Front Office Activities are split into three logical desks, viz., Registration, File Preparation and Screener Desks. The activities presently carried out are in AS IS Process and the proposed is in TO BE process. It is the considered opinion of users to leave out the Token Issue system out of the present scope. Therefore this document addresses the user stories of only three desks as mentioned in the workflow document and PDF charts.
Registration Desk Activities (New Patients)
Note:
- Personnel – Registration Desk /Registration Attendant(s)
- Preparation– Before Operations start for the day
- Check for stock of Registration Card of all colors
- Keep plastic covers for the Registration Card
- Start Time - Work Begins at 9AM in the morning when patients starts
- All interaction with the system are provided in this color
Registration Desk Activities
AS IS PROCESS | TO BE PROCESS |
| Registration Desk Attendant Sign-on to the system |
| Beginning of Day Operation – Initialize Token numbers |
Call out the token Number and Name | The next Token Number to be called is Pulled up on screen with Token Number and Patient Name. |
Attendant 1 - Enters Patient details into Registration Card | Attendant 1 – Calls out the Patient Name and Token Number |
Enter Details in Ledger for TB patients, diabetes, rheumatic heart disease HIV and cancer patients | Checks if the patient already has a registration card, then
|
| Confirms from the Patient on details by Reading out from the screen |
| Saves the Record |
Attendant 2 - Enter Patient Details into the Patient File | Not Required in the TO BE Process |
Attendant 3 – Enters Patient Details into Computer | Not Required in the TO BE Process |
Enter Details in a Ledger with the patient serial number | Not Required in the TO BE Process A report will provide these details |
| Pulls out the Registration Card of the right color and feeds into the Printer The following is the Color Code
|
Collects the fee (Rs. 10 for adults, Rs 5 for Child) | Same as in AS IS Process |
Sends Patient to Weight Record desk / Vital Record desk | Same as in AS IS Process |
Impact of the New Registration Process
a. The ledger for entering the patient is done away with
b. Ledger for specific Diseases is done away with
c. Only New Registrations are queued up for processing. The returning patients are directed to another desk for fetching files
d. Position one computer and One Printer for each Registration Attendant Desk (minimum two required)
e. Networking may be required for the computers
f. Registration Card to be preprinted and formatted as per the existing card. Printer should be able to take the registration card that is thicker than paper.
g. Role of the Registration Desk is limited to
i. Recording Patient Demographic Details
ii. Query on Patients Demographics
iii. Printing Registration Card
iv. Collecting Registration Amount
Registration System Services
1. Token Number Increment
2. Population of New Patient Object
3. Registration Number Generation Service (Increments the Max Registration number by 1).
4. Patent Details Query Service
5. Re Printing Service
Data Elements – New Registration
1. Date Time
2. Token Number for the day
3. Patient Demographic Details (Patient demographics Object)
a. Patient Name (first),
b. Patient Last Name /Surname
c. CasteName (Master Data)
d. Fathers/Husband Name
e. Age/ Date of Birth
f. Sex
g. Education (drop down),
h. Family Card no
i. District (Master data),
j. Tehsil
k. Gram Panch
l. Village (Master data )
m. Occupation (Master data ),
n. Class (Master Data),
4. Referral Text entry
a. Referred by Doctor / Sub Center
5. Free Text Entry
a. Neighborhood (free text),
6. Specific Patient Registry Type (TB, Diabetes, Rheumatic Heart Disease HIV and Cancer)
7. Patient This.Visit details
a. Chief Complaint (Free Text)
b. Remarks (blank)
c. Person accompanying with
i. Name
ii. Contact Number
iii. Relationship to Patient
8. Cash Collection Amount (master data)
9. Registration Attendant details
UX / Activities to be Performed for New Registration
1. Call out the Token Number
2. Verify the Token Number and Take Name
3. Enter Demographics Details
4. Enter Free Text Details such as Chief Complaints, Remarks
5. Enter Registry Type
6. Save the Form
7. Wait for the Prompt "Print Registration Card"
8. Print Registration Card
9. Collect Registration Amount
10. Send patient to File Readiness Desk
New Registration Forms with data elements
All mandatory elements are shown in red. There could be changes to these during the pilot / PoC as and when scheduled
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[ToDo:: Do we have to add 'File Readiness' and 'Screener' tasks here.]
Documentation / How-To
Process Workflow
Registration
NEW REGISTRATION
Mondays, Wednesday and Fridays are dedicated to outpatient consultations, while Tuesday, Thursdays and Saturdays are set aside for surgery and for visiting the three sub-centers. On an average out-patient day (M, W, F) the physicians at JSS see between 250 and 320 patients from 9:30am until 8pm.
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There is a separate, parallel system for TB patients, diabetes, rheumatic heart disease HIV and cancer patients, which involve a ledger book, a card registration system and an excel database. Although these patients are also registered in the main registration system. All data can be exported into Excel spreadsheets.
SHCEDULEING AND QUEUING
Of the total number of patients seen each day in the OPD, only about 40 or 50 might have a prior appointment. JSS does not encourage the general public to make prior appointments because it favors those who have the means to do so (the relatively wealthy, those who live in close proximity to JSS) at the expense of those who do not. Given the limited number of physicians, and the time each physician would like to dedicate to each patient, there is a limited number of patients that can be seen each day.
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For cases that qualify as emergencies, the patient might go to the IPD and then later have their registration papers made. Or they could be admitted and receive a registration number the next day. At the same time, they could be refered elsewhere and never receive get a registration number. Another category of patients is maternity. Mothers who arrive with contractions go straight to the labor room. Currently between fifty and seventy-five percent of the women spend the night after delivering.
RETURNING PATIENTS
When returning patients arrive at JSS they stand in line to receive a numbered token, give their name and registration number. Employees estimate the 90-95% of returning patients return with their registration card. Using the registraiton number on the patient's card, a JSS employee in the registration department searches for the returning patient's file and opens the registration window when he has located it. For the 5-10% of returning patients who do not bring their card, this employee will search for their information on the computer next to the window for newly registering patients using patient's name, village and age. Employees report a very high rate of success of finding patients this way.
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Otherwise, for returning patients there is no input of information into the computer. Their return to JSS is simply recorded into a large ledger book. Also, there is currently no printing facility in the registration office. 159,471 are registered in the system as of Aug 27.