Process Model

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

(To zoom into diagram scroll over the diagram, and in the top left corner there will be a + and - sign. Click on the + to zoom and - to shrink.)

This business process diagram shows the patient intake process of the Flower Medical Center (FMC) Hepatic Oncology Center (HOC). I used the MIS Essentials textbook (Kroenke, 2014) to help me build the business process along with interviews from professionals that work in this process. This process can originate in three different ways.

The first is for a patient to be an FMC Tumor Conference patient.

At these conferences, physicians from the FMC liver disease center, FMC transplant center, and the FMC HOC discuss potential treatment options for a complex patient. If they determine the patient should not go to the FMC HOC they will figure out the best treatment plan for the patient (end of the process). If the physicians determine that the patient should go to the FMC HOC they decide which of the three physicians (Dr. Levi, Dr. Pope, or Dr. Bon) will be the best fit for the patient.

Then a representative of the department who presented the patient at the conference will call the patient to update them and to let them know that a nurse from the FMC HOC will be calling them to schedule an appointment. During the call, the representative will obtain permission from the patient, for the nurse of the specified doctor to call the patient to schedule an appointment. The nurse for Dr. Levi is Stephanie. The nurses for Dr. Pope are Amy (A-L) and Linda (M-Z). The nurse for Dr. Bon is Alyssa. Whichever nurse receives the email or call from the other department fills out as much information as possible on the FMC HOC Oncology/Surgery Service Intake Form for Established Patient Within FMC (pink form). The nurse obtains the pertinent information for the pink form from the established patient’s electronic medical records in the Electronic Medical Records System (EMRS) system (computer).  The nurse also verifies the patient’s health insurance in EMRS. Once this is done, the nurse calls the patient. If the patient does not pick up the phone the nurse documents the call in ERMS (computer) and in the telephone log chart (paper) and then tries to call the patient again at a later time. This process continues until the nurse reaches the patient. 

Once the patient answers the call, the nurse verifies all the patient’s information: social security #, address, home phone #, work/cell #, age/DOB, referring MD, PCP, Insurance information, Alternate Contact, Allergies, current medications, pharmacy, past surgical and medical history, social history, family history.  The nurse completes the rest of the form based on the patient’s answers to the questions on the form. If the patient’s information has changed the nurse should write down all of the changes on the form and update them in EMRS. If the patient’s information is the same the nurse makes sure the patient has had a CT scan with IV contrast done within the past month to month and a half (this information can be found in EMRS). If the patient has not had a CT scan done recently, the nurse will first schedule the patient for an appointment to see the doctor. The nurse schedules the patient an appointment based on the patient’s demographics, personal choice, the best office location for the patient, the availability of the patient, and the availability of the doctor. When the appointment to see the doctor has been scheduled, the nurse will schedule the patient for a CT scan the morning of the patient’s appointment with the doctor. The nurse will then send the information to the medical assistant to obtain authorization from the patient’s insurance company. If the patient has had a CT scan done recently the nurse schedules the patient an appointment with the physician based on the patient’s demographics, personal choice, the best office location for the patient, the availability of the patient, and the availability of the doctor.

After the nurse has successfully scheduled the patient an appointment, the nurse needs to determine if the patient has evidence from the medical records of gallstones and/or if the referring physician has referred the patient for a lap chole or a liver biopsy. If the nurse decides that the patient has either of these indications, the nurse schedules the patient an appointment with the anesthesiologist for the same day as their scheduled appointment. If the nurse determines that the patient does not have either of these indications, the nurse needs to determine if the HOC physician has spoken with the referring physician about the patient’s medical history to determine if the patient is going to be pre-op. If the HOC physician and referring physician decide that the patient is going to be pre-op the nurse schedules the patient an appointment with the anesthesiologist for the same day as their scheduled appointment.

Next the nurse needs to decide whether the patient has access to the internet and the ability to print out the New Patient Packet (NPP) from their email. If the patient is able to print out the packet, the nurse tells the patient that the HOC center (the nurse) is going to send the NPP to them via email. The nurse instructs the patient to fill out the packet and bring it with them to their next appointment. If the patient does not have access to the internet or is not able to print the NPP, the nurse needs to determine if the patient has a mailbox or a Post Office Box (P.O. Box). If it is not a P.O. Box, the nurse tells the patient that they are going to receive the NPP in the mail. Additionally, the nurse instructs the patient to complete the packet and to bring it with them to their appointment. If the patient’s mailbox is a P.O. Box, the nurse has to ask the patient if there is somewhere else the packet can be delivered that is not a P.O. Box. If there is another location or address, the nurse tells the patient that the FMC HOC will send the NPP to that address. The nurse also instructs the patient to complete the packet and to bring it with them to their scheduled appointment. If the patient does not have somewhere else for the packet to be delivered, the nurse must help the patient determine a way to get the NPP.

