvideGoal
asevidenced
Numberof
Focused
through
clientsreceiving
Counseling
objective,
counseling
6. Provide
standardized,
services
Feedback
evidencebased
7. Behavior
screeningtools
Change?
andassessments
8. UpdateRecord
9. GoalsMet?
10. NewGoals?
1.
2.
14|P a g e

CoordinateCare
OBJECTIVES
BUSINESSRULES
Improve
HIPAA
continuityofcare Programor
Reduce/
jurisdictional
eliminate
requirements
duplicationof
National
services
standardsof
Improve
practice
interagency
communication
TRIGGER
Needtowork
withmorethan
oneagency
Referral
Clientrequest
TASKSET
1. IdentifyNeed
2. Preparefor
Meeting
3. Identify
meeting
Participants
4. Meet
5. ContinueCare?
6. CloseCase
7. UpdateCare
Plan
8. UpdateClient
INPUTS
Clienthistory
Individual
providercare
plans
OUTPUTS
MEASURABLE
OUTCOMES
Interagencycare Improvedaccess
plan
toneeded
services
Allproviders
haveaccessto
comprehensive
patient
information
Reduced
duplicationof
services
15|P a g e

PatientRegistration
OBJECTIVES
Capturepatient
demographics,
contact
information,
specialneeds,
reasonforvisit,
andbilling
information
Obtaininformed
consentfor
services
Complete
specificprogram
requirements
BUSINESSRULES
TRIGGER
HIPAA
Patiententers
clinic
Programor
jurisdictional
requirements
Clinicalprotocols
HealthResources
andServices
Administration
policies
TASKSET
1. Patientsignin
2. Have
appointment?
3. Emergency?
4. RefertoERor
UrgentCare
Center
5. Schedule
appointment
6. Existing
patient?
7. Collectpatient
demographics
8. Establish
patientrecord
9. Pullexisting
record
10. Reviewwith
patient
11. Updateor
prepareany
neededforms
12. Directpatient
towaitingarea
untilcalled
13. Notifystaffthat
patientisready
14. Processforms
INPUTS
Patient
demographic
data
Insurance
Program
eligibility
Reasonforvisit
Specialneeds
Consent
Appointment
details
OUTPUTS
Billing
information
Patientconsent
Patientrecord
Appointment
status(noshow,
arrived,etc.)
Clinic
appointment
statistics(turn
awayrate,
outstanding
appointments,
productivity)
MEASURABLE
OUTCOMES
Neworupdated
patientrecord
16|P a g e

ClinicVisit
OBJECTIVES
Assess,
diagnose,and
treatpatient
Bill
appropriately
forservices
BUSINESSRULES
Clinical
protocols
Programor
jurisdictional
requirements
National
standardsof
practice
Insurance
regulations
TRIGGER
Patient
registered
TASKSET
1. Patientregistration
2. Recordvitals
3. Interviewpatient&
documentmedical
history
4. Obtainconsentfor
services
5. Performexamand
screenings
6. Labtestsneeded
7. Processlaborder
8. Reviewlabresults
9. Provideassessment
/diagnosis
10. Providepreventive
healthservices?
11. Providepreventive
healthservices
12. Counselingneeded?
13. ProvideCounseling
14. ProvideEducation
15. Medication
required?
16. Dispense
medication
17. Provideprescription
18. Documentthevisit
19. Directpatientto
checkout
INPUTS
Patientdata
Pharmacy
inventory
OUTPUTS
MEASURABLE
OUTCOMES
Grantdata
Patientreceives
appropriate
Clinicaldata
services
Diagnosis
Patientproblem Clinicreceives
paymentfor
list
services
Listof
Accessible
medications
clinicaldata
Interventions
Referrals
Updated
inventory
Billingform
Receipt/bill
17|P a g e

PatientFollowup
OBJECTIVES
Ensurepatientis
completing
treatmentplan
BUSINESSRULES
Clinical/
Department
protocols
HIPAA
Insurancestatus
Legal
requirements
Consentstatus
TRIGGER
Patientmisses
appointment
Patientcancels
appointment
Timebased
trigger
Labresults
TASKSET
1. Receivefollow
upreport
2. Reviewpatient
record
3. Followup
required?
4. Attemptpatient
contact
5. Contactmade?
6. Reassessneeds
7. Appointment
needed?
8. Schedule
appointment
9. Updaterecord
INPUTS
Appointment
status
Patientcontact
information
Treatmentplan
Templatesfor
contact(letters,
emails,etc.)
OUTPUTS
Followupreport
Tracking
information
Rescheduled
appointment
Updatedrecord
Contactmethod
MEASURABLE
OUTCOMES
Updated
treatmentplan
Updatedpatient
record
Increasein
patient
adherence
18|P a g e

ProcessLabOrder
OBJECTIVES
Accurateand
consistent
orderingoflabs
Obtain
appropriate
consentfor
services
Billforservices
Deliverorderand
specimento
appropriatelab
BUSINESSRULES
Procedures
dictatedby
contractwithlab
Fundingbased
requirements
Specimentesting
protocols
Billing
procedures
TRIGGER
Labtestsare
needed
Abnormallab
results
Standardsofcare
orstanding
orders,e.g.
presumptiveTB
Inadequate
specimen
TASKSET
INPUTS
1. Placeorder
Labprocedures/
2. Additional
documentation
consent
required?
3. Consentgiven?
4. Collectand
prepare
specimen
5. Internallab?
6. Deliver
specimentolab
forprocessing
7. Analyze
specimen
8. Capturetest
results
9. Disseminate
results
10. Notify
practitionerof
results
11. Reportable?
12. Conditions
reporting
OUTPUTS
Labresults
Incomplete/
overduetasks
report
Logreports
Confirmation
order
Labresults
MEASURABLE
OUTCOMES
Timely,accurate
labresults
deliveredtothe
right
person/place
Billingcomplete
&payment
received
Labtest
processed
Labdata
availablefor
statistical
reporting
19|P a g e

ReviewLabResults
OBJECTIVES
Labresultsare
reviewedbythe
appropriate
personina
timelymanner
Abnormalresults
arefollowedup
Labresultsare
reviewedin
contextwith
medicalhistory
andpastresults
tosupport
diagnosis
BUSINESSRULES
TRIGGER
Standardsofcare Labtestsare
processedand
AgencySOPs
resultsreturned
Preventiveand
Health
Maintenance
Guidelines
Program/grant
guidelines
TASKSET
1. Receivelab
resultsand
review
2. Followup
required?
3. Providenew
ordersorfollow
standingorders
4. Patientfollowup
5. Updatepatient
recordand
ensurefollow
through
INPUTS
Labresult(s)
and/orreport
Patientrecord
Clinicalnotes
Otherlaborders
OUTPUTS
Communication
topatient
Referral
Graphs/charts/
statistics
Population
trending
Treatmentplan
QA/EndofDay
report
MEASURABLE
OUTCOMES
Labresultsare
reviewedand
actedupon
Resultsare
communicatedto
thecorrect
patient
20|P a g e

DirectlyObservedTherapy
OBJECTIVES
Ensure
treatment
adherence
BUSINESSRULES
Treatment
protocol
Legal
requirements
TRIGGER
Presumptive
diagnosis
Physicianorder
Courtorder
Positivelab
result
TASKSET
1. Receive
physicians
orders
2. Contractsigned?
3. Explainthe
program
4. Complete
contractforDOT
5. Assesspatient
6. Confirmorders
&instruct
patient
regardingany
regimenchanges
7. Ensurecorrect
amount&type
ofmedicationis
preparedtotake
8. Observepatient
swallowing
correctdosage
ofmedication
9. Updatechart
anddocument
anyother
pertinent
findings
INPUTS
Physicianorders
Labresults
Patientcontact
information
Inventory
Medicalhistory
Demographics
andpatient
description/
picture
Templates
Clinic
appointment
schedule
OUTPUTS
MEASURABLE
OUTCOMES
Dosagecounts
Treatment
successfully
Updated
completed
inventory
Updatedpatient
record
ContractforDOT
Treatment
schedule&
record
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Business Process Task Flows

Ataskflowdiagramisagraphicalmodelthatillustratestheactivitiesofabusinessprocess,aswellaswho
performsthoseactivities,knownasfunctionalgroups.Thetaskflowprovidesastoryforthebusiness
processbeingdiagramed.Thecomponentsofthetaskflowdiagramaredefinedaslistedbelow:
1.
2.
3.
4.
5.
6.
7.
8.
Poolsagroup,department,organizationorunitthatcontainsmultiplefunctionalswimlanes
(functionalgroups).
SwimLanesafunctionalindividualorgroup.Theseareentitiesthatperformorareaccountable
fordesignatedactivitiesintheprocess.
StartEventaprocessmappingshapeusedtodefinethestartoftheprocess.
Activityanactionperformedbythefunctionalindividualorgroup.
Decisionarequiredconclusionneededintheprocess.Thesearetypicallyapprovalsor
resolutions.
SubProcessashapeusedasacallouttoanotherprocess.
EndEventaprocessmappingshapeusedtodefinetheendoftheprocess.
ActivityDetails/Narrativethesupportinginformationforeachprocess.
Figure1.TaskFlowDiagramLegend
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Electronic Health Records

