Read the following case studies below: Case Study 1: Ordering Labs – using an EM
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Question
Read the following case studies below:
Case Study 1: Ordering Labs – using an EMR
Case Study 2: Routine Prescription Refill – no EMR
After reading, create a word document and list the generic clinic processes that are explicitly described in the case studies. For each generic process, list three variations that you think are common and three likely exceptions.
Case Study 1: Ordering Labs - using an EMR
Mr. Smith arrives at the office of Doctor Jones for a scheduled appointment. He checks in as usual with the receptionist, provides money to cover his co-pay, and within 15 minutes is called back to an exam room. Once in the exam room, Nurse Adams asks his chief compliant, takes his vital signs, and confirms his medications with the medications listed in Mr. Smith’s electronic chart. Mr. Smith states that the reason for his visit is that the toe nail of his right big toe has become discolored. He suspects toenail fungus, and has tried several home remedies and over the counter anti-fungals, but they have not helped. He wants to get rid of his toenail fungus. Nurse Adams asks him to remove his shoe and sock so that Doctor Jones can look at his toe.
Dr. Jones examines the toe and also strongly suspects toenail fungus. He is considering prescribing a new oral anti-fungal. He explains the available treatment options to Mr. Smith and advantages and disadvantages of each. Mr. Smith indicates interest in the oral anti-fungal option. Doctor Jones explains to Mr. Smith that some oral antifungals in a small percentage of patients cause liver problems, and that if Mr. Smith wants to try the medication, he needs to draw blood for a panel of liver tests before he starts the medication to make sure that his liver function is normal, and after he has taken the medicine for a while, to make sure that he is tolerating the oral anti-fungal. Mr. Smith agrees.
Nurse Adams prepares to draw two tubes of blood from Mr. Smith. In the phlebotomy room in the office, Nurse Adams completes a lab sample requisition form, and peels bar-coded labels from the form and sticks them on the lab tubes. As each tube is filled, Nurse Adams peels a label from the sample requisition form and sticks the label on the tube. Immediately afterward, the tubes are placed in a centrifuge, and in cold storage (the lab courier arrives every day at 4:30 and picks up the samples and requisition forms). Nurse Adams returns to the exam room and explains that someone from the office will call Mr. Smith the next day when the lab results are back. Mr. Smith thanks Nurse Adams and the office visit concludes.
Case Study 2: Routine Prescription Re-fill – no EMR
Patty, a patient at Suburban Family Clinic, takes Benecar 20mg once a day (QD) for blood pressure control. She has taken this medicine for two years with good results. Patient Patty is a regular patient of Doctor Dan’s. Patient Patty does not use the “auto refill” program at her local pharmacy. Today, she noticed that she only has a few pills left and calls Doctor Dan’s office, who does not use an EMR and does not use ePrescribing.
Receptionist Ronald answers the phone. Patient Patty explains that she needs another prescription because hers has run out. Receptionist Ronald asks Patient Patty for her pharmacy information, takes a message, and gives it to Nurse Ned who works with Doctor Dan.
Nurse Ned pulls Patient Patty’s chart, confirms that she is well controlled on the medication, and has been taking it for two years with good results. Nurse Ned provides the request and a report on his review of the chart to Doctor Dan in the hallway later that morning. Doctor Dan agrees and charts a re-fill.
Nurse Ned provides the chart with the re-fill indicated to Receptionist Ronald, who calls the prescription into the pharmacy.
Explanation / Answer
1. The generic processes described in the case are shared below. The variation in bold implies the process that was followed in the case.
1. Patient check-in
Exceptions - Patient does not show up, the patient leaves before the visit starts or patient is not eligible for services (no insurance coverage)
2. Taking patient to exam room
Exceptions - Patient is taken to a make-shift room as all rooms are full, patient leaves before rooming or doctors are not available to meet the patient while rooming is being done.
3. Patient Visit
Exceptions - Patient leaves due to some emergency and can't meet the doctor, the doctor has to leave for an emergency and cannot meet patient or scheduled doctor has to see other patients.
4. Labs
Exceptions - No equipment to draw a sample, sample got damaged or non-compliance by patients. For example - Not in a fasting state for blood glucose measurement.
2. The generic processes described in the case are shared below. The variation in bold implies the process that was followed in the case.
1. Re-filling of prescription
Exception - Patient not eligible for refill, patient forgets to call for re-fill or patient buys from the market based on prescription.
2. Confirm need for Prescription
Exceptions - Charting data is incorrect, the patient shares wrong information during the call or drug is not effective,
3, Re-fill of prescription
Exceptions - EMR not connected with pharmacy, pharmacy accepts only written requests (not over the phone) or the patient does not visit doctor/ pharmacy for collecting prescription.
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