Allscripts EHR Certified Workflows v. 11.1

Allscripts Enterprise EHR

Certified Workflows
v. 11.1.x

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11/18/2009 2 Allscripts Enterprise EHR Certified Workflows

Table of Contents
Certified Workflows Overview ............................................................................................................. 8
(A) Appointment Scheduling................................................................................................................ 9
(B) Appointment Preparation............................................................................................................. 11
(C) Appointment Check-In................................................................................................................. 13
(D) Patient Visit Overview ................................................................................................................. 15
(E) Intake Introduction ....................................................................................................................... 18
(E1) Intake Process – Basic .............................................................................................................. 20
(E2) Intake Process – Detailed.......................................................................................................... 24
(E3) Intake Process – With Order ..................................................................................................... 29
(F) Retrieve Introduction.................................................................................................................... 34
Adult Patient View – Clinical Desktop View:.............................................................................. 35
Pediatric Patient View – Clinical Desktop View:........................................................................ 36
Pediatric Patient View: .............................................................................................................. 37
(F1) Chart Review – Basic ................................................................................................................ 38
(F2) Chart Review – Detailed ............................................................................................................ 41
(G) Document Introduction ................................................................................................................ 44
Utilizing Structured Notes – General Note Concepts ................................................................ 45
Patient Education Materials – Print Actions .............................................................................. 47
(G1) Note: Acute Visit ....................................................................................................................... 52
(G2) Note: New or Chronic Visit ........................................................................................................ 57
(G3) Note: Procedure Visit ................................................................................................................ 62
(G4) Note: Health Maintenance......................................................................................................... 66
(G5) Note: Results Review................................................................................................................ 70
(G6) Dictation .................................................................................................................................... 73
(G7) Admin Forms............................................................................................................................. 76
(H) Order and Plan Introduction ........................................................................................................ 78
(H1) Ad Hoc Prescription................................................................................................................... 80
(H2) Meds Management.................................................................................................................... 86
(H3) Med Administration.................................................................................................................... 90
(H4) Immunizations ........................................................................................................................... 94
(H5) Future Orders ............................................................................................................................ 97
(H6) Ad Hoc Diagnostic Orders....................................................................................................... 101
(H7) Follow-up or Referral Orders................................................................................................... 105
(H8) Instructions/Supplies Orders ................................................................................................... 108
(H9) Order Reminders..................................................................................................................... 111
(H10) QuickSets.............................................................................................................................. 114
(H11) CareGuides ........................................................................................................................... 117
(J) Finalize and Charge Introduction ............................................................................................... 120
(J1) Basic Ambulatory Charges....................................................................................................... 122


(J2) Charging from Note.................................................................................................................. 127
(J3) Charging for Orders ................................................................................................................. 130
(J4) Charging for Administrations.................................................................................................... 133
(J5) Review Encounter Charges ..................................................................................................... 135
(K) Follow-Up and Checkout Introduction ....................................................................................... 138
(K1) Scheduling Order Appointments.............................................................................................. 139
(K2) Referral Appointments............................................................................................................. 142
(L) Renewal Management Introduction ........................................................................................... 146
(L1) Prescription Renewals ............................................................................................................. 148
(L2) Surescripts Renewals .............................................................................................................. 156
(M) Document Management Introduction ........................................................................................ 159
(M1) Inbound Transcription ............................................................................................................. 161
(M2) Transcription with Dual Signature ........................................................................................... 165
(M3) Document Reconciliation ........................................................................................................ 169
(N) Transcribe Introduction.............................................................................................................. 172
(N1) Transcribe Basics.................................................................................................................... 173
(P) Scanning Introduction................................................................................................................ 177
Active Chart Scanning Strategies ........................................................................................... 178
Scanning Correspondence Approach ..................................................................................... 179
Lessons Learned Statements from Allscripts Clients .............................................................. 179
(P1) Scanning Active Charts ........................................................................................................... 181
Certified Workflow Tips ........................................................................................................... 184
(P2) Scanning Correspondence ...................................................................................................... 186
(Q) Miscellaneous Introduction........................................................................................................ 190
(Q1) Call Processing ....................................................................................................................... 192
(Q2) Tracking Overdue Orders........................................................................................................ 197
(Q3) Financial Authorization............................................................................................................ 200
(R) Results Introduction................................................................................................................... 204
(R1) Entry of Paper Results ............................................................................................................ 206
(R2) In-House Testing ..................................................................................................................... 210
(R3) Results Verification.................................................................................................................. 213
(R4) Results Referral ...................................................................................................................... 222
(R5) Results Communication .......................................................................................................... 225
(S) Inpatient Introduction ................................................................................................................. 230
(S1) Inpatient Charges .................................................................................................................... 232


Certified Workflows

This Certified Workflows guide contains all of the Certified Workflows for Allscripts Enterprise EHR
Version 11.1. Each of these workflows is discussed in detail in the following sections.
The following are overview road maps of the Patient Visit Workflows, Non-Patient Visit Workflows,
and the Inpatient Visit Workflows.
Figure 1 Patient Visit Workflows Road Map


