Table 1.
Individual Steps for the In-Clinic Transaction
| Steps | Tasks | Days Elapsed |
|---|---|---|
| 1 | NCC reviews patient referral history | 1 |
| 2 | NCC checks with PCP about plan for referral | 28 |
| 3 | NCC consults PS, requests referral from PCP | 32 |
| 4 | PCP enters referral information into GDB | 32 |
| 5 | PS notes patient is referred | 32 |
| 6 | PS triages referral, checks insurance, mails letter about completing PQ before first appointment | 33 |
| 7 | PS notes referring clinic, edits referral | 33 |
| 8 | PS receives call from patient and gives PQ instructions | 35 |
| 9 | PS (in PQ database) provides user ID and password, documents in EMR | 35 |
| 10 | NCC checks referral status, waits for patient response to calls/letter | 36 |
| 11 | Patient logs in and completes PQ | 37 |
| 12 | NCC notes completed PQ, reviews referral, marks “in process,” and puts in scheduling queue | 38 |
| 13 | PS leaves voice mail with patient to call back and schedule with MDA per NCC | 38 |
| 14 | NCC reviews patient’s case notes and progress notes, enters data, starts goals | 38 |
| 15 | NCC reviews GDB, checks on appointment, calls patient for follow-up | 42 |
| 16 | PS (in call with patient) schedules patient for appointment, makes changes to GDB | 44 |
| 17 | PS assembles 6 forms for new patient packet, sends to patient | 44 |
| 18 | Patient completes forms, returns them to clinic | 44 |
| 19 | MA makes two changes to GDB for patient | 67 |
| 20 | Patient travels to clinic | 68 |
| 21 | Patient checks in at front desk with PS, provides ID, insurance, and file | 68 |
| 22 | Patient fills in another PQ in waiting area, provides medication and allergy list | 68 |
| 23 | PS prepares chart, queries multiple databases | 68 |
| 24 | MA prepares a room | 68 |
| 25 | MA directs patient from waiting area to room, takes vitals | 68 |
| 26 | MDA, MDF, and NCC see patient in room | 68 |
| 27 | MDA, MDF, and NCC exit room to consult | 68 |
| 28 | MDA, MDF, and NCC return to room with suggestion of referral | 68 |
| 29 | Paper record deposited in inbox in provider area | 68 |
| 30 | Patient returns to front desk, completes visit, makes follow-up appointment | 68 |
| 31 | Paper record from MDA taken from inbox, entered into GDB | 68 |
| 32 | NCC sends MDF’s plan to patient and PCP | 69 |
| 33 | Batch Scheduler accesses patient’s GDB note | 70 |
| 34 | PS enters two referrals into GDB, places in work queue for insurance authorization by FC | 72 |
| 35 | Two referrals, one approved and one denied by FC | 74 |
| 36 | PS leaves voice mail for patient to call back to schedule, sends letter | 74 |
| 37 | NCC discusses treatment plan with patient by phone and e-mail | 77 |
| 38 | PQ coordinator makes change in GDB for patient | 77 |
| 39 | NCC reviews GDB record, leaves voice mail with patient, sends message to PCP in GDB | 89 |
| 40 | PCP replies to NCC’s note | 90 |
| 41 | PS reschedules follow-up for patient with MDA | 96 |
| 42 | Patient cancels follow-up; PS reschedules follow-up | 97 |
| 43 | Patient cancels rescheduled follow-up | 103 |
| 44 | NCC reviews measures, calls patient for update and to schedule appointment | 138 |
| 45 | NCC calls and e-mails patient to facilitate follow-up | 140 |
| 46 | NCC e-mails patient | 153 |
Abbreviations: EMR, electronic medical record; FC, financial coordinator; GDB, global databases and Web-based EMR functionality; MA, medical assistant; MDA, attending MD (Pain Specialist); MDF, pain fellow; NCC, nurse care coordinator; PCP, primary care provider/community provider; PQ, patient questionnaire (background and history, outcomes assessment); PS, patient support services.