Assessment
Case Manager
1
Case Assigned
Start
2
Contact Client
3
Client
Reached?
Activity Details /
Narrative
Yes
5
Schedule
Appointment
No
4
Close
Case
8
Provide
Education
Activity Description:
General Process Notes
Objective:
1. Case Assigned
Gather information to determine client
needs/strengths and eligibility for specific
The case manager is notified of a newly
services
assigned client/case
Develop a patient care plan
2. Contact Client
The case manager will attempt to contact the
Measurable Outcomes:
Identification of client needs
client via email, phone, letter, etc.
Client involvement in setting goals
Care plan is created
3. Client Reached?
Client agreement
If contact is successful, the case manager will
determine next steps for the client
Connecting client to the most appropriate
If no contact is made, attempts will continue
services
Receive payment for assessment(s)
Incidence of cases for a time period and
jurisdiction
6
Encounter/Visit
4. Close Case
If the client is unreachable after a reasonable
number of attempts the case status will be
changed to closed
Number of attempts required to contact the
client is determined by the program
5. Schedule Appointment
An appointment is scheduled with the client
The client may choose not to schedule the
appointment and the case may be closed
7
Enroll in
Program
Yes
No
Client
Health Department
page 1 of 2
7. Enroll in Program?
The client determines if they will enroll in the
program
8. Provide Education
If the client chooses not to enroll, the case
manager may provide further education or a
referral for another program, additional
services, etc.
6. Encounter/Visit
The encounter can take various forms
including face-to-face, telephone, letter, etc.
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Patient Registration

page 1 of 1
2
Have appt?
Clinical Office Assistant
Health
Department
Start Event
Activity Details /
Narrative
6
Existing
patient?
Yes
11
Update or
prepare any
needed forms
9
Pull existing
record
10
Review with
patient
7
Collect patient
demographics
8
Establish patient
record
No
4
Refer to ER or
Urgent Care
Center
Yes
3
Emergency?
No
No
5
Schedule
Appointment
End
Yes
1
Patient sign-in
1. Patient sign-in
5. Schedule appointment, contd
COA captures name, arrival time, and
COA captures minimum level of patient
Objective:
appointment time, if available
demographics (name, DOB, SSN)
Capture patient demographics, contact
Patient is notified of the appointment date and
information, special needs, reason for visit,
2.
Have
appointment?
time and any requirements to bring
and billing information
COA confirms scheduled appointment slot in
Obtain informed consent for services
6. Existing patient?
clinic schedule or performs search to identify
Complete program requirements
appointment time and scheduled provider and
COA searches database to determine if patient
appointment status is updated to checked-in
is already an established patient with an
existing patient record
If no appointment, COA determines if patient
New or updated patient record
can be accommodated in the schedule
7. Collect patient demographics
General Notes:
For new patients (no established patient
3. Emergency?; 4. Refer to ER or Urgent Care
COA (Clinical Office Assistant) swim lane
record), demographics and other pertinent data
represents Medical Office Assistant (MOA), Center
are captured to create a new record
Practitioner determines if the patient is
Licensed Practical Nurse (LPN) or Certified
experiencing a medical emergency
Data collected can include name, date of birth,
Nurse Assistant (CNA) job titles
address, telephone number, SSN, legal sex,
All medical emergencies are directed to the
race, ethnicity, marital status, responsible
local emergency room or urgent care center
party, preferred language, eligibility data, and
contact information
5. Schedule appointment
If the patient did not have an appointment, the
Additional information to complete an income
COA identifies an available appointment time
assessment may also be collected at this time
and schedules the patient for the time slot
Anonymous services may not collect personallyCertain situations require that the patient be
identifiable demographic data and not all
seen that day
programs may require all data to be collected
8. Establish patient record

COA creates a new electronic health record
from the data collected from the patient with a
unique patient identifier
9. Pull existing record
COA pulls-up the patient record for viewing
10. Review with patient
COA reviews patient data with patient and
makes any necessary updates
Patient may be asked to sign-off on changes
made to record or validation of existing data
11. Update or prepare any needed forms
Required forms are generated for patient
completion and signature
Consent forms typically must be presented to
patients for agreement and signature on a
regular basis
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Patient Registration
Clinical Office Assistant
Health
Department
page 1 of 1
12
Direct patient to
Waiting Area
until called
13
Notify staff that
patient is ready
14
Process forms
End
Activity Description, cont.:
Activity Details /
Narrative
12. Direct patient to waiting area until called

COA directs patient to appropriate area to wait
for provider to call patient back for services
13. Notify staff that patient is ready

COA initiates alert to notify staff that patient is
waiting and captures location as applicable
System may print stickers, chart/patient form
may be placed in holding area, or alert may be
electronic (flashing light, name added to
display, etc.)
14. Process forms
COA processes any paperwork created during
registration process and links documents to the
electronic health record for patient
Timing may differ. Paperwork may be processed
at end of the day or immediately following
registration
COA may also at this time print forms and add
to patients paper-based chart
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Process Lab Order
Practitioner/
Clinical Staff
Health
Department
page 1 of 1
2
Additional
consent
reqd
1
Place order
Start
No
Yes
No
End
3
Consent
given?
Yes
4
Collect and
prepare
specimen
5
Internal lab?
No
6
Deliver
specimen to lab
for processing
10
Notify
practitioner of
results
11
Reportable?
Lab
Yes
Activity Details /
Narrative

Objective:
Accurate and consistent ordering of labs
Obtain appropriate consent for services
Bill accurately for services
Deliver order and specimen to
appropriate lab
Activity Description:
7
Analyze
specimen
8
Capture test
results
5. Internal lab?
If specimen is to be analyzed in-house, no
additional processing or packaging may be
necessary
9
Disseminate
results
Yes
12
Submit Report
No
End
9. Disseminate results
Results are returned to the requesting facility
Additional processing may be required at
facility to incorporate into patient EHR as
results are typically returned separately for
each test
1. Place order
The practitioner orders the test and the lab
order is entered into the system. Patient
6. Deliver specimen to lab for processing
demographic information is entered
Patient instructions and specific procedures for
Specimens are packaged for transit to an
specimen collection are generated by system
external lab where they will be processed
10. Notify practitioner of results
For internal labs, the specimen and paperwork
The ordering practitioner is notified of results
Timely, accurate lab results delivered to 2. Additional consent required?; 3. Consent
are transferred to the lab and do not require
and must sign-off on receipt
the right person/place
given?
May trigger release to web portal, automated
additional packaging
Billing complete & payment received
Additional consent may be required for
call, letter, etc.
7. Analyze specimen
Lab test processed
specific test protocols & must be collected. If
Lab data available for statistical
Details of each specimen are collected in the
11. Reportable?; 12. Submit Report
consent is not obtained, status is updated and
Reportable disease results may be reported by
reporting
lab log and specimens are tracked through the
no specimen processing may occur
both the lab and the clinic to the appropriate
testing process
authorities
General Notes:
4. Collect and prepare specimen
Practitioner may vary by location (e.g.
Patient may have specimen collected at an off- 8. Capture test results
Unique identifiers are used to link lab results
Test results for each specimen and test are
RN, LPN, RNP, Physician, etc.)
site location
to patient results in order to de-duplicate
captured along with any specimen observations
reports and provide accurate occurrence
Lab may be in-house or external
Data is collected to identify the patient &
Labs may be performed anonymously
Details of the test method and reference range
Each report is logged to provide an audit trail
billing details, details of specimens that are to
Clinical staff often operate under
are documented and abnormal results flagged
be collected & how they should be processed
standing orders for specific situations or
are outlined, & the ordering physician and the
conditions
person responsible for collection are identified
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Business Process Requirements