Figure 2 Non-Patient Visit Workflows Road Map

Figure 3 Inpatient Visit Workflows Road Map


Certified Workflows Overview
The Certified Workflows consist of the following items:
▪ High-level Road Maps = 3
▪ Overview Workflow = 1
▪ Introductions = 13
▪ Workflows = 50
The Overview Workflow (Patient Visit – D) is a high-level overview of the entire patient visit and is
designed to provide the “big” picture of the overall steps involved in the process. It provides a break-
out of each “work lane” (also referred to as a “swim lane”) to assist in breaking out the work into
more easily understood sections (workflows). The Overview Workflow (D) can be used to achieve an
“end-to-end” understanding, but the details behind each step are contained in the subsequent 50
workflows.
The 13 Workflow Introductions (E, F, G, H, and so on) include a summary of the particular “work
lane,” a VISIO diagram, and information concerning the terminology or concepts being utilized. The
Workflow Introductions contains a series of questions/decisions and acts as a guideline for which
specific workflow path to follow.
Each Workflow section of this document (E1, E2, and so on) contains the detail steps to complete
the workflow. Each workflow has a VISIO diagram with the corresponding summary and detailed
steps. The user role is defined for each process step. Each workflow has been validated by Allscripts
employees and clinical consultants.
These Certified Workflows and the “Pre-Configuration” go “hand-in-hand.” Pre-configuration is
configuring the software in such a manner so that you can log into the Allscripts Enterprise EHR
software and perform any of the 50 Certified Workflows without being stopped because, for example,
you have not yet built the correct enterprise task views, Worklist views, or set the system
preferences and so on. The Pre-configuration “Gold” database contains all of these items already
configured to enable the Certified Workflows. One of the primary purposes of the Pre-Configuration
is to support the Certified Workflows.


(A) Appointment Scheduling
The first step of a patient visit is the scheduling of the appointment. The purpose of the following
Appointment Scheduling workflow is to achieve a basic understanding of the data flow at the time of
first contact with the patient and the impact to Allscripts Enterprise EHR.

Figure 4 (A) Appointment Scheduling

(3)
(1) (2) Staff creates New
A Patient requests Is appointment for Yes Patient in practice
appointment a new patient? management system
(PMS)

(4)
Staff schedules (5)
appointment in PMS Patient demographic B
No
& populates & scheduling info
Comments with sent to TouchWorks
reason for visit

To schedule a patient appointment, do the following:
1) The start of a patient visit begins with the patient requesting an appointment from your front
desk, scheduling line, or another role in your organization that handles patient appointments.
2) Is the appointment for a new patient? The amount and type of information you need to obtain
from the patient depends on whether the individual is an established patient or a new patient.
3) If the patient is a new patient, then you typically collect a certain set of basic demographic
information from the patient and enter it into the Practice Management System (PMS).

If a “mini registration (reg)” is done at this time and a temporary medical record
number is utilized, verify this number will be handled correctly in your
registration/scheduling interface.

4) If the patient is an established patient, or once the demographic information is collected for a
new patient, you then schedule the appointment in the Practice Management System and add
comments regarding the reason for the visit.


5) The registration and scheduling information is then sent via an interface to Allscripts Enterprise
EHR. This enables all Allscripts Enterprise EHR users to monitor their schedules directly from
Allscripts Enterprise EHR without having to switch to the Practice Management System.

It is important to understand what patient demographic data interfaces with
Allscripts Enterprise EHR from the Practice Management System.

6) Once the patient appointment is scheduled, the next step within the patient visit is appointment
preparation. Proceed to workflow (B) Appointment Preparation for the Certified Workflow
steps.


(B) Appointment Preparation
After scheduling the appointment, the second step to prepare for the patient visit is typically the
preparation of the paper chart. Your organization’s use of the Allscripts Enterprise EHR Scan
module for scanning paper charts into the electronic health record will impact this workflow step.
Your organization will go through two phases for this process. The first phase is the transition of
having paper charts and scanning in active (historical) chart information. The second phase occurs
when all paper charts have been scanned and you no longer have to consider them in your
workflow.
Your organization can select from among several strategies to complete the scanning of active
(historical) paper charts. Please refer to the (P) Scanning Introduction chapter for additional
details.

Figure 5 (B) Appointment Preparation

A

(2)
(1) Medical
B Is appointment for Yes Records
new patient? prepares new
patient packet

P1

(4)
(3)
Medical Records
Existing patient
No Yes scans patient
have a paper
information prior to
chart?
visit

No C


To prepare for a patient appointment, do the following:
1) The first step of the appointment preparation process is to determine if the appointment is for a
new or an established patient. If the patient is new and your organization is scanning, no paper
chart will currently exist and typically one will not be created.
2) If the appointment is for a new patient, a patient packet is usually prepared for the patient to fill
out upon check-in per the organization’s protocol. This could include demographic, insurance or
Health Insurance Portability and Accountability Act (HIPAA) forms, patient medical history
information, and so on. This information is typically prepared by either the Medical Records or
Front Desk roles.
3) If the appointment is for an existing patient, it is important to understand whether a paper chart
exists. If a paper chart does not exist or has already been scanned, no work to pull the chart is
needed.

Many organizations use a field within their Practice Management System or a chart
tracking system as a method to track whether a paper chart has been scanned.
This makes it easy for staff to quickly know if they need to pull a chart for the visit.

4) If a paper chart exists, your organization’s scanning procedure will impact this workflow in terms
of timing. Allscripts recommends that the scanning of paper charts be done optimally at least 2
weeks prior to the patient visit if possible. This ensures that needed documentation is available
for the visit within the system. Please refer to workflow (P1) Scanning Active Charts for the
Certified Workflow steps.
5) Once the necessary information is prepared for the patient appointment, the next step within the
patient visit is appointment check-in. Proceed to workflow (C) Appointment Check-In for the


(C) Appointment Check-In
The day of the appointment arrives and the patient comes to the clinic. The purpose of the following
Appointment Check-In workflow is to achieve a basic understanding of when the patient checks-in
for the visit and the impact of that process for the Front Desk and the data sent to Allscripts
Enterprise EHR.

Figure 6 (C) Appointment Check-In

To prepare for a patient check-in, do the following:
1) The patient typically registers at the front desk, a defined check-in area, or at a reception area.
2) The data collection process may differ depending on whether the patient is a new or an
established patient.
3) If the patient is new, the patient is given the new patient packet to complete.
4) Front Desk updates the required information in the Practice Management System. If a “mini
registration” was done at the time the appointment was made, this step may also include
assigning a permanent medical record number to the patient.