Once the patient is informed that they will either get the NPP through email or the mail, the nurse has to document the call in EMRS (computer) and in the telephone log chart (paper). If the nurse determined that the patient can print out the NPP, the nurse sends an email to the patient with the NPP attached, makes a copy of the completed FMC Hepatic Oncology Center Oncology/Surgery Service Intake Form for Established Patient Within FMC (pink form) for the utilization nurse, scans the form into the EMRS, and sends a copy of the form to the abstractors. When the abstractors receive a copy of the form they make sure everything is updated in the EMRS. When the patient receives the email, he/she prints out the NPP and fills it out. Then the patient brings the packet to their scheduled appointment. If the patient is scheduled to get a CT scan the morning of their appointment with the physician, they go to their scheduled CT scan appointment first and then to their appointment at FMC HOC (end of the process). If a patient does not have a scheduled CT scan appointment, he/she arrives at their appointment at FMC HOC (end of the process).

If the patient is getting their NPP through mail, the nurse makes a copy of the completed FMC Hepatic Oncology Center Oncology/Surgery Service Intake Form for Established Patient Within FMC (pink form) for the utilization nurse, scans the form into the EMRS, sends a copy of the intake form to the abstractors, and gives a copy of the intake form to the secretaries to inform them that they need to send a new patient packet through the mail. When the abstractors receive a copy of the form they make sure everything is updated in EMRS. Once the patient receives the NPP via mail, he/she completes the packet and brings it to their scheduled appointment. If the patient is scheduled to get a CT scan the morning of their appointment with the physician, they go to their scheduled CT scan appointment first and then to their appointment at FMC HOC (end of the process). If a patient does not have a scheduled CT scan appointment, he/she arrives at their appointment at FMC HOC (end of the process).

The second way this process can start is if a referring physician sees a patient in their office.

If the physician does not think the patient should go to FMC HOC they will determine the best treatment plan for the patient (end of the process). If the doctor decides that the patient should go to FMC HOC, he/she will refer the patient to the FMC HOC.  The referring physician will have their office staff call FMC HOC for a patient referral. When the FMC HOC secretary receives a call from the referring physician, she asks them if they have a Patient Appointment Request & Pre-Registration Form. If the office does the secretary will tell them to fill out the paper and fax it back to the FMC HOC office. If the office does not have a referring physician form the secretary will tell them that she is going to send the form to them by email/fax depending on referring physician's office preference. The secretary instructs the referring physicians office to fill out the form and fax it back to the FMC HOC office. 

When the referring physician’s office receives the fax/email, they need to complete the Patient Appointment Request & Pre-registration form. If the patient has been seen at a FMC facility before the referring physicians office faxes the completed form back to the FMC HOC office. However, if the patient has not been seen in an FMC facility before, the office needs to fax the completed form and the patient’s medical records back to FMC HOC. When the FMC HOC secretary receives the fax from the referring physician’s office or if the patient’s records are already in the EMRS, the secretary needs to see if the referring physician referred the patient to a specific doctor. If the physician requested a specific FMC HOC physician the secretary delivers (usually by hand) the form to a nurse based on the specified doctor. (The nurse for Dr. Levi is Stephanie. The nurses for Dr. Pope are Amy (A-L) and Linda (M-Z). The nurse for Dr. Bon is Alyssa) If the referring physician did not specify a physician the secretary delivers the form to one of the nurses based on the next doctor in the rotation (for fairness).

Whichever nurse receives the form from the secretary has to decide whether the patient has been in any FMC facilities before. If the patient has been in an FMC facility before they have the same process as a patient who is referred by an FMC Tumor Conference. If the patient has not been seen in any FMC facilities previously, the nurse calls the patient. If the patient does not answer the phone the nurse documents the call in the telephone log chart (paper) and tries to call the patient again at a later time. This process continues until the nurse reaches the patient.

Once the patient answers the call, the nurse fills out the FMC HOC Oncology/Surgery Service Intake Form (white form) based on patient’s answers to the nurse’s questions. Once the nurse has completed the form the nurse asks the patient if he/she has had a CT scan with IV contrast done within the past month to month and a half. If the patient has not had a CT scan done recently the nurse will first schedule the patient an appointment to see an HOC doctor. The nurse schedules an appointment based on the patient’s demographics, personal choice, the best office location for the patient, the availability of the patient, and the availability of the doctor. Once the appointment to see the doctor has been scheduled, the nurse will schedule the patient an appointment for a CT scan the morning of the patient’s appointment with the doctor. The nurse will then send the information to the medical assistant to obtain authorization from the patient’s insurance company. If the patient has had a CT scan done recently the nurse requests that the patient calls the facility where he/she had the scan done and to obtain the scan on a disk and get the doctor’s report of the CT scan. Then the nurse schedules the patient for an appointment based on the patient’s demographics, personal choice, the best office location for the patient, the availability of the patient, and the availability of the doctor.

