When John enters the clinic, his first interaction is with the front desk personnel. As he signs in, several different options are available:

Patient Registration

If this is his first visit, the front desk staff member can fill out an abbreviated Patient Registration form. This includes basic information such as name, date of birth, gender, address, and phone number. Once a patient record has been created, multiple users can access the account simultaneously (e.g. one user might want to enter more detailed patient information and another user might want to enter insurance information on a different workstation).

Check-In

Regardless of whether or not this is Johns's first visit, he will need to be checked in. Checking him in serves several purposes:

• If he has an appointment, PracticeStudio will document in the Appointment Scheduler that John showed up so that his name will not appear on No-Show reports (and thus, he won't get into any trouble because of no-show-related insurance issues).
• While checking him in, your front desk person can print a routing slip—a sort of disposable travel card that can follow him through the clinic. The routing slip is a soft template that can be changed to match the requirements of your clinic. It typically includes balance information, diagnosis codes, and the most recent, pertinent chart information. A calendar can also be included that shows all of the patient's existing appointments.
• As soon as John is checked in, his location will appear in Patient Tracking and you can monitor his movement throughout the clinic—as well as how much time he spends in different rooms in your clinic and which users are in those rooms with him—right up until he checks out.

Insurance Information

If he is a new patient and his insurance information has not yet been captured, that information can be entered at the front desk or forwarded to insurance staff.

Once John has been placed in an examination room, your nurse will begin entry of initial information for John's encounter. The "Nurse Entry" button within PracticeStudio EMR guides the nurse's entry in logical steps, screen by screen.

CC and HPI

The first step for your nurse is to enter Chief Complaint and History of Present Illness data. All text is generated by touching (or clicking on) the appropriate buttons, and the resulting narrative text reads correctly and is recorded as discrete data elements. The History of Present Illness entry is categorized into Location, Quality, Severity, Duration, Timing, Context, Modifying Factors, and Associated Symptoms. Again, these areas document all of the required E/M criteria.

Exam, ROS, PFSH Menu

Next, a menu is displayed that allows your nurse to select the appropriate Exams and Review of Systems. In many cases, the first entry screen selected is the Constitutional Exam. This form includes general information such as Height, Weight, Blood Pressure, Pulse, Respiration, and General Appearance. As the information is entered, all E/M Coding bullets are being recorded.

• PFSH: If selected, subsequent screens allow for entry of all aspects of Past, Family, and Social History. A full complement of screens for recording any illnesses, surgeries, injuries, and/or prior treatments is included in this section.
• ROS: Following the PFSH screens are summary and individual anatomical region Review of Systems screens, which allow the reporting or denial of symptoms in all pertinent systems. Each form includes a "Denies All" button, which quickly documents E/M coding requirements while allowing the nurse to enter pertinent positive symptoms.

Current Medications

In a typical encounter, the nurse will then open RxWriter® and enter (or confirm) all of John's current medications and medication allergies. If John is a new patient, the nurse can download his medication history and import either the entire history or only certain medications into John's record. If John is an existing patient, the medication list from his previous encounter will be displayed for updating.

Review and Initial Evaluation

After the nurse has completed basic entry, EMR ChartView can be launched in preparation for your entrance into the exam room.