It is important to validate the change from a “mini reg” to a permanent medical
record in your registration/schedule interface.

5) For an established patient, the Front Desk verifies demographic and insurance information, and
updates as needed.

Patient updates should be entered immediately into the Practice Management
System to allow for accurate and timely data flow into Allscripts Enterprise EHR.

6) The final step is to change the appointment status in the Practice Management System to
“Arrived.”


7) The patient demographic and insurance data entered in the Practice Management System is
sent via the registration/scheduling interface to Allscripts Enterprise EHR. This includes the
updated appointment status and comments, which enables the clinical staff to see when patients
have arrived and why they are coming in.
8) Front Desk scans documents as appropriate. This may include the new patient packet, patient’s
insurance card or driver’s license, and so on. Your organization needs to consider all instances
where “loose” correspondence is received and has to be scanned into the electronic health
record. Please refer to workflow (P2) Scanning Correspondence for the Certified Workflow
steps.
9) Front Desk updates the patient location and status. To set the patient location and status, follow
these steps:
a) Front Desk should be logged into Allscripts Enterprise EHR. If not logged in, launch the
application by double-clicking on the Allscripts Enterprise EHR desktop icon.
b) From the Chart menu, the daily Schedule tab should be active. Make sure the appropriate
schedule is displaying. Adjust the provider or date where appropriate.
c) Review the schedule and single-click on the desired patient. The Clinical Toolbar enables.
d) From the Clinical Toolbar, click the Patient Location drop-down list. A list of available
locations displays.
e) Select the appropriate location.
f) To set the status, click the Status drop-down list. A list of available statuses displays.
g) Select the appropriate status.
10) Staff uses Allscripts Enterprise EHR to monitor the arrival status of patients on their schedule.
11) Once the patient is checked-in, proceed to workflow (D) Patient Visit Overview to review the
high-level Certified Workflow steps for the entire patient visit.


(D) Patient Visit Overview
The purpose of the following Patient Visit Overview workflow is to achieve a high-level
understanding of the steps involved in the overall patient visit process including the steps performed
by the nurse and provider during a typical visit. See the corresponding workflows as indicated in the
following diagram, for more detailed instructions concerning each process.

Figure 7 (D) Patient Visit Overview

D: Patient Visit Overview

C
E
(1) (3)
Intake

(2)
Clinical Staff escorts Clinical Staff sets
Clinical Staff
D patient to exam area exam room indicator,
completes intake
to begin intake patient ready for
process
process provider

F
Retrieve

(5)
(4)
Provider completes
Provider begins
review of patient
patient visit
data

G
Document

(7)
(6)
Provider completes
Provider goes to
all note sections as
note, updating chief
appropriate for
complaint as needed
encounter

H
Order & Plan

(8)
(9) (10)
Does an order
Yes Provider creates Provider completes
need to be
order plan
created?

No
J
Finalize &
Charge

(11) (12) (13)
Provider reviews Provider signs Note Provider reviews &
Note Output(s) Output(s) submits charges
Follow-up &

K
Checkout

(15)
(14)
Clinical Staff
Provider updates (16)
completes required End
Patient Status, if Patient checks out
patient follow-up as
needed
appropriate


Patient Visit Overview:
1) The first step of the patient visit process is for the clinical staff to bring the patient back from the
waiting area to the exam area to begin the patient intake process. Typically, the staff monitors
the Schedule screen in Allscripts Enterprise EHR and is notified the patient is there when the
status of the appointment is updated to “Arrived.” Regardless of the physical location, a PC,
Tablet PC, or other means of data entry should be available.

The patient’s arrival status must be updated in the Practice Management System
before the encounter documentation can be started.

2) The intake process is usually done either outside the exam room at a pre-determined “vitals”
area or in the exam room itself. Either way, the exact order of when the staff takes vital signs vs.
collecting current medications or the chief complaint is determined by the physical location of the
patient, taking into consideration HIPAA regulations and discussions with the patient that must
be kept private. Follow the collection of (E) Intake Process workflows for the Certified Workflow
steps depending on the type of visit.
3) The final step prior to the clinical staff transitioning the patient to the provider is to indicate that
the patient is ready for the provider. You can do this using the Patient Location and Status
fields in Allscripts Enterprise EHR or using a visual exam room indicator such as lights, flags, or
a card system. Your organization could choose to continue using a visual indictor or simply
switch to using the electronic equivalent by utilizing the Patient Location and Status fields. An
additional option is to use both methods.
4) The provider is now ready to begin the visit.
5) As the provider begins the patient visit, they usually review the chart prior to entering the exam
room. The device in use (Tablet PC, PC, laptop, and so on) typically determines the location of
this review. This review, prior to engaging the patient, is to familiarize themselves with the
details regarding the patient. This data could include prior medical records for a new patient,
results, orders, prescriptions, and so on. Allscripts Enterprise EHR has many components
located on the Clinical Desktop to help facilitate this type of clinical “retrieval” of information.
Follow the collection of (F) Retrieve workflows for the Certified Workflow steps.
6) Once the provider completes the clinical review and begins the patient visit, they either begin the
note or go to a note if one was started by the clinical staff.
7) Once the note is opened, the note sections and note forms defined for the visit type selected will
automatically compile based on administrative defaults and setup. Follow the collection of (G)
Document workflows for the Certified Workflow steps on documenting the patient visit. The
documentation process changes depending on the type of visit, such as an acute or chronic visit,
a procedure visit, an HMP visit, or a visit that includes dictation, and so on.
8) During the visit, the provider determines if an order needs to be placed. If no order is necessary,
the provider may want to document what was discussed within the Discussion/Summary section
of the note.
9) If an order needs to be created, the provider creates the desired order, which is typically done by
order type such as a prescription, laboratory, radiology, supply, follow-up appointment, referral,
immunization, or a request for an administration. Follow the collection of (H) Order and Plan
workflows for the Certified Workflow steps. These workflows contain certified steps for creating
both ad hoc and problem-based orders.


