Workflow
If there are a small number of patients in a day, workflow may not be much of an issue. Workflow becomes more of an issue when there are lots of patients, a small amount of room, and the potential for confusion.
The workflow of the Midwife-EMR system was designed for handling up to 100 patients a day, i.e. up to 100 prenatal exams. The workflow itself was in place in the clinic long before the Midwife-EMR application was written, therefore the Midwife-EMR application adapted itself to the existing workflow.
The workflow is coordinated through the use of laminated badges with priority numbers on them numbered 1 to 100. Each patient upon arriving at the clinic is given a priority number which keeps the flow of patients "first come, first serve" as the patients move through the system.
There are a number of stages that the patients flow through in order to complete their prenatal exam and the stages vary according to whether the patient is a new patient or a returning patient.
There is a lot of freedom in how workflows are designed. The steps below should be taken as one way it could be done (and the careful observer might notice that the diagram above varies from the prose below). The point is that workflows are site specific.
Sign-in: the patient signs in at the entrance and receives their priority number. At this point the new patient is not in the computer system but their priority number (with barcode, see Priority Barcodes) is known. Basically the Midwife-EMR application knows a person with priority number 1 has arrived but it does not know yet who that is. Postponing the entering of patient data until a little later in the process allows the patients to come into a waiting room without causing a backlog of people at the entrance to the building.
Waiting area: the patient waits for their turn, based upon priority number, to have the general information entered into the computer system by the clerk and later for their midwife interview. While the patient waits, the patient completes a one page form that collects general information such as name and address as well as questions about the patient's current health and family history.
Data entry: the patient meets with the clerk who creates the patients record in the computer system. The clerk also weighs the patient and takes blood pressure readings, which as entered in the patient's first prenatal exam record.
Midwife interview: the patient meets with a midwife who discusses the patient's current health and medical history with them. The midwife enters this information into the patient's record.
Prenatal exam: the patient has their first prenatal exam (for this pregnancy at this clinic) with the midwife. The midwife edits the initial prenatal exam record created by the clerk when the weight and blood pressure was taken. The midwife completes the fields of the prenatal exam and schedules the next prenatal exam date with the patient.
Check out: the patient checks out when they return the priority badge. When the badge is returned the barcode on it is either scanned or hand-entered on the patient check-out screen and the Midwife-EMR application records that the patient's prenatal exam is completed.
Note that the checkout can be done by the guard or staff at the exit of the building or by the midwife performing the prenatal exam.
Sign-in: the patient enters the building and the staff looks up the patient by name or other identifying information in the system. The priority badge barcode is scanned into the system associating the patient with the priority number for the day. The patient is given the priority badge to use while in the building.
Waiting area: the patients wait in a waiting area and often are able to watch health related videos, etc.
Charts-pulled: the patient charts are pulled by staff by referring to the Priority List screen. This is a real-time list of patients that have arrived and been assigned priority numbers. Eventually the goal is to go paper-less but in the meantime charts are pulled.
Weight/BP: the clerks take the patient's weight and blood pressure readings and enter the same into a new prenatal record for the patient.
Prenatal exam: the prenatal exam is done by the midwife. This is done the same way as the new patient workflow above.
Check out: the patient returns the priority badge and the barcode on the badge is used to check the patient out of the system. Like the new patient workflow above, this can be done by the midwife after the prenatal exam is complete or by the staff at the building exit.