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The Free Open Source EncounterPRO-OS EMR Clinical Groupware for Pediatrics and Primary Care Website

 

Under the Creative Commons Attribution 3.0 License

 

 

© 2010 The EncounterPRO Foundation

 

Please attribute The EncounterPRO Foundation as the creator of this work. Please indicate the title of the Work: The Free Open Source EncounterPRO-OS EMR Clinical Groupware for Pediatrics and Primary Care . Please include this URL for the Work: www.encounterPRO.org.

 

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EncounterPRO-OS Pediatric EMR Screenshots, Including Office View and Workplan Editor | Print |

"Why Do Your Screens Looks So Different from Other EMRs?"

We get this question all the time. Our screens look unusual because EncounterPRO-OS is based on a completely different technology from that of traditional EMRs. It is an EMR workflow management system (what is currently called clinical groupware). Compared to other non-process aware EMRs, EncounterPRO-OS has larger and fewer buttons on each screen. Fitts's and Hick's laws state that a large target button among a few other non-target buttons is easier to hit quickly and accurately than a small target button amongst many competing target buttons. Data and order entry in EncounterPRO-OS are fast because on each screen there are only a small number of large easy to hit targets.

   

So, you may ask, if each screen only has a few options, how can I do all the things I need to do during a patient encounter? By anticipating the sequence of screens, each with the relevant options appropriate to that task step, and presenting that sequence of screens to the user in quick succession. Each screen presents itself as part of the office workflow—bringing the right information, options, and tools to the right caregiver at the right time. The result is a decrease in the time it takes the physician to chart the vast majority of encounters, compared to competitors' systems or to paper charts.

EncounterPRO-OS Videos and Screenshots

Videos:  
Pediatrician Charts Routine Sick Visit in 37 Seconds (on EncounterPRO.com)
  The following two videos address two realistic pediatric scenarios included in this request for video demonstration of EncounterPRO:
Short Well Visit: Pediatrician Perspective (5 MB, Flash video, right-click to download, double-click to execute)
Short Sick Visit: Pediatrician Perspective (5 MB, Flash video, right-click to download, double-click to execute)
  Older videos (Illustrating more screens, explaining the unique Office View and Workplan Definition Editor):
Longer Sick Visit: Nurse and Pediatrician (Version 4)
Family Medicine: Nurse and Physician (Version 4)
Ob/Gyn: Nurse, (Version 4)
Ob/Gyn: Physician (Version 4)
  (Videos require Adobe Flash Player.)

Note that the order of the following screens is determined by the Standard Child Well Visit New Patient workplan. You can have different workplans for different visit types, different routine activities in your office, and even for different physicians who prefer different workflows.

Office View/Encounter Coordination

The Office screen is a tool that gives the physicians and staff the information and choices they need to manage their patients from check-in to check-out. Among many other features, the Office Screen shows the name of the patient in each office location, the service that the patient requires (e.g., examination, taking of vital signs, specified tests and immunizations), and how long the patient has been waiting for each service (shown by the number of minutes in parenthesis). The screen also shows—through color coding—the provider of the service. In addition, an asterisk shows that a service is currently being performed. Each status bar is hot; touching it brings up the right screen to accomplish the task. EncounterPRO-OS's Office View (called a "radar view" by usability engineers, for obvious reasons) is the most visible manifestation of what makes EncounterPRO-OS different from traditional "singleware" EMRs. It's clinical groupware--and they're not.

Vitals

When the nurse or technician enters his or her code in the exam room with the patient, the vitals screen automatically opens (because this is what the customizable workplan tells the EncounterPRO-OS workflow engine to do). Patient demographic information previously entered by the front office flows to the screen and is displayed at the top.

Chief Complaint

The Chief Complaint screen allows you to document the patient's reason for today's visit. You can enter complaints, the duration and onset of the symptoms, as well as noting any absent symptoms. If a symptom is not on the list, type it and then, if you wish, click "Add to List". Notice there are just a few (relative to other EMRs) big buttons. This is out of respect for Fitts and Hicks Laws in order to maximize quick, easy, and accurate data entry.