Requirementsdescribetheneededfunctionalityofaninformationsystemandanswerthequestion:How
wouldyouseeaninformationsystemsupportingactivityX?Eachidentifiedbusinessprocessislisted
belowwithactivitybasedrequirements,butnotalllistedactivitieswithinthebusinessprocesshave
associatedrequirements.Thespecificationsforeachbusinessprocessarenotintendedtosuggestany
physicalimplementationstrategy.
BusinessProcess#1:Recruitment/Outreach
1.1.
IdentifyVariationinReferrals
1.1.1.
Allowusertodefinebaseline/thresholdforvariationsinreferrals/reports
1.1.2.
Maintainanddisplayhistoricalreferraldata:numbers,types,etc.
1.1.3.
Alertappropriateindividualswhenreferralsreachuserdefinedthresholds,timeintervals,etc.
1.1.4.
Allowusertoeditdistributionofnotifications
1.1.5.
Provideabilitytoqueryreferralhistorybyuserdefinedcriteria(e.g.client,referralsource,case
manager,date,etc.)
1.2.
AnalyzeIssue/Information
1.2.1.
Print/displayreportofreferrals
1.2.2.
Supportanalysisofcasemanagercaseload,availability,andutilization
1.2.3.
Provideabilitytosetthresholdsforutilizationbyuserdefinedcriteria(e.g.,
disease/outbreak)
1.3.
1.2.4.
Alertappropriateindividualswhencasemanagerutilizationmeetsthresholdlimits
1.2.5.
Comparecurrentreferral/reportratesagainsthistoricalratestoidentifytrends
1.2.6.
Allowusertoenterdetailsoflocaleventwithsearchfunctionality
1.2.7.
Supportgeographictrendingtoidentifyclusters
Referral/RecruitmentNeeded
Nosystemrequirements
1.4.
DevelopRecruitingPlan
1.4.1.
Proposetargetpopulationforrecruitmentbasedonreferralhistory
1.4.2.
Suggestreferralsources
1.4.3.
Allowusertocreaterecruitmentplan
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1.5.
ImplementPlan
1.5.1
1.5.2
Display/printrecruitmentplanreport
Distributerecruitmentplantoappropriateindividuals
BusinessProcess#2:Screening/EligibilityDetermination
2.1.
2.2.
2.3.
2.4.
IdentifyAtRiskIndividuals
2.1.1.
ImportdatafromexternalsystemsincludingEHRs,surveillance,labsystems,etc.
2.1.2.
Allowusertoeasilysetupormodifyscreeningparameters
2.1.3.
Assign/captureriskinformationfromelectronicreferrals/reports
2.1.4.
Allowusertofilter/sortbasedonrisk
2.1.5.
Supportcreation/importofcasedefinitions
2.1.6.
Supportcreation/importofprogrameligibilityrequirements
ConductScreening
2.2.1.
Flagclientswhomeetcasedefinition/eligibilityrequirements
2.2.2.
Display/printreportofeligibleclients
2.2.3.
Providemethodtocontacteligibleclientsand/orclientsassociatedcareprovider(s)
2.2.4.
Recordstatusofclientcontactanddocumentattempts
MeetCriteria?
2.3.1.
Capturereasonforclientineligibility
2.3.2.
Filter/reportbasedonreasonforineligibility
ReferClient
2.4.1.
2.5.
2.6.
Allowusertoinitiatereferralprocess
ResourcesAvailableforCaseManagement?
2.5.1.
Allowusertoaddclienttoprogramorcasemanagerwaitlist
2.5.2.
Notifyclientofwaitliststatus
2.5.3.
Display/printwaitlist
2.5.4.
Allowusertomanagewaitlist
AcceptCaseManagement?
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2.6.1.
2.7.
Capturereasonclientdeclinedservices
InitiateIntake
2.7.1.
Allowusertoassignclienttocasemanager
2.7.2.
Display/printcaseload/clientsbycasemanager
2.7.3.
Allowusertoscheduleclientappointment(s)withcasemanager
2.7.4.
Generateappropriateformswithclientinformationprepopulated
2.7.5.
Routeformstoappropriateindividuals/clients/casemanagersforcompletion
BusinessProcess#3:Intake
3.1
ReceiveReferral/Report/CaseFinding
3.1.1
Provideabilitytoreceivereferral/report/casefindingselectronically
3.1.2
Capturedemographicsassociatedwithreferral
3.1.3
Generatereferralreportbasedonuserdefinedcriteria
3.1.4
Allowusertoselect/sortbyreferraldate,client,provider,referraltype,referralsource,
etc.)
3.1.5
Queryopen/activereferralsaccordingtouserdefinedcriteria
3.1.6
Capturehouseholdmembers,contacts,andotherpotentialcases
3.1.7
Provideabilitytosendandreceivereferral/clientinformation(e.g.,sendcopyofreferral
toprimarycareprovider)
3.1.8
Alert/displaynew,open,activereferrals
3.1.9
Allowfordeduplicationofreferrals
3.1.10
Assignprioritybasedonreferralsource,programrules,diseasedefinition/acuity,zip
code,etc.
3.2
ExistingClient?
3.2.1
Matchreferredclienttoexistingclient(s)records
3.2.2
Providelistofpotentialrecordmatches
3.2.3
Identitycurrentstatus(closed,active,etc.)
3.2.4
Appendnewdatatoexistingclientrecord
3.2.5
Allowusertocreatenewclientrecord
3.2.6
Alert/flagifmatchingclientrecordisexistingbutnotactive
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3.2.7
3.3
3.4
3.5
Allowusertoupdatestatusofclient
CompleteInitialDocumentation
3.3.1
Assignuniqueclientrecordnumber
3.3.2
Prohibitassignmentofnewrecordnumberforexistingclient
3.3.3
Alert/flagmissinginformationinclientrecord
3.3.4
Allowdesignationofmandatoryfieldstosavearecordandassignnumber
3.3.5
Prepopulateformswithclientinformation;allowmanualoverride
Update/CombineRecord
3.4.1
Allowfordeduplicationofclientrecords
3.4.2
Appendreferralinformationintoexistingclientrecord
3.4.3
Edit/updaterecordwithcurrentclientinformation
3.4.4
Allowtheexchangeofclientrecordupdateswithothersystems,includingbilling
Eligible/ResourceAvailable?
3.5.1
Generatecasemanagercaseloadreport
3.5.2
Interfacewithaninventorysystemtoviewavailableinventory
3.5.3
Provideinteroperabilitywithhospitals,clinics,otherpublichealthagencies,billable
services,labs,etc.inordertoexchangepatientdata,programavailability,etc.
3.6
3.7
ReferClient
3.6.1
Captureclientdecisiontoaccept/denyofferedservicesorcasemanagement
3.6.2
Capturecasemanagernotes/commentsandupdaterecord
3.6.3
Allowcasemanagertoinitiatecaseclosure
AssignCase
3.7.1
Generatecaseloadreporttodeterminerecommendedstaffassignment
3.7.2
Documentstaffassignments
3.7.3
Calculateweightedcaseassignments(basedongeographiclocations,specialties,acuity,
fulltimeversusparttime)
BusinessProcess#4:Assessment
4.1
CaseAssigned
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4.1.1
Notifycasemanagerofassignedcase
4.1.2
Flagcase/clientas"highrisk"basedonuserdefinedcriteria
4.1.3
Displaycaseloadusinguserdefinedfilter/sortcriteria
4.1.4
Generate/display/printcaseloadsummarybycasemanager
4.1.5
Generate/display/printcaseloaddetailbyclient
4.1.6
Allowusertoeditcasemanagerassignmentwithsupervisorapproval
4.1.7
Allowsystemadministratortolimitaccesstoclientfilesbasedonuser,role,orother
userdefinedcriteria
4.1.8
4.2
4.3
ContactClient
4.2.1
Autogeneratecommunicationinformingclientofeligibilityandnextsteps
4.2.2
Display/editcurrentclientinformation
4.2.3
Logcontactattempts
4.2.4
Allowusertosuppressemailrecipientlist
ClientReached?
4.3.1
4.4
CloseCase
4.4.1
4.5
Allowusertoflagacaseforreassignment
Allowusertoinitiatecaseclosure
ScheduleAppointment
4.5.1
Allowusertocreate/scheduleclientappointment
4.5.2
Displaycasemanagerschedule
4.5.3
Sendelectronicappointmentdetailsalongwithanyadditionalinformationneeded(e.g.,
cancellationpolicy,requirementsforappointment,etc.)
4.5.4
Display/printclientappointmentschedule
4.5.5
Captureappointmentdisposition(complete,noshow,canceled,etc.)
4.5.6
Display/printclientappointmenthistorywithdisposition
4.5.7
Display/updateappointmentmasterschedule
4.5.8
Provideabilitytoschedulerecurringappointments
4.5.9
Sendappointmentreminders(viaphone,email,etc.)
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4.6
4.7
Encounter/Visit
4.6.1
Display/printoverviewofservicesprovided
4.6.2
Allowcasemanagertodocumentencounter
EnrollinProgram
4.7.1
4.8
ProvideEducation
4.8.1
4.9
4.10
Capturereasonclientdeclinedservices
Allowcasemanagertoselectappropriateeducationalinformation
SignConsentForms
4.9.1
Prepopulateformswithappropriateclientinformation
4.9.2
Allowusertocustomizeformsbasedonfacility/program
4.9.3
Trackincompletedocuments/forms
4.9.4
Providealertstocasemanagerforneededupdatestoformsbasedondefinedcriteria
4.9.5
Maintainchecklistofallconsentformsneeded/signed
CollectData
4.10.1
Allowimportofclientdatafromotherprograms
4.10.2
Supporttopicspecificassessmenttoolsandinputofassessmentresults(acuitytool,