After the nurse has successfully scheduled the patient an appointment, the nurse needs to determine if the patient has evidence from the medical records of gallstones and whether the referring physician has referred the patient for a lap chole or a liver biopsy. If the nurse decides that the patient has either of these conditions, the nurse schedules the patient an appointment with the anesthesiologist for the same day as their scheduled appointment. If the nurse concludes that the patient does not have either of these conditions, the nurse needs to make sure that the FMC HOC physician has spoken with the referring physician about the patient’s medical history to determine if the patient is going to be pre-op. If the FMC HOC physician and referring physician determine that the patient is going to be pre-op the nurse schedules the patient an appointment with the anesthesiologist for the same day as their scheduled appointment.

Next the nurse needs to decide whether the patient has access to the internet and the ability to print out the New Patient Packet (NPP) from their email. If the patient is able to print out the packet, the nurse tells the patient that the HOC center (the nurse) is going to send the NPP to them via email. The nurse instructs the patient to fill out the packet and bring it with them to their scheduled appointment. If the patient does not have access to the internet or is not able to print the NPP, the nurse needs to determine if the patient has a mailbox or a Post Office Box (P.O. Box). If it is not a P.O. Box, the nurse tells the patient that they are going to receive the NPP in the mail. Additionally, the nurse instructs the patient to complete the packet and to bring it with them to their appointment. If the patient’s mailbox is a P.O. Box, the nurse has to ask the patient if there is somewhere else the packet can be delivered that is not a P.O. Box. If there is another location or address, the nurse tells the patient that the FMC HOC will send the NPP to that address. The nurse also instructs the patient to complete the packet and to bring it with them to their scheduled appointment. If the patient does not have somewhere else for the packet to be delivered, the nurse must help the patient determine a way to get the NPP.

When the patient is informed that they will either get the NPP through email or the mail, the nurse has to document the call in the telephone log chart (paper). If the nurse determined that the patient can print out the NPP, the nurse sends an email to the patient with the NPP attached, makes a copy of the completed FMC HOC Oncology/Surgery Service Intake Form (white form) for the utilization nurse, scans the form into the EMRS system, and sends a copy of the form to the abstractors. When the abstractors receive a copy of the form they add the new patient into the EMRS system and put the patient’s information (from form) into the system. When the patient receives the email, he/she prints out the NPP and fills it out. Then the patient brings the packet to their scheduled appointment. If the patient is scheduled to get a CT scan the morning of their appointment with the physician, they go to their scheduled CT scan appointment first and then to their appointment at FMC HOC (end of the process). If a patient does not have a scheduled CT scan appointment, he/she arrives at their appointment at FMC HOC (end of the process).

If the patient is receiving their NPP through mail, the nurse makes a copy of the completed FMC HOC Oncology/Surgery Service Intake Form (white form) for the utilization nurse, scans the form into the EMRS system, sends a copy of the intake form to the abstractors, and gives a copy of the intake form to the secretaries to inform them that they need to send a new patient packet through the mail. When the abstractors receive a copy of the form they add the new patient into the EMRS system and put the patient’s information (from form) into the system. Once the patient receives the NPP via mail, he/she completes the packet and brings it to their scheduled appointment. If the patient is scheduled to get a CT scan the morning of their appointment with the physician, they go to their scheduled CT scan appointment first and then to their appointment at FMC HOC (end of the process). If a patient does not have a scheduled CT scan appointment, he/she arrives at their appointment at FMC HOC (end of the process).

The third way this process can start is if a patient decides to go to FMC HOC on their own.

If he/she decides to go to FMC HOC, he/she calls FMC HOC for an appointment. Usually, a secretary answers the phone. When the secretary answers the phone they fill out the Patient Appointment Request & Pre-registration form with the following information: patient’s name, DOB, SS#, home phone #, diagnosis/problem, referring physician, name of insurance, plan ID#, and whether he/she is requesting a specific FMC HOC physician (based on what the patient tells the secretary).

Next the secretary needs to determine if the patient has electronic medical records in the EMRS system. If the patient is not in the system, the secretary tells the patient to fax their medical records to FMC HOC. The secretary communicates with the patient that once FMC HOC receives the records, a nurse will call them to schedule an appointment. Subsequently, the patient has to request the records from their doctor’s office or they have to ask their doctor to fax their records directly to FMC HOC. After the patient requests their records or asks their doctor to fax the records, the patient/doctor faxes the patient’s medical records to FMC HOC.

When the secretary receives the patient’s medical records or if the patient’s medical records were already in the EMRS system, the secretary has to determine if the patient requested a specific FMC HOC doctor. Based on whether the patient wants a specific doctor or not, the secretary determines which nurse (the nurse for Dr. Levi is Stephanie. The nurses for Dr. Pope are Amy (A-L) and Linda (M-Z). The nurse for Dr. Bon is Alyssa) the secretary will deliver the Patient Appointment Request & Pre-registration form to. Once the secretary gives the form to one of the nurses the process is the same as the referring physician’s process.

Works Cited

Kroenke, D. M. (2014). MIS Essentials (pp.28-33). Upper Saddle River, NJ: Pearson Education, Inc.

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