AOHC EMR Implementation Toolkit EMR Implementation Plannin.docx

AOHC EMR Implementation Toolkit | EMR Implementation
Planning Guide – Version 1.0
AOHC EMR IMPLEMENTATION TOOLKIT
EMR Implementation Planning Guide
1
EMR Implementation
Planning Guide
A Ten-Step Guide to Planning
for Successful Implementation of an
Electronic Medical Record (EMR) System

2
Contents

Purpose of this guide
............................................................................ 3
Step 1: Establishing the project team
................................................... 4
Step 2: Project activities and phases
.................................................... 5
Step 3: Planning for change
.................................................................. 9
Step 4: Communication planning
........................................................ 10
Step 5: Data migration and data retention from legacy systems
....... 11
Step 6: Training
................................................................................... 12
Step 7: Identifying EMR reporting requirements
............................... 13
Step 8: Executing and validating deployment
.................................... 14
Step 9: Executive approval to go live
.................................................. 15
Step 10: Post-Go Live activities and support
...................................... 16

For questions or comments, please contact:
AOHC EMR Project
Association of Ontario Health Centres
[email protected]

3
Purpose of this guide
The EMR Implementation Planning Guide is a ten-step
framework to help
you understand activities necessary for successful
implementation of the
new Electronic Medical Record (EMR) system at your health
centre. It’s
designed to provide opportunities for advance planning and
resource
allocation, and timelines for deployment activities.
EMR implementation will be a collaborative effort involving
teams from
your centre, the EMR vendor, and AOHC staff working on the
EMR
project. Depending on the size of your centre and resource
availability,
the number of project team members will vary. At a minimum,
however,

all executive directors or a designated senior manager will need
to
review the Guide to understand funding and resource
commitments and
assign staff to the EMR project as appropriate.
When and how to use the Guide
Intended as a step-by-step planning tool, the Guide provides
valuable
information to help you make decisions regarding the timing of
the EMR
Go Live date, and resource commitments necessary for
successful
adoption of the new EMR. Regardless of when your centre is
scheduled
for EMR implementation, this document will help you start
thinking
about what’s needed for smooth implementation. As the system
is
deployed across the sector, the Guide will be updated with
lessons
learned to ensure information remains current.

On-site implementation
This guide is a pre-implementation planning tool. Once your
EMR Go
Live date has been confirmed, a comprehensive EMR
implementation
approach will be available to support project teams in system
implementation at your centre. Encompassing processes, guides,
tools
and activities, the EMR implementation approach will support
EMR
adoption and use, and help determine your centre’s needs at a
detailed
level, including budget and resource requirements.
4

Step 1: Establishing the project team
Key Points
� While the AOHC and the EMR vendor will play key roles and
act in
partnership with the centre, each centre is responsible for its
own
EMR implementation project.
� Centres will be required to assign a dedicated project
manager, who
will be responsible for project deliverables and keeping the
project
on track.
The centre's project team
The centre's project team is pivotal to the overall success of
EMR system
implementation. Although the full project team may be assigned
later in
the project lifecycle, the executive sponsor and project manager
should
be assigned prior to the start of the project.
ROLE RESPONSIBILITIES

EXECUTIVE PROJECT
SPONSOR
Accountable for the overall success of
the project, the executive sponsor
assigns the project manager. Prosci, an
internationally-recognized change
management firm, has identified active
and visible executive sponsorship as the
most important factor in project success.
Together, the
executive sponsor
and project manager
identify members of
the centre's project
team. They lead
change and manage
resistance to change.
PROJECT MANAGER Typically a senior manager experienced

in leading multi-faceted implementation
teams, the project manager makes EMR
implementation decisions on behalf of
the centre, and is responsible for day-to-
day management of EMR
implementation for the duration of the
project.
PROJECT TEAM The project team works on all aspects of
EMR implementation with
a focus on the following:
� Budget/agreement
management
� Business change
� Information technology
management
� Privacy and security
� Communications
� Data migration
� Training
� Reporting
Depending on resource availability and EMR implementation
complexity, one person may fulfill multiple roles. The key