etc.)
4.11
4.10.3
Allowusertocreatereminders
4.10.4
Allowusertodefineandflagincompletefieldstosupportchartreview
DevelopGoals
4.11.1
Supportprogram/grantspecifictemplates
4.11.2
Captureestablishedgoalsanddifferentiatebetweenclientandcasemanagergoals
4.11.3
Allowusertoexportselectedgoalstocareplan
4.11.4
Applyuserdefinedalternativereferencenotesorattributes(tagging)todocumentsthat
areeasilysearchable
4.11.5
Allowusertoupdategoals
4.11.6
Providereminderstoupdategoalsbasedonuserdefinedcriteria
4.11.7
Supportreportingofgoals
4.11.8
Routegoalreportselectronicallytoappropriateindividuals,i.e.primarycareprovider
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4.11.9
Allowusertolinkgoalstoreferrals
4.11.10 Recommendreferralsbasedongoals
4.12
DevelopCarePlan
4.12.1
Supportcreationofa"contract"ordocumentthatoutlinestheplanofaction
4.12.2
Supportprogram/grantspecifictemplates
4.12.3
Allowusertodisplay/update/printthecareplan
4.12.4
Provideabilitytoshareselectedcareplan,activities,andgoalswithauthorized
providers
4.13
4.14
4.12.5
Track/monitorprogressofclient
4.12.6
Providereminderstoupdateplanbasedontime,event,etc.triggers
4.12.7
Maintaincareplanhistory
AcceptPlan
4.13.1
Populatecalendarwithcareplanactivities,goals,appointments,etc.
4.13.2
Allowusertoprintorsharecalendar
DocumentImpressions/Notes
4.14.1
Provideabilitytocapturenotes
4.14.2
Supportabilityforcasemanagertosetclientspecificreminders
4.14.3
Locknotestopreventchangesuponcasemanagersignoff
BusinessProcess#5:CloseCase
5.1
ReviewCarePlan
5.1.1
Displaycareplanandclientprogressasavisualrepresentationordashboard(e.g.
percentageofgoalachieved,percentofstepsinplancompleted)
5.1.2
Recordstatuschanges/outcomes
5.1.3
Import/receiveelectroniclabreports,medicationadministrationrecords,vaccination
records,etc.
5.2
5.1.4
Documenteducationreceivedbyclient
5.1.5
Flagmissingdataelements
5.1.6
Record/displaythefinaldispositionofcareplanreview
CloseCase?
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5.2.1
5.3
Continue/ReviseCarePlan
5.3.1
5.4
Allowusertoeditcareplananddocumentnotestosupportchanges
DevelopTransitionPlan
5.4.1
Documentreasonforcaseclosure
5.4.2
Linktocommunityresourcesinordertoprovideclientwithmaterialsandcontact
information
5.4.3
5.5
Create/printclientletteroutliningreasonforcaseclosureandnextsteps
CreateClosingSummary
5.5.1
Generate/display/printcaseclosingsummaryincludingreasonforclosure,final
disposition,andanyotherpertinentnotes
5.6
5.7
5.8
5.5.2
Documentnextsteps/expectations
5.5.3
Documentcommunicationorcommunicationattemptswithclient
SignOff
5.6.1
Provideautogeneratedqueueofcaseclosurespendingapproval
5.6.2
Removeclosedcasesfromstaffcaseload
5.6.3
Notifycasemanager/supervisor/designatedindividualsofclosedcase
5.6.4
Capturesupervisorapprovalofcaseclosure
UpdateStatus
5.7.1
Allowusertoupdatecasestatus
5.7.2
Triggerbillingsystem/procedures
5.7.3
CaptureICD9/ICD10codes
5.7.4
Provideabilitytoreopenacaseafterclosure
NotifyReferringAgency/Partners
5.8.1
Generateandrouteelectronicallyreportsandreferralsummary
5.8.2
Capturedate/timestampandrecipientsfornotifications
5.8.3
Supportuseofagencyletterhead
5.8.4
Allowusertocreateacustomizablenote
5.8.5
Managereferringagency/partnercontactinformation
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5.9
CreateCaseClosureLetter
5.9.1
Generatecaseclosureletterforclient
5.9.2
Allowusertoedit/print/routeletter
BusinessProcess#6:ReferClient
6.1
6.2
InquireAvailableServices
6.1.1
Connecttoexternalsystemstodetermineavailabilityofservices
6.1.2
Import/createapplicationformsforavailableservices
6.1.3
Maintainreferringagency/partnercontactinformation
6.1.4
Providehelpfulhintsareaorpopupsthatarecontextdependentandupdateable
ProvideInformation
6.2.1
Allowusertolinktomaterialsfromproviderorappendelectroniccopiestoprovider
record
6.3
6.2.2
Triggeralertsthatinformationmaybeoutofdatebasedonuserdefinedtimelines
6.2.3
Allowusertoinitiaterequestforupdatedinformationfromproviders
OfferAvailableServices
6.3.1
Display/printdetaileddescriptionofavailableserviceandanyrequireddocuments
6.3.2
Display/printhoursofservice/locations/phonenumbersforservices
6.3.3
Display/printspecificreferrallocationdetailsincludingdirections,mapsbuslines,mass
transit,etc.
6.4
Accept/Interest
6.4.1
6.5
UpdateRecord
6.5.1
6.6
Allowusertoupdateclientrecordwithnotesincludingreasonforrejectionofservices
GenerateReferral
6.6.1
Allowusertoupdateclientinformation(e.g.,demographics)
6.6.2
Enablethecreation,documentationandtrackingofreferrals/counselingorders
includingreasonforreferral,wherereferred,appointmentdateandtime,clinicaland
administrativedetailsofthereferral,andconsentsandauthorizationsfordisclosuresas
required
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6.7
6.6.3
Populateformswithclientinformation
6.6.4
Routereferraltoappropriateproviders/programs/etc.
6.6.5
Provideabilitytoattachrelevantinformationtoreferral
6.6.6
Allowusertoupdateclientrecordwithreferralinformation
6.6.7
Notifyclient'sassociatedcareproviderofreferral
ProvideServices
6.7.1
Receiveconfirmationthatclientaccessedservices
6.7.2
Receivesummaryofservicesprovided,appointmentinformation,andreferralresultsvia
fax,directlyentry,scan,orwebinterface
6.8
Followup
6.8.1
Flagreferralsthatareoverduewithnostatusupdateorresultsreceived
6.8.2
Providefollowupreminderforcasemanager
6.8.3
Displayreferralhistoryforeachclient
6.8.4
Provideabilitytogeneratereferralreports
6.8.5
Requireacknowledgementofreceiptofresultsandcompletionofreview
6.8.6
Supportcaseconferencing
BusinessProcess#7:ProvideEducation
7.1
AssessNeeds
7.1.1
Linktointernalandexternaleducationresourcestoprint/determineavailabilityof
materials
7.1.2
7.2
ReferralNeeded?
7.2.1
7.3
Allowusertolinktoreferralmodule
DevelopGoals
7.4.1
7.5
ReferClient
7.3.1
7.4
Capture/updateclienteducationgoals
DeliverEducation
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7.6
7.5.1
Suggestappropriateinformationbycondition
7.5.2
Supportdifferentlanguagesforeducationalmaterials
7.5.3
Displayavailableinventoryofpreprintededucationalmaterials
7.5.4
Allowusertoordereducationalmaterials
7.5.5
Print/distributeeducationmaterialsorlinkstoassociatedmaterials
7.5.6
Display/printhistoryofeducationprovidedtoclient
ProvideFeedback
7.6.1
7.7
EvaluateLearning
7.7.1
7.8
Capturecasemanagernotes/commentsaroundclientunderstanding/compliance
Understand/Comply?
7.8.1
7.9
Captureclientfeedback
UpdateRecord
7.9.1
Appendcasemanagerevaluationtopatientrecord
BusinessProcess#8:ProvideCounseling
8.1
8.2
AssessNeeds
8.1.1
Linktoeducationresourcesrelevanttocaseandaccessmaterials
8.1.2
ReferralNeeded?
8.2.1
8.3
ReferClient
8.3.1
8.4
Capture/updateclientgoals
ProvideGoalFocusedCounseling
8.5.1
8.6
Allowusertolinktoreferralmodule
DevelopGoals
8.4.1
8.5
Capturecasemanagernotes/comments
ProvideFeedback
8.6.1
Captureclientunderstanding/compliance/notes
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8.7
BehaviorChange?
8.7.1
8.8
UpdateRecord
8.8.1
8.9
Allowusertoupdateclientrecordwithcounselingevaluationandupdatecareplan
GoalsMet?
8.9.1
8.10
NewGoals?
8.10.1
BusinessProcess#9:CoordinateCare
9.1
IdentifyNeed
9.1.1
9.2
PrepareforMeeting
9.2.1
Importrelevantinformationfromcaserecordtoclientsynopsis("onepager")
9.2.2
Generateclientreleaseofinformationdocumentwithappropriateinformation
populated
9.2.3
9.3
Generatelistofpartneragenciesassociatedwithaspecificclient
IdentifyMeetingParticipants
9.3.1
Provideabilitytoschedulecarecoordinationmeeting(s)withindividualsorgroup
attendees
9.4
9.3.2
Allowusertodistributeinvitationsforcarecoordinationmeeting
9.3.3
Associatecarecoordinationmeetingwithaclientrecord
9.3.4
Trackattendeeresponsestoinvitation(accept/tentative/decline)
9.3.5
Provideremindersforupcomingmeeting
9.3.6
Generatepartneragencyreleaseofinformationform
9.3.7
Providelinkstoagencypoliciesandprocedures