10) Documenting the plan is part of ordering and typically involves all the orders that make up the
patient “Careplan” for the assessed problem(s).
11) Prior to signing the note, the provider makes one final review of the completed note by viewing
all output documents and carbon copy recipients. A note can be associated to a single or to
multiple output documents. Any additional note inputs should be done from the Note Authoring
or Accumulator workspaces.
12) Once the note is ready, the provider signs the note outputs. This can be done by either viewing
and signing each individual output or using the Sign action in the Note Authoring workspace to
sign all output documents simultaneously.
13) After completing the patient visit, the provider is ready to submit charges for the encounter.
Follow the collection of (J) Finalize & Charge workflows for the Certified Workflow steps.
14) Once the provider has completed the patient visit, the final step is to update the Patient
Location and Status fields. This enables all staff to know the visit is completed and whether the
patient is departed, ready for transport, or if follow-up is needed.

A system preference can be set to automatically clear the Patient Location field
after a certain length of time defined by the organization. This would eliminate the
user requirement to clear this field.

15) Additional tasks may be required of staff members prior to the patient leaving the office. These
tasks could include such items as scheduling a follow-up or referral appointment, having orders
pending to be collected or completed, and so on. Follow the collection of (K) Follow-Up and
Checkout workflows for the Certified Workflow steps.
16) Once the required follow-up is completed, the patient checks out.


(E) Intake Introduction
The patient intake process involves the gathering of patient information by the clinical staff in
preparation for seeing the provider. The intake process is usually done either outside the exam
room at a pre-determined “vitals” area or in the exam room itself. The specific order of taking vital
signs, collecting relevant patient history (such as allergies, medication history, and so on) and
indicating the chief complaint will be determined by the physical location of the patient.
It may also be common for the clinical staff to begin the note for the provider. The decision for the
clinical staff to begin a note is typically organizationally driven and is presented as a decision point
within each Intake workflow.
Figure 8 (E) Intake Introduction

D

Acute or
E established patient Yes E1
visit?

No

Chronic or new E2
Yes
patient visit?

No

Patient visit with E3
Yes
an order?

No

End


The following workflows in this section address the most common intake types, as defined below:

Intake Type Description

Basic Typically associated with an acute care visit or with an established
patient returning for a simple check-up or problem. See workflow
(E1) Intake Process – Basic.

Detailed Is commonly associated with a new patient who requires a
thorough examination of past medical information, a chronic
patient visit, or a patient that is having multiple problems. See
workflow (E2) Intake Process – Detailed.

With Order Used for a patient visit that requires an order (typically a nursing
order by protocol) placed as part of the Intake Process. See
workflow (E3) Intake Process – With Order.


(E1) Intake Process – Basic
The clinical staff brings the patient back to an exam room to begin the intake process. This workflow
is to achieve an understanding of what information is typically reviewed and updated within Allscripts
Enterprise EHR during a basic intake process.

Figure 9 (E1) Intake Process - Basic

To perform a basic intake, follow these steps:
1) The clinical staff begins the Intake process by selecting a patient with a status of “Arrived” from
the Schedule within Allscripts Enterprise EHR. To bring a patient into context from the daily
schedule, do the following:
a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the
c) Review the schedule and double-click on the desired patient. The Clinical Desktop displays.


2) The clinical staff sets the patient location and status to reflect where the patient is. To set the
patient location and status, follow these steps:
a) From the Clinical Toolbar, click the Patient Location drop-down list. A list of available
locations displays.
b) Select the appropriate location.
c) To set the status, click the Status drop-down list. A list of available statuses displays.
d) Select the appropriate status.
3) The clinical staff is now ready to collect the patient’s vital signs. To enter a patient’s vital signs
into Allscripts Enterprise EHR, follow these steps:

a) From the Clinical Toolbar, click on the Add Vital Signs icon. The default vital signs
view displays within the Order Details page.
b) Enter all the necessary vital sign information for that patient.
c) When finished, click OK.
4) From the Clinical Desktop, the clinical staff reviews the patient’s allergies and current
medications under the respective component. Allergies and medications are the common
patient history components that are typically reviewed as part of a basic visit type.
5) Do allergies and/or medications need to be updated? If no updates are needed, proceed to step
7.
6) If updates are needed, the clinical staff updates the patient’s history within the Add Clinical Item
(ACI) workspace. The ACI is the principal workspace where they can update the patient’s
allergies and medications without having to go to multiple places.
a) To add a new allergy, do the following:
i) Under the Allergies component, click New on the action toolbar to launch the Add
Clinical Item workspace. The ACI displays with the History Builder and Allergies tabs
active.
ii) To search for a medication allergen, click the Medication option; to search for a non-
medication allergen, click the Non-medication option.
iii) Find an allergy using Specialty or Personal Favorites, QuickList, or by Master search.
iv) Select an allergy by entering a checkmark in the appropriate box or double-click on the
desired allergy to add details.
v) Repeat steps ii – iv as needed.

Clinical staff can specify that a patient has no known allergies where appropriate by
selecting No Known Drug Allergies or No Known Allergies.

b) To add a new medication history, do the following:
i) Click on the Med Hx tab.
ii) Select the Active Problem view from within the “Problem” section of the patient pane
(located at the top on the left-hand side), if needed.
iii) Highlight the appropriate problem by single-clicking on the problem name.


iv) Find the medication using Specialty or Personal Favorites, QuickList, or by Master
search.
v) Select a medication by entering a checkmark in the appropriate box or double-click on
the desired medication to add details, such as SIG information.
vi) Repeat steps iii – v as needed.

Best Practice is to link medication histories to the appropriate problems. This will
automatically add that medication to the health management plan for that problem
as well as aid in building of QuickSets.