consideration is the time and effort each role requires to ensure
overall project success. It’s important to include clinical
representation on the project team.
5
Step 2: Project activities and phases
Key Point
� This guide is a pre-implementation planning tool. Once your
EMR
Go Live date is confirmed, a comprehensive EMR
implementation
approach will be available to support system implementation at
your centre. Encompassing processes, tools and activities, the
approach will be updated regularly to leverage lessons learned

from
earlier EMR system implementation at other centres.
Project Phases
1 Peer leaders are health centre staff who will champion the use
of the EMR to
sector colleagues through best practices and lessons learned.
Peer leaders will
likely be drawn from centres that adopted the EMR system early
in the sector-
wide implementation schedule.
ENGAGEMENT ASSESSMENT
PREPARATION
& PLANNING
DEPLOYMENT
GO LIVE
WEEKEND
POST-
IMPLEMENTATION

� Initial project
planning
discussions
with centre
� AOHC/centre
preliminary
meeting to
kick off
project
� Detailed
needs
analysis to
assess
centre's
business
and
technical
readiness
� Project
planning

� Project
Scope of
Work,
Funding
Agreement,
budget
preparation
� Business
process
redesign
preparation
� Data
migration
preparation
� Pre-production
environments
allocated
� Data migration
trial runs to
create a clean

extract file
� Business
process
redesign
� User training,
EMR demos
� Identification/
development
of ad hoc
reports
� Peer leader
1
group support
� Data
conversion,
validation
� Final
readiness
checklist
completion
� Go/No-Go
Live meeting

� Data validation
by end users
� Addressing
issues
� End user
support
� Peer leader
group support
� Transition to
adoption/
operations
phase
1 month
approximately
1 month
approximately
3 months
approximately
3 days Ongoing
6 - 12 months

approximately
Readiness Deployment
Adoption &
Maintenance
6
Engagement Meeting
Designed to kick off the project, the engagement meeting brings
together
senior centre executive and project team members and the
AOHC EMR
Project Team, who will work in partnership to implement the
EMR
system. The centre's executive sponsor should assign a project
manager

prior to the meeting. Meeting activities include reviewing
project
milestones, resource assignment, roles and responsibilities, and
establishing a high-level approach to project communications
and issues
management. The funding agreement and budget templates will
also be
reviewed at this session.
ACTIVITY START Four months prior to your EMR Go Live
date
DURATION Half-day session
Assessment Phase
The centre's technical and business leads are assigned during
this phase.
Working with leads, the AOHC EMR Project Team will conduct
a detailed
business and technical needs analysis including network
requirements
of the centre. Information gathered at this stage will be used to
evaluate

gaps in business processes or technology, inform the EMR
implementation budget and support development of the Project
Scope of
Work (SOW) and funding agreement between the AOHC and
your centre.
PHASE START Four months prior to your EMR Go Live date
DURATION One month approximately
Preparation and Planning Phase
Your centre's full project team should be assigned prior to the
start of
this phase. Activities include:
� Development of the project work plan using an AOHC EMR
Project template
� Review of results from the business and technical needs
analysis
� Project Scope of Work (SOW) preparation by the centre and
the
AOHC, and signature by the centre, AOHC, and vendor
� Preparation of the EMR implementation budget
� Funding agreement preparation, and signature by centre and

AOHC executive directors
� Data migration and transfer activities
� Documenting current workflows
� Enabling deployment portal access
� Ordering network services, infrastructures upgrades,
equipment,
etc.
7
PHASE START Four months prior to your EMR Go Live date
DURATION One month approximately
Deployment Phase
The deployment phase involves all activities required to

advance the
project from planning and preparation to the day the EMR goes
live at
your centre. Activities in this phase include:
� Meetings to coordinate EMR implementation activities
� Vendor team engagement with centre/AOHC project teams
� Allocation of data migration, training, demonstration and pre-
production environments
� Data migration trials
� Identification of additional local reporting requirements
� Preparing staff for the new EMR
� Identifying and implementing local EMR configurations (i.e.,
setting up authorized users, assigning role-based access, etc.)
PHASE START Three months prior to your EMR Go Live date
DURATION Three months approximately
Go Live Weekend
Occurring from Friday to Monday, Go Live weekend is the most
critical
part of EMR implementation. A time of intense activity for
centre, AOHC,