Meet
9.4.1
Capturemeetingnoteselectronicallyandlinktoclientrecord
9.4.2
Distributemeetingnotestoappropriateindividuals
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9.5
ContinueCare
9.5.1
9.6
CloseCase
9.6.1
9.7
9.8
UpdateCarePlan
9.7.1
Allowusertoupdatecareplan
9.7.2
Generate/display/printcareplan
9.7.3
Distributecareplantopartneragenciesandauthorizedindividuals
UpdateClient
9.8.1
Generatecommunicationoutliningcarecoordinationoutcome
9.8.2
Provideabilitytoedit/routecommunication
BusinessProcess#10:PatientRegistration
10.1
10.2
PatientSignin
10.1.1
Capturepatientnameandarrivaltime
10.1.2
Capturepatient'sappointmentstatus(scheduledappointment,walkin)
Haveappointment?
10.2.1
Allowusertoqueryappointmentschedulebyuserdefinedfactors(e.g.,name,DOB,
SSN,etc.)
10.3
10.2.2
Returnquerywithlistofpossiblematches
10.2.3
Captureappointmentstatus(checkedin,missed,etc.)
Emergency?
10.3.1
10.4
RefertoERorUrgentCareCenter
10.4.1
10.5
Provideuserwithlistoflocalfacilitiesforemergenciesorurgentcare
Scheduleappointment
10.5.1
Displayappointmentschedulebyuserselectedfactor(e.g.,timeslot,appointmenttype,
provider,etc.)
10.5.2
Provideabilitytocreateandscheduleanewappointment
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10.6
10.7
10.5.3
Capturethecomplaint,presentingproblemorotherreason(s)forthevisit
10.5.4
Maintainmultiple,separateschedulesforproviders,servicearea,etc.
10.5.5
Provideabilitytoeditandsaveexistingappointments
10.5.6
Captureminimumrequiredpatientinformationinappointment
10.5.7
Providepatientwithnotificationofscheduledappointment
Existingpatient?
10.6.1
Allowusertoquerypatientrecorddatabasetodetermineifexistingpatient
10.6.2
Returnquerywithlistofpossiblepatientrecordmatches
10.6.3
Allowusertoselectpatientandenterintopatientrecord
Collectpatientdemographics
10.7.1
Validatedatarealtime(e.g.,formatchecks,completeness,limitchecks,etc.)
10.7.2
Capturedatacollectedfrompatientinnewrecordincludingdemographics,
billing/guarantorinformation,legalstatus,consent,etc.)
10.7.3
Linktootherprogramsystemstodetermineexistingprogrameligibilityandcoverage
information
10.7.4
Allowpropagationofdatafromexistingpatientrecord(e.g.,informationfromparent's
recordusedtoregisterchildasnewpatient(address,guarantor,insurance,etc.))
10.7.5
10.8
10.9
Establishpatientrecord
10.8.1
Allowusertocreateandsaveanewpatientrecord
10.8.2
Assignauniquepatientidentifier
10.8.3
Alertuserbeforecreatingnewrecordifasimilarrecordalreadyexists
10.8.4
Allowusertolinkuniquepatientidentifierstoindicatefamily/relationship
Pullexistingrecord
10.9.1
10.10
Storedemographicinformationseparatelyfromclinicaldatatoprotectpatientidentity
Allowusertoviewexistingpatientrecordfromquery
Reviewwithpatient
10.10.1 Provideabilitytoeditpatientdataandsavechanges
10.11
Updateorprepareanyneededforms
10.11.1 Allowusertoselectprogram/visittype
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10.11.2 Provideuserwithlistofrequiredformsbasedonprogram/visittype
10.11.3 PrepopulateformwithdatafromEHR
10.11.4 Allowusertoeditspecificfieldsinform
10.12
Directpatienttowaitingareauntilcalled
10.12.1 Nosystemrequirements
10.13
Notifystaffthatpatientisready
10.13.1 Createanalerttostaff/providerthatpatientisready
10.13.2 Allowusertoselectoreditalertrecipients
10.13.3 Trackpatientthroughserviceflow
10.14
Processforms
10.14.1 Appendscanneddocumentsgeneratedduringregistrationtothepatientrecord
BusinessProcess#11:ClinicVisit
11.1
Patientregistration
11.1.1
11.2
Recordvitals
11.2.1
Providetemplateforrecordingvitals
11.2.2
Providegraphicaldisplayforcomparisonortrending
11.2.3
Highlightandcreatealertforabnormalvitals
11.2.4
Providecalculationsfortypicalhealthmeasures(e.g.,BMI,growth,percentweightgain,
etc.)
11.3
11.2.5
Provideconversionbetweenmetricandimperialsystems
11.2.6
Captureaccurateelectronicdatadirectlyfrommedicaldevicesandequipment
11.2.7
Supportupdateableordercatalog
Interviewpatientanddocumentmedicalhistory
11.3.1
Provideabilitytoupdatemedicalhistoryfromprevioushistoryorvisit
11.3.2
Provideversioncontroltoprovidenarrativeofmedicalhistory
11.3.3
Createalertsforcertainhealthconditionsincludingallergies,adversedrugreactions
11.3.4
Promptforprogram/diseasespecifichistory
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11.3.5
Allowusertoupdateproblemlisttocapturenewproblemsanddeactivateproblemsno
longeraffectingpatient
11.4
11.5
11.6
11.3.6
AllowusertoimportmedicalhistoryfromanEMR
11.3.7
Distinguishbetweendatareportedbypatientandclinicallyauthenticateddata
Obtainconsentforservices
11.4.1
Storestandardconsenttemplatesforservices/procedures
11.4.2
Promptuserifadditionalconsentisrequiredforservice
11.4.3
Capturethepurposesforwhichconsentwasobtainedandtheassociatedtimeframe
Performexamandscreenings
11.5.1
Presentcurrentguidelinesandestablishedprotocolstopractitioner
11.5.2
Providetheabilitytocreateexams/screenings/assessments
11.5.3
Captureresultsofexamsandscreenings
11.5.4
Providecheckboxesforcommonresults(normal,abnormal)
11.5.5
Allowusertocapturecommentsforallresults
11.5.6
Allowusertoeditexams/screeningstocaptureadditionalservices
Labtestsneeded?
11.6.1
11.7
Providerecommendationsbasedonprotocols
Processlaborder
11.7.1
Providetheabilitytogenerateinstructionspertinenttothepatientforstandardized
tests/procedures(e.g.,fasting)
11.8
Reviewlabresults
11.8.1
11.9
Provideassessment/diagnosis
11.9.1
Capturediagnosis
11.9.2
ProvideICD9/ICD10codes
11.9.3
Appendproblemlistbasedonhistoryandexams/screenings
11.9.4
Supportuseofstandardcareplans,guidelines,and/orprotocolstomanagespecific
conditions
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11.9.5
Identify,track,andprovidealert/notificationtoindicatevariancesfromstandard
protocolsorcareplans
11.10
Providepreventivehealthservices?
11.10.1 Generatealertsforpreventativeservicesthataredueforpatient
11.11
Providepreventivehealthservices
11.11.1 Linktoimmunizationregistriestoimport/exportimmunizationhistory
11.11.2 AllowusertodirectlyenterimmunizationhistoryintoEHR
11.11.3 Provideuserwithimmunizationforecast
11.11.4 Alertuserthatimmunizationisdue
11.11.5 Capture,displayandreportallimmunizationsassociatedwithapatient
11.11.6 Printimmunizationhistoryinstandardtemplate
11.11.7 Capturescreeninghistory
11.11.8 Displayhistoryofallscreeningsperformedwithdateandresults
11.11.9 CapturePHSeducationdelivered
11.11.10 Displaycumulativehistoryofeducationdelivered
11.12
Counselingneeded?
11.13
Providecounseling
11.14
Provideeducation
11.14.1 Documentwhateducationwasdelivered
11.14.2 Provideaccesstoeducationalinformationrelevanttothatpatient
11.14.3 Printmaterialsfromlibrary
11.14.4 Suggesteducationalmaterialstobeprovidedbasedonproblemlist,diagnosis,etc.
11.15
Medicationrequired?
11.15.1 Displaylistofmedications
11.15.2 Flagcontraindications,allergies,druginteractions,andotherpotentialadversereactions
whennewmedicationsareprescribed
11.15.3 Autopopulatelistofmedicationsfromdispense/prescribeorders
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11.15.4 Requiremandatorydatabecompletedpriortoprescribing
11.15.5 Calculateanddisplaydrugdoseoptionsbasedonpatientparametersincludingageand
diagnostictestresults
11.15.6 Presentsuggestedlabmonitoringasnecessaryforprescribedmedication
11.15.7 Alertpotentialerrorssuchaswrongpatient,drug,dose,route,ortimefor
administrationofmedication
11.15.8 Captureallergy,intolerance,andadversereactionstomedications
11.16
Dispensemedication
11.16.1 Capturecriticalinformation:nameofmedication,dosage,quantity,lotnumber,date
andtimedispensed,providername,etc.
11.16.2 Linktoinventorysystem
11.17
Provideprescription
11.17.1 Capturecriticalinformation:nameofmedication,dosage,quantity,lotnumber,date
andtimedispensed,providername,etc.
11.17.2 Captureallowablerefills,DEAorlicensenumber,etc.
11.17.3 Allowusertoeprescribeorprintprescription
11.18
Documentthevisit