7) Once they have reviewed those items with the patient, the clinical staff selects the patient’s chief
complaint (primary complaint that triggered the appointment). Follow these steps to select the
chief complaint:
a) From within the Add Clinical Item workspace, click on the Chief Complaint secondary tab. If
not within the ACI, click on the Add New Problem icon from the Clinical Toolbar.
b) Find the appropriate chief complaint using an incremental or alphabetical search.

For a chief complaint to appear within the Add Clinical Item workspace there must
be an associated published symptom form.

c) Select the chief complaint by entering a checkmark in the appropriate box. The items display
in the problem section of the patient pane.
d) Click OK when finished. The Clinical Desktop displays.
8) Does the clinical staff begin the note? Some organizations allow the clinical staff to begin the
note and document designated pieces of the patient visit.
9) If yes, the clinical staff starts the note. Follow these steps to begin a note:
a) From the Clinical Toolbar, click on the Note Authoring icon to start a new note. The Note
Selector screen displays.
b) Validate the Note Style selected is Note.
c) Select the appropriate Specialty, if needed.

Clinical staff can determine which specialty to default within the Note Selector page
by setting the “Default Specialty ID” preference.

d) Select the appropriate Visit Type and/or Visit Sub-Type.
e) Review the Chief Complaint(s). Click OK to continue with no changes or click on the
Add/Remove Chief Complaint link to modify. Once complete, click OK.
f) The Note Authoring workspace (NAW) displays. The system compiles the correct note forms
based on the specialty, visit type, chief complaint(s) and the patient’s age and sex.
g) Clinical staff updates the appropriate note sections per the organization’s protocol.
10) Clinical staff reviews all the information that was entered for the encounter.
a) If the clinical staff began a note, the encounter review takes place within the Note Authoring
workspace. To review the encounter information, use any of the following:


 Click on the Encounter Summary icon from the Clinical Toolbar. The Encounter
Summary page displays.
 Click on the desired Note Section from the table of contents.
 Select the desired output and click View.
b) If no note was created, follow these steps to review the encounter information:
i) From the Clinical Toolbar, click on the Encounter Summary icon. The Encounter
ii) All unsaved information will appear in magenta-colored text.
iii) Clinical staff reviews the encounter information and edits, if necessary.
11) Clinical staff updates the patient status to reflect the next step within the patient visit and
commits the data.
a) To set the patient status and commit the encounter information from the Note Authoring
workspace (NAW), follow these steps:
i) Click the Status drop-down list from the Clinical Toolbar.
ii) Select the appropriate status.
iii) Click Sign. The Note Signature page displays.
iv) Enter your password and click OK.

All unsaved data is committed when the note is signed.

b) To set the patient status and commit the encounter information from the Encounter
Summary, follow these steps:
i) Click the Status drop-down list. A list of available statuses displays.
iii) Click Save and Continue.
12) Clinical staff returns to the daily schedule to prepare for the next patient. To return to the daily
schedule, click on the Schedule horizontal toolbar.

For the instances where the clinical staff begins the note, administrators can set the
Note preference “Default Navigation After Signing” to Schedule to automatically
take them to the daily Schedule after signing the note to prepare for the next
patient.

13) Once the patient intake process is complete, proceed to the (F) Retrieve workflows for the


(E2) Intake Process – Detailed
The clinical staff has brought the patient back to an exam room to begin the intake process. The
purpose of the following workflow is to achieve an understanding of what information is typically
reviewed and updated within Allscripts Enterprise EHR during a more detailed intake process. This
usually involves a more in depth look at the patient’s overall history.
Figure 10 (E2) Intake Process - Detailed

E

(2) (3)
(1)
Clinical Staff sets Clinical Staff (4)
E2 Clinical Staff selects Yes
the patient location collects patient Is patient new?
patient off schedule
& status vitals

No

(5) (6) (7)
Clinical Staff Does patient hx Clinical Staff
Yes PMH
reviews patient need to be updates patient
history updated? history
PSH

Fam Hx

No Social Hx

Allergies

Med Hx
(8)
Clinical Staff selects Immun Hx
chief complaint

(9) (10)
Clinical Staff begins Yes Clinical Staff starts
note? note

(12) (13)
(11)
Clinical Staff Clinical Staff returns
Clinical Staff F
No updates patient to schedule to
reviews encounter
status & commits prepare for next
information
data patient

To perform a detailed intake process, follow these steps:
1) The clinical staff begins by selecting a patient with a status of “Arrived” from the Schedule within
Allscripts Enterprise EHR. To bring a patient into context from the daily schedule, do the
following:
locations displays.


3) The next step is to collect the patient’s vital signs. Follow these steps to enter a patient’s vital
signs into Allscripts Enterprise EHR:
a) From the Clinical Toolbar, click on the Add Vital Signs icon. The default vital signs view
displays within the Order Details page.
b) Enter all the necessary vital signs information for the patient.
4) Is the patient new? The intake process may differ depending on whether the patient is a new or
an established patient. If the visit is for a new patient, proceed to step 7.
5) For an established patient, the clinical staff begins by reviewing the patient’s history from the
Clinical Desktop with the patient to ensure that the information is accurate and up-to-date.
6) Does any of the patient’s information need to be updated?
7) Clinical staff updates the patient’s history within the Add Clinical Item (ACI) workspace. The
ACI is the principal workspace where they can update the patient’s past medical history, past
surgical history, family history, social history, allergies, medication and immunization without
having to go to multiple places.
a) To add a new problem and/or update problem history, follow these steps:
i) From the Clinical Toolbar, click on the Add New Problem icon. The Add Clinical Item
workspace displays with the History Builder tab active.
ii) Click on the corresponding secondary tab to add problem information:
▪ PMH ─ Past Medical History
▪ PSH ─ Past Surgical History
▪ Fam Hx ─ Family History
▪ Social Hx ─ Social History

