Creating a Flowchart




Workflow chart at the Front Desk clerk in a small physician office withno information technology (Electronic health records)



Ina simple physicians office the tasks of the Front desk clerk includeamong others scheduling appointments, registration of new andrepeat patients, verifying insurance, dealing with referrals,collating and organizing received information. The front desk alsorefers patients to the required personnel such a nurse, laboratorytechnician or to the physician. In addition, the front desk doesother lesser tasks such as receiving and making telephone calls,mailing letters, copying and issuing certificates. It is important tonote that not all physicians’ office operates in the same way andthere are differences each office functions in its own unique way.As such, the workflow illustrated above with regard to tasks andprocesses may not match or be uniform with others. The tasks may varydue to differences in protocols, practices adopted by various thirdparties such as insurance firms, laboratory or patient’s treatmenthistory with the physician. In the same breath, the workflow adaptedabove changes with the type and kind of patients dealt with. Forinstance, each patient may have a different treatment protocol thatmay involve making telephone calls to insurance firms or using theverification machine to assess the authenticity of patient’sinsurance card (Morrissey, 2006).

Inthe above flowchart the front desk clerk is overloaded consideringthe amount of tasks required in a small physician’s office. Oftenthan not, these tasks processes are source of delay and may not beeffectively handled by the front desk clerk. It is imperative thatsome tasks be delegated to another office in order to ease work andensure efficient and effective healthcare services. In assessing thisworkflow, a number of metrics were considered depending on the tasksperformed. These tasks are identified as the basis of workflow delayin service provision in the physician’s office (Mala, Eswaran, Ramand Bettijoyce, 2012).

Scheduling:In a physician office with no computerized operations makes the Frontoffice clerk work a great challenge scheduling is time consumingexercise. In this office, paper records are maintained and this is asource of time wastage especially when the clerk cannot find theappointment details. In other instances, the clerk might forget tofile referral appointments and this leads to disorganized service.For instance if the patient forgets the appointment date, the clerkhas to search or reschedule the appointment.

Newand old patient registration:Mostly, the clerk is limited by the information received from thepatients and how to validate such details. In some cases, this mightlead to incorrect referral, diagnoses and poor service provision.Clerks may also find it time consuming verifying data from otherphysicians and this requires making endless expensive follow-upcalls. Registration of repeat patients is not easier as this requiresmaintaining files that are update and this may lead to wastage oftime if no proper electronic records were kept (Morrissey, 2006). Inthis office only paper records are used and this makes the problemmore complex. In this case, the primary problem is informationmanagement the clerk is required to update all data as received fromdoctors, referrals physicians, insurance firms and repeat treatmentappointment. These activities are complex and time consuming giventhat the clerk uses paper records (Hing and Burt, 2007).

InsuranceverificationThere exists multiple insurance firms and verifying their coverage isa daunting task for the front desk clerk. The clerk is required todocument and maintain multiple insurance providers list which isupdate. The physician’s office policy is that each patient’sinsurance provider must be verified before the patient is grantedappointment with the physicians. In the absence of electronic system,searching and keeping update records becomes time consuming(Hillestad, Bigelow, Bower, Girosi, R. Meili, Scoville and Taylor,2005).

Ananalysis of this flowchart shows that the clerk is not onlyoverworked but some tasks may not be performed optimally as required.The metric used in assessing the effectiveness of this flowchart are

  • Time wastage

  • Efficiency

  • Quality of services

Proposedchanges for improvement

Inorder to change and improve operations at the office, there is needto delegate and share out the tasks to others. In particular, thefront office should have four personnel working as a team. Timewasted and inefficiencies caused would be saved if the operationsinvolved are shared. In this arrangement, one clerk would deal withscheduling and registration of patients, the other deal withinsurance verification and making referrals for patients. The thirdclerk would deal with other non-scheduled tasks such as organizingreports, receiving and making telephone calls. In this way theworkload would significantly reduce, allow for effective andefficient service provision. Alternatively, the office should beequipped with electronic health records system in order to reducetime, inconvenienced caused by paper records and save resources. Inthis case, only two clerks would be necessary if health electronicsystems are adopted.


Theflowchart indicates tasks operations for a clerk at a smallphysician’s office. While the flowchart shown may not correspond toother front desk operations in other organizations, the flowchartindicates the common tasks that cut across many small physiciansoffice. The number of tasks and tools used in performing the tasksleads to delay and poor quality services. The clerk is required tomake patients registrations, conduct insurance verifications andperform other non-scheduled tasks. In order to improve operations andreduce time wastage, it is recommended that electronic health recordsbe adopted at the office (Simon, Kaushal, Cleary, Jenter, Volk, Poon,Orav, Williams, and Bates, 2007). In addition, the practice needs tohire more clerks for efficient operations and services at the office.


Hillestad,R., J. Bigelow, A. Bower, F. Girosi, R. Meili, R. Scoville, and R.Taylor. (2005). “Can Electronic Medical Record Systems TransformHealth Care? Potential Health Benefits, Savings, and Costs.” HealthAffairs24, no. 5: 1103–17.

Hing,E., and C. W. Burt. (March 2007). “Office-based Medical Practices:Methods and Estimates from the National Ambulatory Medical CareSurvey.” AdvanceData from Vital and Health Statistics,no. 383. Department of Health and Human Services, Centers for DiseaseControl and Prevention, National Center for Health Statistics.

MalaRamaiah, Eswaran Subrahmanian, Ram D. Sriram and Bettijoyce B. Lide.(2012).“Workflow and Electronic Health Records in Small MedicalPractices.” Perspectivesin Health Information Managementp.1-16. Accessed from

Morrissey,J. (2006). “A Day in the Life of a Medical Record.” NationalAlliance for Health Information Technology. July 21, 2015).

Simon,S. R., R. Kaushal, P. D. Cleary, C. A. Jenter, L. A. Volk, E. G.Poon, E. J. Orav, H. G. Lo, D. H. Williams, and D. W. Bates. (2007).“Correlates of Electronic Health Record Adoption in OfficePractices: A Statewide Survey.” Journalof the American Medical Informatics Association14, no. 1: 110–17.