11.18.1 Captureencounterdetailsusingdirectentryoftext;structureddataentry(templates,
forms,lists);ortranscriptionofdictation
11.18.2 Accesspatientinformationneededtosupportcodingofdiagnosis,procedures,billing
11.18.3 Createsummaryviewsorreportsofencounter
11.18.4 Receiveandincorporatepatientencounterdata(e.g.,diagnostictestsandreports,lab
results,images)fromexternalsystems
11.18.5 Completebillingform
11.18.6 Providetheabilitytolinkdispersedinformationforanindividualpatient
11.18.7 Allowinformationmistakenlyassociatedwithpatienttobeassociatedtothecorrect
patient
11.18.8 Identifyallprovidersbynameandroleassociatedwithaspecificpatientencounter
11.19
Directpatienttocheckout
11.19.1 Allowusertoscheduleappointments
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11.19.2 Displaychargesforvisit
11.19.3 Printreceipt
11.19.4 Acceptpayments
11.19.5 Allowusertorefundmoney
11.19.6 Billinsurance/3rdparty/programsforservices
BusinessProcess#12:PatientFollowup
12.1
12.2
Receivefollowupreport
12.1.1
Trackstatusofallscheduledappointments(checkedin,missed,cancelled,etc.)
12.1.2
Generateafollowupreportbasedonuserspecificationsandtimeperiod
12.1.3
Distributereporttoappropriatestaff
12.1.4
Allowusertodesignateandeditlistofstafforrolesforreportdistribution
Reviewpatientrecord
12.2.1
12.3
12.4
12.5
Followuprequired?
12.3.1
Provideabilitytodocumentclosureandremovepatientfromfollowupreport
12.3.2
Allowusertoeditstatusoffollowup
Attemptpatientcontact
12.4.1
Provideacontactmethodforpatient
12.4.2
Storetemplatesforuseinfollowupattempts(email,letter)
12.4.3
AutopopulatefieldsoftemplatewithinformationfromEHR
12.4.4
Provideabilitytodelegate/referfollowuptootherstaff
Contactmade?
12.5.1
12.6
12.7
Provideabilitytoaccesspatientrecordsdirectlyfromreport
Documentfollowupattemptstocapturemethod,time,date,result,etc.
Reassessneeds
12.6.1
Provideabilitytoreviewpreviousplans/interventions/problems
12.6.2
Capturenotesfromreassessment
Appointmentneeded?
12.7.1
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12.8
12.9
Scheduleappointment
12.8.1
Provideaccesstotheschedulingsystem
12.8.2
Allowusertoedit/rescheduleappointment
12.8.3
Providenotificationtopatientofappointmentdetails
Updaterecord
12.9.1
Capturefindingsandnewtreatmentplan
12.9.2
Capturereferralinformation
12.9.3
Indicateifpatientcarehasbeentransferredtoanotherfacility/provider
BusinessProcess#13:ProcessLabOrder
13.1
PlaceOrder
13.1.1
Allowselectionofordersfromcatalogandprogramspecificprotocols
13.1.2
Supportsearchqueriesoflabordercatalog
13.1.3
Allowusertoeditordertocaptureadditionalinformationsuchaspatientinstructions
13.1.4
Allowusertoquerythestatusofanorder(initiated,placed,received),modifyan
existingorder,andverifythatanorderhasbeencompleted
13.1.5
Provideuserwithspecimencollectioninstructions(e.g.,coloroftube,typeofspecimen,
etc.)
13.2
13.1.6
Printspecimenlabels,requisitionforms,orotherrequiredmaterialsforlabprocessing
13.1.7
Providenotificationtoappropriatestaffthatorderhasbeenplaced
13.1.8
Prefillstandarddatainorder
Additionalconsentrequired?
13.2.1
13.3
Flagtestswhereadditionalconsentisrequired
Consentgiven?
13.3.1
Trackstatusofconsent(denied,consented,withdrawn)anddate/timestamp
13.3.2
Triggerworkflowforlabprocessinguponrecordingofconsent;prohibitorderfrom
proceedingwithoutsufficientpatientconsent
13.4
Collectandpreparespecimen
13.4.1
Capturerequiredinformationaboutpatient,specimenscollected,provider
identification,etc.
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13.4.2
Capturedetailsofspecimencollectionincludinghowcollected,responsibleparty,
time/datestamp,etc.
13.5
13.6
13.7
13.8
13.9
13.10
Internallab?
13.5.1
Provideelectroniccommunicationwithoutsidelabs
13.5.2
Confirmtheorderandspecimenwerereceived
Deliverspecimentolabforprocessing
13.6.1
Provideinstructionsforpackagingandhandlingofspecimens
13.6.2
Providecontactdetailsforexternallabs
13.6.3
Documentshippingofspecimensanddetailsofreceivingfacility
Analyzespecimen
13.7.1
Documentreceiptofspecimensandcapturespecimendetailsinlablog
13.7.2
Reportvariationbetweentypeofspecimenorderedandactualspecimenreceived
13.7.3
Documentstatusofspecimenthroughoutprocessing
Capturetestresults
13.8.1
Capturetestmethodandreferencerangeused
13.8.2
Capturetestresultsforeachspecimen/testpair
13.8.3
Flagabnormal/critical/reportableresults
13.8.4
Captureadditionalobservations
Disseminateresults
13.9.1
Providerequestingfacilitywithreportoftestresultsforeachpatient/testordered
13.9.2
Allowdataentryofscannedresults
Notifypractitionerofresults
13.10.1 Createalert/notificationwhenlabsresultsareavailableforreview
13.10.2 Providealertsforcriticalvalues/results
13.10.3 Allowusertodesignatedelegatestoensuretimelyreview
13.11
Reportable?
13.11.1 Generateprompttoreportorprovideautoreportfunctionfordesignatedresults
13.12
Conditionsreporting
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13.12.1 Transmitappropriatepatientlevelclinicalinformation(e.g.results)topublichealth
notifiableconditionprograms
13.12.2 Createlogofreportableevents
13.12.3 Conformtorequirementsforsurveillance/reportingofnotifiableconditions
13.12.4 Enabletheautomatedtransferofrequiredinformationtoandfromlocaldisease
specificregistriesandothernotifiableregistries
13.12.5 Supportidentificationofpatientsrelatedbylivingcondition,relationship,
employer/worklocationtosupportsurveillanceanalysisandreporting
13.12.6 Providetheabilitytocaptureandupdatepublichealthreportingguidelines
BusinessProcess#14:ReviewLabResults
14.1
Receivelabresultsandreview
14.1.1
Provideabilitytogroupandprioritizeresultsbasedonuserdefinecriteria
14.1.2
Provideabilitytoassignresultstospecificpractitionerforreview
14.1.3
Indicatelabresultstatusanddetails(e.g.,reviewed(time/date/user)orpendingreview,
etc.)
14.1.4
Bundlelabsforreviewbylaborder(e.g.,reviewCBCpanelinentiretyforindividual
patient)
14.1.5
Providealertiflabresulthasnotbeenacteduponwithinuserdesignatedwindow
14.1.6
Reconcilelabresultsreceivedwithlogoflaborders
14.1.7
Providealertifresultsareoverdue
14.1.8
Provideabilitytodrilldowntopatientrecordfromresults
14.1.9
Supportgraphicalortablebasedcomparisonoftrends
14.1.10 Providealertorflagbasedonstandardofcareorbestpractice
14.2
14.3
Followuprequired?
14.2.1
Provideabilitytoinitiatereferralfromfollowup
14.2.2
Provideabilitytoreferto/alertadditionalstaff
14.2.3
Indicatestatusofreview(reviewedandcompleted,followupneeded,etc.)
14.2.4
Captureadditionalnotesasneeded
Providenewordersorfollowstandingorders
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14.3.1
Providerulebasedpromptsorguidelines,i.e.,clinicaldecisionsupportbasedon
standardsofcare,protocols,etc.
14.4
14.5
14.3.2
Allowinputandtransmissionoforders
14.3.3
Providenotificationofneworders
14.3.4
Allowsignoffofneworders
14.3.5
Supporttrackingoforders
Patientfollowup
14.4.1
Flagpatientforfollowupandtrackprogress
14.4.2
Providetimebasedalertsforfollowupbasedonuserdefinedwindow
Updatepatientrecordandensurefollowthrough
14.5.1
Capturenotes,followupactions,changestotreatmentplan,neworders,etc.
14.5.2
Receiveandstoredataelementsoflabresultsinpatientrecord
14.5.3
Provideabilitytocreate/viewchartsandgraphs
14.5.4
Printresults,notes,andotherpertinentmedicalinformation
14.5.5
Linktohealthmaintenance
14.5.6
Generateendofdayreporttoflagoutliers(e.g.,pendingorders,overduelabresults,
abnormalresultsnotreviewed,followupnotcomplete,etc.)
14.5.7
Validatethatresultsarelinkedtocorrectpatient(i.e.,crossreferencespecimen
identificationorothermethod)
BusinessProcess#15:DirectlyObservedTherapy
15.1
Receivephysician'sorders
15.1.1
AlertappropriatestaffoforderforDOTusingroleoruserdesignation
15.1.2
Providerequiredinformationneededtoclarifyorder(e.g.,contactinformationfor
originator)
15.2
15.3
15.1.3
Indicatestatusoforder
15.1.4
Provideabilitytoforwardorder
15.1.5
Allowusertoprintorders
Contractsigned?
15.2.1
Allowusertoviewsignedcontractandassociateddetails