Some organizations choose not to have clinical staff enter problems as part of the
intake process. Instead, all problems are managed by the provider. Allscripts
enables the clinical staff to enter problem history as “unverified” and have the
provider verify them while seeing the patient.

iii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master
search.
iv) Select a problem by entering a checkmark in the appropriate box or double-click on the
desired problem to add details.
v) Repeat steps ii – v as needed.
b) To add a new allergy, do the following:
i) Click on the Allergies tab.




c) To add a new medication history, do the following:
search.


d) To add a new immunization history, do the following:
i) Click on the Immun Hx tab.
iii) Highlight the ‘Health Maintenance’ problem by single-clicking on the problem name.
iv) Find an immunization using Specialty or Personal Favorites, QuickList, or by Master
search.
v) Select an immunization by entering a checkmark in the appropriate box. The
Immunization Details page displays.
vi) Enter a Date (required) by clicking on the Calendar icon. The Select a Date dialog
displays.
vii) Select a date or a fuzzy date.
viii) Click OK.
ix) Repeat steps iii – viii as needed.
chief complaint:





f) The Note Authoring workspace (NAW) displays. The system compiles the correct note forms
based on the specialty, visit type, chief complaint(s) and the patient’s age and sex.
workspace. To review the encounter information, use any of the following:
 Click on the desired Note Section from the table of contents.
iii) Clinical staff reviews the encounter information and edits it, if necessary.
commits the data.
workspace, follow these steps:





In the cases where the clinical staff begins the note, administrators can set the Note
preference “Default Navigation After Signing” to Schedule to automatically take
them to the daily Schedule after signing the note to prepare for the next patient.



(E3) Intake Process – With Order
The clinical staff brings the patient back to an exam room to begin the intake process. This workflow
is to achieve an understanding of what information is typically reviewed and updated within Allscripts
Enterprise EHR during the intake process where an order is placed per protocol for the patient visit.
Figure 11 (E3) Intake Process – With Order

E

(4)
(2) (3)
(1) Clinical Staff (5)
Clinical Staff sets Clinical Staff
E3 Clinical Staff selects reviews patient Clinical Staff selects
the patient location collects patient
patient off schedule history and updates chief complaint
and status vitals
as appropriate

H

(6) (7)
Is order required Yes Clinical Staff
per protocol? completes order

(8) (9)
No Clinical Staff begins Yes Clinical Staff starts
note? note

(10) (12)
(11)
Clinical Staff Clinical Staff returns
Clinical Staff F
No reviews and saves to schedule to
updates patient
encounter prepare for next
status
information patient

To perform an intake process with an order, follow these steps:
1) The clinical staff begins the Intake process by selecting a patient with a status of “Arrived” from
the Schedule within Allscripts Enterprise EHR. To bring a patient into context from the daily
schedule, follow these steps:
application by double-clicking the Allscripts Enterprise EHR desktop icon.
locations displays.


3) The clinical staff is ready to collect the patient’s vital signs. To enter a patient’s vital signs into
Allscripts Enterprise EHR, follow these steps:
a) From the Clinical Toolbar, click the Add Vital Signs icon. The default vital signs view
displays within the Order Details page.
b) Enter all the necessary vital signs information for that patient.
4) The clinical staff begins reviewing the patient’s history from the Clinical Desktop with the patient
and updates it as appropriate.
a) To update an existing chart item, do the following:
i) From the Clinical Desktop, right-click on an item and select Edit from the context menu.
ii) Add the necessary details.
iii) Click OK.
b) To add a new problem and/or update problem history, follow these steps:
i) From the Clinical Toolbar, click on the Add New Problem icon. The Add Clinical Item
workspace displays with the History Builder tab active.
ii) Click on the corresponding secondary tab to add problem information:
▪ Active ─ Active Problems
▪ PMH ─ Past Medical History
▪ PSH ─ Past Surgical History
▪ Fam Hx ─ Family History
▪ Social Hx ─ Social History

Some organizations choose not to have clinical staff enter problems as part of the
intake process. Instead, all problems are managed by the provider. Allscripts
enables the clinical staff to enter active problems and problem history as
“unverified” and have the provider verify them while seeing the patient.

iii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master
search.
iv) Select a problem by entering a checkmark in the appropriate box or double-click on the
desired problem to add details.
v) Repeat steps ii – v as needed.
c) To add a new allergy, do the following:
i) Click on the Allergies tab.




d) To add a new medication history, do the following:
search.


e) To add a new immunization history, do the following:
i) Click on the Immun Hx tab.
iii) Highlight the ‘Health Maintenance’ problem by single-clicking on the problem name.
iv) Find an immunization using Specialty or Personal Favorites, QuickList, or by Master
search.
v) Select an immunization by entering a checkmark in the appropriate box. The
Immunization Details page displays.
vi) Enter a Date (required) by clicking on the Calendar icon. The Select a Date dialog
displays.
vii) Select a date or a fuzzy date.
viii) Click OK.
ix) Repeat steps iii – viii as needed
chief complaint:



6) Is an order required per protocol? If an order is not required, the clinical staff closes the Add
Clinical Item workspace by clicking OK.
7) If an order is required, clinical staff places an order. Clinical staff remains within the Add Clinical
Item workspace (after documenting the chief complaint) and clicks on the corresponding primary
tab (Rx/Orders or Problem-based) specific to their ordering behavior. Refer to the (H) Order &
Plan workflows for the Certified Workflow steps for ordering.


f) The Note Authoring workspace displays. The system compiles the correct note forms based
on the specialty, visit type, chief complaint(s) and the patient’s age and sex.
workspace (NAW). To review the encounter information, use any of the following:
 Click on the desired note section from the table of contents.


iii) Clinical staff reviews the encounter information and edits, if necessary.
commits the data.
workspace, follow these steps:



In the instances where the clinical staff begins the note, administrators can set the
Note preference “Default Navigation After Signing” to Schedule to automatically
take them to the daily Schedule after signing the note to prepare for the next
patient.