and vendor project teams, activities include:
� Data migration and IS/IT teams copying the database(s) and
sending files to a centralized migration environment
� Data conversion using data migration tools
� Exporting data to the new EMR, and data validation
� Executive approval to go live.
For more information on this activity, see Step 8: Executing and
validating deployment, and Step 9: Executive approval to go
live.
ACTIVITY START Three days before your EMR Go Live date
DURATION Three days
8

Post-Implementation Phase
Even after your new EMR is up and running and in active use,
there are
still a series of activities to undertake, including:
� Data validation by end users
� Super user2 support of end users
� AOHC and vendor team support for a specified period
� Peer leader support
� Ongoing practices to support full EMR adoption
For more information on the Post-Implementation Phase, see
Step 10:
Post-Go Live support and EMR adoption.
PHASE START As soon as your new EMR is live
DURATION Ongoing
2 EMR users at your centre who receive additional training on
the new system
so they may share knowledge and assist other staff. See Step 6
- Training.

9
Step 3: Planning for change
The new EMR will bring significant change to your centre. To
help you
plan for change, the AOHC Transition Management Team will
work with
you to develop a strategy to support the transition of people,
processes
and technology.
Three key activities are required to develop a change strategy
and
prepare providers and staff for EMR implementation from a
business
process perspective:

1. Set the strategic direction by defining goals around the use of
the new EMR to support and improve client-centered care.
2. Map current processes to identify the people, processes and
tools currently used to provide client care. Likely led by your
centre's change manager with assistance from the AOHC
Transition Management Team, this is an opportunity to identify
what works well at your centre, and more importantly, what
doesn’t, and to identify processes or workflows that need
improvement.
3. Define to-be processes by re-thinking and re-designing
processes to ensure a client-centered practice. This activity
provides opportunities to plan organizational changes in your
daily workflow based on the improved features and
functionality
of the new EMR. This exercise should be a centre–wide
initiative
with representation from all areas of care and operational
support.
Change management helps organizations and individuals

affected by
new processes and technology understand the need for changing
current
behaviour, and provides practical approaches and tools to help
organizations and individuals implement and adopt new skills
and
behaviours. To support you in these activities, the AOHC EMR
Project
Team will provide guides, tools and expert assistance.
date
DURATION Four months
10

Step 4: Communications planning
Communications planning focuses on informing and engaging
staff from
throughout your centre, and stakeholders, on changes that will
result
from implementation of the new EMR. Providing early
awareness and
keeping these audiences informed of project progress and the
impact the
new system will have on their day-to-day lives is an important
part of
overall project success.
A communications plan should at a minimum fulfill the
following
objectives:
� Provide staff with awareness and understanding of upcoming
changes early on
� Inform any centre partners, such as laboratories, of EMR
implementation, to give them time to make necessary process
changes

� Keep users and stakeholders informed about project progress,
as
well as EMR adoption status
� Inform and update your board of directors and LHIN about
the
project and current status.
A comprehensive guide and communications planning template
will be
provided by the AOHC EMR Project Team once your EMR Go
Live date is
confirmed. Communications planning should start four months
before
your EMR Go Live date and continue throughout the project, up
to
approximately one month after your Go Live date.
date