15.2.2
Alertuserofmissingdocumentation
Explaintheprogram
15.3.1
Allowusertoselectmaterialsbasedonlanguage/culture
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15.4
15.5
15.6
15.3.2
Documentwhatmaterialsweregivenandwhen
15.3.3
Capturelevelofunderstanding
CompletecontractforDOT
15.4.1
Providestandardtemplateforcontract
15.4.2
Autofillcontractfieldsfrompatientrecord
15.4.3
Document"RefusaltoSign"andprovideappropriatenotifications
15.4.4
Providepatientwithcopyofcontractandschedule
15.4.5
ConnecttoCaseManagement/SurveillancemoduleinEHR
15.4.6
Allowusertocreatenewtreatmentschedule
Assesspatient
15.5.1
Provideprotocolbasedscreeningform/templateforpatientassessment
15.5.2
Providealertsforcontraindicationsand/orrequiredfollowupbasedonfindings
Confirmordersandinstructpatientregardinganyregimenchanges
15.6.1
Provideaccesstophysician'sorders
15.6.2
Capturepatientsignoffoforder
15.6.3
Provideaccesstopatientcontract,schedule,incentives,treatmentplan,andclinic
appointments
15.6.4
Allowusertoappendadditionalinformationtoappointments(e.g.,updatedlocation,
etc.)
15.7
15.6.5
Allowusertorescheduleappointments
15.6.6
Allowusertoconfirmandupdateallergystatus,intolerance,andadversereactions
Ensurecorrectamountandtypeofmedicationispreparedtotake
15.7.1
Documentmedicationwithdate/time/providersignature
15.7.2
Providecumulativecountofdosestakenduringspecifiedtimeframe
15.7.3
Linktoinventorysystemtodecrementdosageanddocumentpatientdetailsfor
inventoryreconciliation
15.8
15.9
Observepatientswallowingcorrectdosageofmedication
15.8.1
Documentmedicationtaken/refused,time/date,location,etc.
15.8.2
Differentiatebetweenadministeredandobserved
Updatechartanddocumentanyotherpertinentfindings
15.9.1
Allowusertoaccesstreatmentschedule
15.9.2
Promptusertoconfirmappointmentifoutsideoftreatmentwindow
15.9.3
Provideabilitytocreateletterorothercommunicationtodocumentthattreatmentis
15.9.4
Capturenotesofvisitincludingfindings,changestoappointments,etc.
15.9.5
CapturepatientdatafromremotedevicesorwebbasedUIsandintegratedataintothe
complete
patient'srecord
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GeneralSystemRequirements
Thereareanumberofgeneralrequirementsthatarenotbusinessprocessspecific,butareimportant
fromtheperspectiveofoverallsystemfunctioning.Thissectionincludesgeneralrequirementsthat
describetheoverallsystemcapabilitiestosupportanelectronichealthrecordssystem.
GeneralCharacteristics
1.1
Provideastableandhighlyavailableenvironment
1.2
Provideauserfriendlyinterfacethatisconsistentthroughoutthesystem
DataCapture
2.1
Acceptdatafrommultipleinputmethodsincluding;paper,onlinewebforms,PC
asynchronously,PCsynchronously,interactivevoiceresponse,barcode,RFID
2.2
Enterthevaluedesireddirectlyorfromadropdowntableofvalidvaluesthrough
standardmouseselectionprocedure
2.3
Allowusertodesignatemandatorydatafieldsandformats
2.4
Supportrealtimedataentryvalidationandqualitycontrol
2.5
Flagincompletefields/forms
2.6
Provideappropriatecalculationsattimeofdataentry
2.7
Logtransactionsattimeofdataentry
2.8
Maintaintransactionloghistory
2.9
Provideasynchronousandsynchronousdatasynchronization
Integration
3.1
Supportmultipleversionsofinterchangestandards
3.2
Incorporateclinicaldataanddocumentationfromexternalsourcesandmaintain
contentasoriginallyreceivedasrequired
3.3
AllowexportofdatafromEHRtopersonalhealthrecord,webportal,otherproviders,
financialsystems,etc.
3.4
Providepatientswithaccesstoelectronichealthrecordthroughwebportal,kiosks,etc.
3.5
Supportintegratedpatientcareincludingcollaborativecareandcasemanagement
acrossdifferenthealthcaresettings
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3.6
Providetheabilitytouseregistryservicesanddirectoriestoidentifypatients,providers,
payers,healthplans,etc.
Reporting
4.1
Providereportingcapabilities(define,generate,distribute)
4.2
Providetheabilitytoexportorretrievedatarequiredtoevaluatepatientoutcomes,
qualityofcare,performance,andaccountability
4.3
AggregatedatafrompatientEHRsperuserdefinedcriteria
Security/Privacy
5.1
Supportdefinitionsofrolesandassignedlevelsofaccess,viewing,entry,editingand
auditing
5.2
Requireuserauthentication
5.3
Provideflexiblepasswordcontroltoaligntonationalpolicyandstandardoperating
procedure
5.4
Createandmaintainaregistryofallpersonnelauthorizedtoaccessthesystemthatis
accessibleonlybyasystemadministrator
5.5
Restrictuserpasswordstocompliantcombinationsofcharactersofastandard
minimumlength
5.6
Trackuserpasswordrevisionsandforceuserstochangetheirpasswordsatdetermined
intervals
5.7
Terminatelogonscreenafterdeterminednumberofunsuccessfultriesbyauserto
login
5.8
Automaticallylogoffidleworkstationsafterapredeterminedperiodoftime
5.9
Preventauserfrombeingloggedontomultipleworkstationsatthesametime
5.10
Traceactionsperformedtotheuniqueactorandprovideauditreporting/change
histories
5.11
Createuniqueuserrightsbasedonfunction,screendisplaysinformationtype,etc.
5.12
Storedatacentrallyinaphysicallysecurelocation
5.13
Supportsecuredataencryptionandexchange
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5.14
Fullycomplywithpatientprivacystandardsandrequirementsinaccordancewitha
user'sscopeofpractice,organizationalpolicy,orjurisdictionallaw
5.15
Maintainproviderinformationasrequiredincludingfullname,specialty,addressand
contactinformation
5.16
Allowusertoobscuredataandmaskpartsoftheelectronichealthrecordfrom
disclosure
SystemAdministration
6.1
Allowadministrator(s)tomaintaindatamasters
6.2
Allowsystemadministratortocreateuseraccountsanddefine/updatespecific
permissionsandlevelsofaccess
6.3
Allowsystemadministrationbylocalstaff
TechnicalDesign
7.1
Supportabilitytochoosedataentrydevicesandformfactors
7.2
Allowuserstoaccessthesystematalllevels/locations
7.3
Softwaredevelopmentlifecycleshouldbewelldescribedanddocumented
7.4
Enableelectronicdatainterchange(EDI)
SystemAccessandNavigation
8.1
Allowusertoaccessanyallowedfunctionfromanyworkstationonthesystem
8.2
Provideaccesstouserscreensthroughtheuseofmenusandappropriateicons
8.3
Allowusertomoveeasilyfromonescreentoanotherutilizingappropriateiconsor
functionkeys
8.4
Supportuserdefinedinformationviews
ReliabilityandRecovery
9.1
Providequeryresponsetimewithindesignatedtolerances
9.2
Systemmustbemadeavailablewithinadesignatedtimeframe(e.g.,15minutes)inthe
eventofasystemfailure
9.3
Systemmustberestoredtoitsconditionofnomorethanonehourbeforecorruptionor
systemfailureoccurred
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9.4
Archiveandretrievedataanddocumentationasrequired
Workflow
10.1
Allowusertoviewworkflowsfororders,reviews,etc.
10.2
Providetheabilitytocreateandupdateworkflowcontrolrules
10.3
Providetheabilitytocreateandmanageworkflow(tasklist)queues
10.4
Allowroutingofnotificationsandtasksbasedonsystemtriggers
10.5
Supportescalation,redirection,andreassignmentofworkflow
10.6
Provideabilitytodesignateroles/usersfornotifications
Miscellaneous
11.1
Generateandassignuniquerecordnumbers
11.2
Enableflexiblesearchcriteriaforaccessingtransactions
11.3
Supportmultiplelanguages
11.4
Generateandprintforms
11.5
Supportaccessthroughmobiletechnology
11.6
Captureelectronicsignatures
11.7
Provideabilitytoscandocuments(e.g.,consentforms,insurance/eligibility
documentation,andproofofidentity)andlinktoclientorpatientrecord
11.8
Maintainpatientrecord,notes,andresultsinchronologicalorder
11.9
Providesupportfordifferenttypesofdataandassociatedunitsandprecision
11.10
Allowthecreation,retrieving,updating&reportingofstructuredandunstructureddata
11.11
Applychangesinterminologytoallnewclinicalcontent
11.12
Supportmanagementofbusinessrules
11.13
Providetheabilitytocreate,import,ormodifydecisionordiagnosticsupportrules
11.14
Triggerbillingsystem/procedures
11.15
CaptureICD9/ICD10andprocedurecodes
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Appendix A: Glossary of Business Process Terms