(F) Retrieve Introduction
As part of the patient visit, the provider reviews information regarding the patient either just prior to
entering the exam room or during the first few minutes of the exam. The specific type of data
reviewed may vary depending on why the patient is there, but the provider can greatly enhance the
usefulness of the information they retrieve by using any of the following three fundamental methods
for viewing information:
▪ Automated patient summaries
▪ Trends, graphs, or flow sheets
▪ Customized views
Each of these methods enables the provider to choose how to view the contents of the electronic
health record, whether they are reviewing office notes, lab tests, imaging results, consultations,
nursing notes, visit slips, or insurance forms. The purpose of retrieving and viewing chart
information is to provide a better level of patient care and to do so with as little effort as possible.
Figure 12 (F) Retrieve Information

D E1

E2 E3

Acute or
F Established Patient Yes F1
Visit?

No

Chronic or New F2
Yes
Patient Visit?

No

End

The following documents describe the steps to view or retrieve patient chart information for either a
basic chart review or a detailed chart review.


Visit Type Description

Basic Visit The basic visit type is defined as typically associated with an acute
Type care visit for simple self-limited problems, such as would be seen in
an urgent or primary care facility or with an established patient
returning for a simple check-up or problem. See (F1) Chart Review
- Basic workflow for more information.

Detailed The detailed visit type is directed more toward management of one
Visit Type or more chronic problems as seen in internal medicine or specialty
medicine, or for a new patient who requires a more in-depth viewing
of historical data or is presenting with complex or multiple problems.
See (F2) Chart Review - Detailed workflow for more information.

The provider has access to all areas of a patient’s record from the Clinical Desktop. It is important
to understand how the Clinical Desktop is set up in order to optimize workflow. The following
illustration is an example of a suggested starter configuration of the Clinical Desktop for efficient
review of adult patient data:

Adult Patient View – Clinical Desktop View:

This Clinical Desktop View (Adult Patient View) is an Allscripts delivered view which has been set up
as follows:
Layout = View 3
Component Group #1 (Upper Left Pane):


▪ Problem – default view to Active Problems with secondary sort set to Type
▪ Encounter – default view set to All by Appointment
Component Group #2 (Lower Left Pane):
▪ Meds – default view set to Current Medications secondary sort set to Alpha
▪ Allergies – default view set to All with secondary sort set to Urgency
▪ Orders – default view set to Current Orders with secondary sort set to Status
Component Group #3 (Right Pane):
▪ Health Management Plan – default view to Health Management with secondary sort set
to Problem
▪ ChartViewer – default view to All by Section by Sub-Section
▪ Patient Worklist – default to provider preferred Worklist View
The Health Management Plan component is the principal workspace where providers can view and
manage numerous aspects of patient data. It allows providers to quickly review current medications
and orders, HMP reminders and recent results for the selected patient without having to go to
multiple workspaces.

Use the Hide VTB (Hide Vertical Toolbar) and Full Screen controls to maximize the
Clinical Desktop and Component workspace.

The previous view is an excellent starting point for most specialties whether the patient visit is a
basic or detailed visit type. An exception is for the Pediatrics specialty, for which the following
Allscripts delivered view is defined as:

Pediatric Patient View – Clinical Desktop View:


Pediatric Patient View:
Layout = View 3
Component Group #1 (Upper Left Pane):
▪ Problem – default view to Active Problems with secondary sort set to Type
▪ Encounter – default view set to All by Appointment
▪ Patient Worklist – default to provider preferred Worklist View
Component Group #2 (Lower Left Pane):
▪ Meds – default view set to Current Medications secondary sort set to Alpha
▪ Allergies – default view set to All with secondary sort set to Urgency
▪ Orders – default view set to Current Orders with secondary sort set to Status
Component Group #3 (Right Pane):
▪ Growth Charts – Set to display Flowsheets for Normative Growth
▪ Immuns – Set to display Immunization Series
▪ ChartViewer – default view to All Section by Sub-Section
▪ Health Management Plan – default view to Health Management with secondary sort set
to Problem


(F1) Chart Review – Basic
The purpose of the following workflow is to achieve an understanding of what information is typically
reviewed by the provider just prior to entering the exam room or during those first few minutes of the
exam for a basic visit type. The main goal of retrieve or chart review is to allow the provider to view
and interact with as much data regarding the patient as possible. A basic visit is typically associated
with an acute care visit for simple self-limited problems, such as would be seen in an urgent or
primary care facility or with an established patient returning for a routine follow-up. The following
illustration depicts a basic chart review process.
Figure 13 (F1) Chart Review - Basic

F

(1)
(2)
Has note been
F1 Yes Provider selects
started by Clinical
note from schedule
Staff?

(3) (4)
Provider selects Provider reviews
No
patient from today’s encounter
Schedule summary

(5)
Provider reviews
patient’s clinical Problems
information &
updates as needed
Medications

Allergies
(7) (8)
(6)
Need to review Provider reviews
Vital Signs Provider reviews Yes
previous or scanned most recent chart
recent results
notes? notes