Current Medications

Medications noted in previous visits and those ordered by the provider appear automatically on the Current Medication screen. Add new medications as needed or close medications which have been discontinued to keep the list up to date. Some patients will not know the drug package, strength or dosage. When that occurs, you can still add the drug to the list, even if all you know is the name of the drug. If you later find out more information, you can remove the "placeholder" entry and add the medication with all the information.

Allergies

This screen displays any allergies reported by the patient (or parent/guardian). Allergies can be drug, food, environmental, etc. The severity and reaction can be documented for each allergy. For established patients, the clinical staff should confirm the existing allergies or lack thereof at each visit. The 1-Touch buttons at the bottom of the screen allow staff to quickly document that the patient was asked and reported either No New Allergies or No Known Allergies (NKA). When an allergy to a medication is documented on this screen, EncounterPRO-OS displays a red 'A' on all Treatment Lists for any treatments that are contraindicated due to the allergy.

Encounter Screen

The Encounter Screen is where the physician controls entry of patient data at the point of care. This screen is organized along the SOAP model. Below the demographic information and digital photograph, vitals are displayed along with other pertinent patient information. Tabs on the bottom bring up screens showing the open and closed assessments; drug histories; the child's development chart; and the documents that have been scanned into the patient's record. The area in the center of the screen shows a summary of the current encounter. Touching any line brings up details. The button on the left allow a review of past encounters, showing all associated observations, diagnoses, and treatments.

Physical Exam

Using the Physical Exam screen, the physician drills down to the abnormals and relevant normals in a few seconds. For a typical illness or well visit, the touch of a single button (customized by the physician to document all of the characteristics of that condition) records all the physical observations. This screen can be customized to reflect the preferences of the physician.

Assessments

If the patient's ailment is common, the physician touches one of buttons describing the most common assessments he uses in his practice. If the ailment is not among the pick list, he or she can search alphabetically or categorically for every ailment that has an associated current ICD code. At this point the ICD code can also be permanently added to the picklist for future use.

Treatments

This screen is pre-configured by each physician to present the common treatments for each assessment. If the treatment that the physician prefers is not here, he or she may search the database by clicking the "New Treatment" button on the right, or typing in an appropriate treatment on the keyboard (which can be added on to the picklist on the fly for future use). With the Composite Treatment bar, the physician can order a set of treatments with a single touch.

Prescriptions

If the physician selects a drug as a treatment, EncounterPRO-OS automatically brings up the prescription screen. EncounterPRO-OS calculates the dosage based upon the patient's current weight (entered from the vitals screen) and shows the physician's default settings for that particular drug. The physician can change the data shown on each gray bar by touching the bar and then touching a selection from the list that appears. EncounterPRO-OS then recalculates the data based upon the new selection. Every prescription is reviewed again when the physician electronically signs for the encounter and the prescription. If you have SureScripts e-prescribing enabled, through an EncounterPRO-OS partner, there is one extra click.

Billing Approval

At the end of each encounter, the Billing Screen permits review of the prescriptions and the billing data generated by the treatments and procedures selected during the encounter. Touching the billing block brings up a screen that permits billing adjustments and the addition of billing notes, either from an editable menu or by keyboard. This screen also allows a provider (e.g., a nurse practitioner) to request a recheck by another provider.

Workplan (Process Definition) Editor/Workflow Engine

Consider the order of the previous screens: Office View, Vitals, Chief Complaint, Medications, Allergies, and so on. Suppose you wanted to add your favorite Past Family and Social History to the workflow. This can easily be done by going to the Workplan Definition screen. (Workplans are the same as what are referred to as workflow "process definitions" in the workflow management/business process management systems industry.) The first step "Get Patient" occurred when a nurse took the patient to an exam room and clicked on that room in the Office View screen. The rest of these picklist items "programmed" the workflow engine to push the sequence of screens presented to the nurse. You'd click on "Add Step," rummage around amongst the hundreds of screens and screenless tasks in the EncounterPRO-OS, and add it to the workflow, as seen has been done here. EncounterPRO-OS's ability to execute workplans to push tasks to users is what makes EncounterPRO-OS a workflow system. Workflow systems are clinical groupware. EncounterPRO-OS combines to two most important kinds of clinical groupware: the kind that makes sure that groups of users execute routine tasks quickly and correctly, and the kind that helps groups of users "see" each other within a virtual care coordination space so they can depart from highly routinized behavior when this is needed.

 
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