ACTIVITY.Agenerictermfortheworkthatisperformedinthebusinessprocess.Thetypesofactivities
aretaskandsubprocess.
AUTOMATING.Attemptingtoreduceanexistingmanualjobtoasetofcomputerprogramsthatcan
replacetheexistingmanualeffortwiththeminimumofhumaneffortorunderstanding.
BESTPRACTICE.Atechniqueormethodologythat,throughexperienceandresearch,hasshownto
reliablyleadtoadesiredresult.
BUSINESSPRACTICE.Habitualorcustomaryactionsoractsinwhichanorganizationengages.Alsousedin
thepluraltodescribeasetofbusinessoperationsthatisroutinelyfollowed.
BUSINESSPROCESS.Asetofrelatedworktasksdesignedtoproduceaspecificdesiredprogrammatic
(business)result.Theprocessinvolvesmultiplepartiesinternalorexternaltotheorganizationand
frequentlycutsacrossorganizationboundaries.
BUSINESSPROCESSANALYSIS.Theefforttounderstandanorganizationanditspurposewhileidentifying
theactivities,participantsandinformationflowsthatenabletheorganizationtodoitswork.Theoutput
ofthebusinessprocessanalysisphaseisamodelofthebusinessprocessesconsistingofasetofdiagrams
andtextualdescriptionstobeusedfordesignorredesignofbusinessprocesses.
BUSINESSPROCESSREDESIGN.Theefforttoimprovetheperformanceofanorganization'sbusiness
processesandincreasecustomersatisfaction.Businessprocessredesignseekstorestructuretasksand
workflowtobemoreeffectiveandmoreefficient.
BUSINESSRULES.Asetofstatementsthatdefineorconstrainsomeaspectofthebusinessprocess.
Businessrulesareintendedtoassertbusinessstructureortocontrolorinfluencethebehaviorofthe
healthagency(business).
CONTEXT.Organizationalgroupingsorentitiesinvolvedinthebusinessprocessandhowtheyrelateto
oneanothertoachievethegoalsandobjectivesoftheprocess.
CRITICALTASK.Anactionorsetofactionsthataddsanidentifiablevaluetoagivenbusinessprocess
objective.
CUSTOMER.Groupsorindividualswhohaveabusinessrelationshipwiththeorganizationthosewho
receiveanduseoraredirectlyaffectedbytheservicesoftheorganization.Customersincludedirect
recipientsoftreatmentandservices,internalcustomerswhoprovideservicesandresourcesforfinal
recipientsandotherorganizationsandentitiesthatinteractwithanLHDtoprovidetreatmentand
services.
ENTITY.Apersonoragroupofpeoplewhoperformsoneormoretasksinvolvedinaprocess.Theentities
aretheparticipantsintheprocess.Entitiesarerepresentedbycirclesincontextdiagrams.
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FRAMEWORK.Adefinedsupportstructureinwhichothercomponentscanbeorganizedanddeveloped.
Alogicalstructureforclassifyingandorganizingcomplexinformation.Asystemofrules,ideasor
principlesthatprovidesaunifiedviewoftheneedsandfunctionalityofaparticularservice.
GOAL.Themajorhealthgoalthatthebusinessprocesssupports.Thegoalistheendstatetobeachieved
bytheworkofthehealthagencyandshouldbedefinedintermsofthebenefitsprovidedtothe
community/populationorindividual/client.
INFORMATIONSYSTEM.Atoolthatsupportswork.
INPUT(S).Informationreceivedbythebusinessprocessfromexternalsources.Inputsarenotgenerated
withintheprocess.
LOGICALDESIGN.Logicaldesigndescribestextuallyandgraphicallyhowaninformationsystemmustbe
structuredtosupporttherequirements.Logicaldesignisthefinalstepintheprocesspriortophysical
design,andtheproductsprovideguidelinesfromwhichtheprogrammercanwork.
OBJECTIVE.Aconcretestatementdescribingwhatthebusinessprocessseekstoachieve.Theobjective
shouldbespecifictotheprocesssuchthatonecanevaluatetheprocessorreengineertheprocessand
understandhowtheprocessisperformingtowardsachievingthespecificobjective.Awellworded
objectivewillbeSMART(Specific,Measurable,Attainable/Achievable,RealisticandTimebound).
OPERATION.Ataskseriesthatcompletesatransaction.
OUTCOME.Theresultingtransactionofabusinessprocessthatindicatestheobjectivehasbeenmet.
Producingordeliveringtheoutcomesatisfiesthestakeholderofthefirsteventthattriggeredthebusiness
process.Often,measurescanbeassociatedwiththeoutcome(e.g.,howmuch,howoften,decreasein
incidents,etc.).Anoutcomecanbe,butisnotnecessarily,anoutputoftheprocess.
OUTPUT(S).Informationtransferredoutfromaprocess.Theinformationmayhavebeentheresulting
transformationofaninput,oritmayhavebeeninformationcreatedwithinthebusinessprocess.
RESULT.Ataskoutputthatmaybeusedinoneofthreeways:(a)asaninputtothenextsequentialstep,
(b)asaninputtoadownstreamstepwithinataskseries;or(c)astheachievementofanorganizational
objective.
REQUIREMENTS.Thespecificthingstheinformationsystemmustdotomaketheprocessefficientand
achieveitspurpose.
REQUIREMENTSDEFINITION.Thepurposeofrequirementsdefinitionistorefineourunderstandingof
theworkflowandthentodefinedatabaseoutputsneededtosupportthatwork.Requirementsdefinition
servestospecificallydefinethefunctionalitytobesupported.Inaddition,thephysicalconstraintsare
examined,andthespecificprojectscopedetermined.Requirementsdefinitionanswersthequestion:
HowwouldyouseeinformationsystemssupportingTaskX?
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REQUIREMENTSDEVELOPMENTMETHODOLOGY.Alogical,stepwiseapproachtothinkthroughthe
tasksthatareperformedtomeetthespecificpublichealthobjectives(analyzebusinessprocesses),
rethinkthetaskstoincreaseeffectivenessandefficiency(redesignbusinessprocesses),anddescribewhat
theinformationsystemmustdotosupportthosetasks(definesystemrequirements).
STAKEHOLDER.Aperson,group,orbusinessunitthathasashareoraninterestinaparticularactivityor
setofactivities.
SUBPROCESS.Aprocessthatisincludedwithinanotherbusinessprocess.
TASK.Adefinablepieceofworkthatcanbedoneatonetime;i.e.,whathappensbetweentheinbox
andtheoutboxonsomeonesdesk.Abusinessprocessismadeupofaseriesofworktasks.
TASKFLOWDIAGRAM.Graphicaldescriptionoftasksshowinginputs,processes,andresultsforeachstep
thatmakesupatask.
TRANSACTION.Informationexchangesbetweenentities.Mayalsobetheexchangeofgoods(e.g.,a
vaccineorpayment)orservices(e.g.,aninspection)betweentwoentities.Transactionsarerepresented
byarrowsincontextdiagrams.
TRIGGER.Event,action,orstatethatinitiatesthefirstcourseofactioninabusinessprocess.Atrigger
mayalsobeaninput,butnotnecessarily.
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Electronic

Health Record Requirements

About the Project

Business Process Matrices

Business Process Task Flows

Electronic Health Records

Electronic Health Records

Clinical Office Assistant

8. Establish patient record

Electronic Health Records

Clinical Office Assistant

Activity Description, cont.:

12. Direct patient to waiting area until called

13. Notify staff that patient is ready

Electronic Health Records

Process Lab Order

General Process Notes

Business Process Requirements

Appendix A: Glossary of Business Process Terms

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