No G

To retrieve information for a basic chart review, do the following:
1) Has the note been started by the clinical staff? As part of the intake process some practices
have the clinical staff begin the note and document various note sections defined by the
organization.
2) If yes, the provider selects the note from the schedule for the patient being seen. To select a
note from the schedule, follow these steps:
a) Provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the
b) From the Chart vertical toolbar, the daily Schedule horizontal toolbar should be active.
c) Review the schedule and click on the note icon next to the desired patient’s name. The Note
Authoring workspace (NAW) displays.
3) If the note was not started by the clinical staff, the provider selects the patient from the schedule
and brings the patient encounter into context. To bring a patient into context from the daily


a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the
4) Provider opens today’s encounter summary to review the data entered by the clinical staff as
well as view any alerts and/or reminders.
a) To review the encounter information from within the Note Authoring workspace or from the
Clinical Desktop, click on the Encounter Summary icon from the Clinical Toolbar. The
Encounter Summary page displays.
5) Provider reviews the patient’s clinical information and updates as needed. In addition, the
provider will ‘Verify and Add’ for any of the newly entered patient history that was entered by the
clinical staff, as appropriate. The common components of patient data typically reviewed as part
of a basic visit type are:
▪ Active Problems
▪ Current Medications
▪ Allergies
▪ Vital Signs
a) To review the patient’s clinical information from within the Note Authoring workspace, use
any of the following:
▪ Click on the corresponding Note Section from the table of contents to review Active
Problems, Current Medications, Allergies and Vital Signs information.
▪ Click on the corresponding component (tab) within the NAW to review Active Problems
(Problem), Current Medications (Meds/Orders), Allergies (Allergies) and Vital Signs
information (HMP – VitalSigns/Findings).
b) To review the patient’s clinical information from the Clinical Desktop, do the following: click
on the corresponding component (tab) within the Clinical Desktop to review Active Problems
(Problem), Current Medications (Meds), Allergies (Allergies) and Vital Signs information
(HMP – VitalSigns/Findings).
c) To ‘Verify and Add’ any of the newly entered patient history that was entered, do the
following:
i) From the corresponding component, select Type as the secondary sort.
ii) Under the Unverified section, highlight the chart item by single-clicking.
iii) Click on Add/Verify. Providers can also right-click on the item and select Add and
Verify from the context menu.
6) The provider reviews recent results. To review all recent results from the ChartViewer
component, do the following:
a) Click on the ChartViewer component (tab).
b) Select the “Recent Data” View from the drop-down list.
c) Double-click to view any relevant results data.

Allscripts recommends creating a “Recent Data” view that looks at all recent chart
information for the patient within the past two years. This includes all the relevant


patient information that a provider would need to review during the retrieve process.

7) Does the provider need to review any previously entered documentation, including scanned
documents?
8) If the provider needs to review previous or other recent clinical documentation, remain within the
ChartViewer component and do the following:
a) Under the Recent Data View, double-click on the desired document to open in a single
Viewer.
b) Single-click items, select View and View in New Window to open multiple items. These can
then be tiled as desired to view multiple items at once.

Component groups can be resized by “dragging” the edge of the component with
the mouse.

9) Once the provider has completed the retrieve process, they are then ready to begin the patient
visit. Refer to the (G) Document workflows for the Certified Workflow steps for documenting the
patient visit.


(F2) Chart Review – Detailed
The purpose of the following workflow is to achieve an understanding of what information is typically
reviewed by the provider just prior to entering the exam room or during those first few minutes of the
exam for a detailed visit type. The main goal of retrieve or chart review is to allow the provider to
view and interact with as much data regarding the patient as possible. A detailed visit is directed
more toward management of one or more chronic problems as seen in internal medicine or specialty
medicine, or for a new patient who requires a more in-depth viewing of historical data or is
presenting with complex or multiple problems.
Figure 14 (F2) Chart Review - Detailed

1) Has the note been started by the clinical staff? As part of the intake process some practices
have the clinical staff begin the note and document various note sections defined by the
organization.
2) If yes, the provider selects the note from the schedule for the patient being seen. To select a
note from the schedule, follow these steps:
a) Provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the
c) Review the schedule and click on the note icon next to the desired patient’s name. The Note
Authoring workspace (NAW) displays.
3) If the note was not started by the clinical staff, the provider selects the patient from the schedule
and brings the patient encounter into context. To bring a patient into context from the daily
a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the


4) Provider opens today’s encounter summary to review the data entered by the clinical staff as
well as view any alerts and/or reminders.
a) To review the encounter information from within the Note Authoring workspace (NAW) or
from the Clinical Desktop, click on the Encounter Summary icon from the Clinical Toolbar.
The Encounter Summary page displays.
5) Provider reviews the patient’s clinical information and updates as needed. In addition, the
provider will ‘Verify and Add’ any of the newly entered patient history that was entered by the
clinical staff, as appropriate. The common components of patient data typically reviewed as part
of a detailed visit type are:
▪ Active Problems and Problem History
▪ Current Medications
▪ Allergies
a) To review the patient’s clinical information from within the Note Authoring workspace (NAW),
use any of the following:
▪ Click on the corresponding Note Section from the table of contents to review Active
Problems, Current Medications, Allergies and Vital Signs information.
▪ Click on the corresponding component (tab) within the NAW to review Active Problems
(Problem), Current Medications (Meds/Orders), Allergies (Allergies) and Vital Signs
b) To review the patient’s clinical information from the Clinical Desktop, do the following:
i) Click on the corresponding component (tab) within the Clinical Desktop to review Active
Problems (Problem), Current Medications (Meds), Allergies (Allergies) and Vital Signs
c) To ‘Verify and Add’ any of the newly entered patient history that was entered, do the
following:
i) From the corresponding component, select Type as the secondary sort.
ii) Under the Unverified section, highlight the chart item by single-clicking.
iii) Click on Add/Verify. Providers can also right-click on the item and select Add and
Verify from the context menu.
6) The provider reviews patient’s health management plan (HMP). The common components
typically reviewed are as follows:
▪ Vital Signs
▪ Flowsheets & Graphs
▪ Alerts & Reminders
a) To review a patient’s Health Management Plan, do the following:
i) Click on the HMP component (tab).
ii) Select the desired View from the component view drop-down list.
7) The provider reviews recent results. To review all recent results from the ChartViewer
component, do the following:
a) Click on the ChartViewer component (tab).


Allscripts EHR Certified Workflows v. 11.1

Allscripts EHR Certified Workflows v. 11.1

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