• ChartView: ChartView contains a summary of a patient's EMR information; using it, you can review all of the information entered for the current encounter or for any encounter in the past. The EMR data is grouped based on discrete data types, including medications, problems list, all past encounters, lab detail, and diagnosis codes. The patient's photograph is also available during this inquiry, as it is on most posting forms.
• Encounter Information: Each patient encounter is marked by a date and time stamp. This allows review, printing, and maintenance on an encounter-by-encounter basis and is particularly useful when multiple encounters exist on the same date.
• Examination and Review of Systems: You can review and modify any of the information that has been previously posted by the nurse. A wide range of additional examination forms and Review of Systems forms are also available for in-depth recording of the patient encounter. These include forms for all body systems as described by the E/M coding guidelines.
• Wireless or Touch Screen: The Cardiology data set is designed to be used with touch screens or tablet PCs. Depending on the clinic layout and your preference, a combination of both options may work best.
• Previous Encounter Review: You (or your nurse, prior to your access) may choose to view a Previous Encounter Review. This process "rolls forward" all of the pertinent history from the patient's previous encounter. This is especially useful when seeing patients for a recurring problem. As the information is rolled forward, you or your nurse will have the ability to review the data and change specific elements so that they match the current encounter's findings.
• Lab Results Review: For follow-up visits, you may want to quickly review all past lab results. PracticeStudio EMR's ChronoGraph® feature can graph any numerical data: the data can be formatted at run-time to appear in line graphs, bar graphs, or pie charts.

Treatment

Specific procedures can be documented using custom procedure workflows.

• Procedures: You can customize your own procedure workflows or use prebuilt workflows in the data set, which include the following:
  • Carotid Ultrasound
  • Echocardiogram
  • Electrocardiogram
  • Electrophysiology Study
  • Exercise Stress Test
  • Holter Monitor
  • Invasive Procedures (e.g. Catheterizations)
  • Leg Arterial Study
  • Leg Venous Study
  • Nuclear Medicine
  • Pacemaker Implantation
  • Renal Artery Ultrasound
  • Stress Test
  • Tilt Table Test
• RxWriter: At any time, you can open RxWriter, which is capable of eprescribing (or faxing or printing scripts), medication history download, and formulary and benefits checking. RxWriter is Surescripts® certified for Prescription Benefit, Prescription History, and Prescription Routing and provides you with all the required tools for creating and maintaining your patients' prescriptions. The drug database contains over 50,000 drugs.
• Interactions: RxWriter also performs multiple screening tests (drug-drug, drug-allergy, drug-alcohol/food, duplicate therapy, drug disease, and dosage). These screening tests are performed during the prescription process and (optionally) after a new allergy or adverse reaction is added to the patient's record. The results from previously run screenings can be viewed at any time.

Assessment

The final step in documenting John's encounter is the filling out of a patient assessment.

• Assessment Form: The Assessment form displays a patient's problem list, which shows any chief complaints or diagnosis codes that have been entered during the encounter. You can choose to remove or add items to the problem list during encounter posting. Notations pertaining to the patient's prognosis and any follow-up visit information are also entered at this time.
• Patient Education and Excuses: One of the PracticeStudio EMR options includes a database of over 3800 patient education articles created by medical professionals and updated three times per year. You can also create permission slips/excuses: the data set includes Authorization for Absence, Return to Duties (with or without restrictions), and Care Certificate forms. And not only are excuses printed for the patient; they are also noted in the patient's chart.
• Lab Orders: Lab orders are typically placed at this time (although the timing is up to you). PracticeStudio's Lab Management system allows automatic transmittal of lab orders to different labs around the country via industry-standard HL7 exchange. Additionally, if you install a bi-directional interface, lab results are automatically posted back to PracticeStudio. The Messaging system can be set to immediately alert you when lab results arrive; these reports can then be reviewed and marked appropriately when discussed with the patient.
• Charge and Diagnosis Posting: Since PracticeStudio is a comprehensive Electronic Health Record (EHR), CPT and Diagnosis notations made during chart entry can automatically be updated to the PracticeStudio billing system, which not only speeds posting but also prevents most posting errors.

Once you have finalized John's encounter, he would typically be directed to the insurance/collection office or to the front desk.

Finalizing the Visit

Any scripts, education articles, excuses, and/or instructions that have been created for him will already have printed either in the exam room or at the front desk.

Since John's charges have already been posted, the billing personnel can review those charges and collect his automatically calculated copay. (John's insurance plan(s), co-pay amount and type, and remaining deductible were all entered during patient registration.)