11
Step 5: Data migration and data retention
from legacy systems
Data migration and retention of legacy clinical management
system
(CMS) data to the new EMR is the most critical activity in
successful
implementation of the new system. Without proper migration of
existing
client data, the new EMR will fail to support optimal client
care. Due to
data migration complexity and the variation in levels of
electronic record
adoption across the sector, careful and detailed planning is
necessary at
each centre to prepare for successful migration of legacy CMS
data to the

new EMR.
Data migration involves five key activities:
1. Data preparation of paper and electronic charts, as per
instructions, guides and tools provided by AOHC EMR Project
Team.
2. Data mapping of local data values to data fields in the new
EMR.
3. Data migration using AOHC EMR Project Team migration
tools
and data mapping spreadsheets. Data migration will happen in a
dedicated, centralized environment supporting pre-
implementation practice runs and final migration and validation.
This approach will enable project teams to benefit from iterative
data migration trial runs, so data conversion errors can be
corrected, and data can be validated after each trial run.
4. Planning and execution of manual entry of relevant data from
paper charts.
5. Retention of original historical records to ensure compliance

with medical/legal requirements.
Data migration support
Along with a dedicated data migration environment, an AOHC
data
migration coordinator, as well as guides and tools will be
available to
assist you with data preparation, retention and migration.
date
12

Step 6: Training
All staff who will use the new EMR will require training.
Specialized
training will also be necessary for super users, system
administrators,
data management coordinators and financial staff.
The AOHC EMR Project Team will provide you with tools to
help you
develop a training strategy for your centre to meet your short
and long-
term needs. This includes identifying training roles and
responsibilities
and completing a training and course planning matrix.
The EMR vendor will provide onsite training for your staff.3
Each centre
should identify at least one super user4 who can be trained to
provide
onsite expertise and who can, when required, train new staff.
A training environment for staff to practice using the new EMR
will also

be available. Staff will have ongoing access to online training
modules to
refresh knowledge, and supplement training for new staff or
staff with
new responsibilities.
EMR training will be supplemented by a peer leader support
network.
The network will enable clinical staff from other centres
experienced in
using the new EMR, like physicians, nurse practitioners, nurses,
dietitians, social workers and clinical support staff, to act as
mentors to
new users. The program aims to speed adoption of the new
system and
assist you in achieving meaningful use of your EMR.
ACTIVITY START Three months prior to your EMR Go Live
date
DURATION Three months
3 Basic computer skills are a prerequisite to EMR system use.
Training to

support basic computer literacy will not be provided as part of
the AOHC EMR
Project. If some of your staff lack basic computer skills, it’s
important to
recognize and address this gap before they receive training on
the new EMR
system.
4 For a definition of super user, see Step 2, Post-
Implementation Phase.
13
Step 7: Identifying EMR reporting
requirements
The new EMR will offer pre-defined reports to address core
business
needs. Additional reports requested on a sector-wide basis and

available
to all centres will be added based on an approved change
request
process.
If required, centre-specific local reports will be developed to
address the
specific reporting needs of a centre. Driven by the centre's
business
change team, each centre will need to compare their reporting
requirements to standard system reports to verify if additional
local
reports will be required.
The following activities will be required to identify local
reporting
requirements at your centre:
1. Identify current reporting activities across all offices.
2. Assess current reporting activities in terms of relevance and
usefulness and identify new reporting requirements.
3. Prioritize and develop new, local reports.

Identifying EMR reporting requirements should start three
months prior
to your EMR Go Live date, and take approximately one month.
Report
development should begin two months prior to your Go Live
date and
continue after EMR implementation as an operational activity.
ACTIVITY START Three months prior to your EMR Go Live
date
DURATION Three months plus ongoing operational activity
14

Step 8: Executing and validating deployment
Key Point
� Once the new system is deployed and new data is being
entered
into it, there will be no way to synchronize data between the
EMR
system and legacy CMS databases. This means once staff start
using the new system on Go Live Monday, it will not be
possible to
revert to the legacy clinical management system without losing
all
new data.
� Legacy system data will continue to be available for
reference.
Leading up to EMR deployment (Go Live) on Monday morning,
executing
and validating deployment takes place from Friday to Sunday.
The most
critical part of EMR implementation, it will also be a time of
intense
activity for the centre, AOHC, and vendor project teams.

During this three-day period, the data migration and IS/IT teams
will
make copies of the database(s) and send the files to the
centralized
migration environment. Data migration tools will convert the
data and
import it to the new EMR, where the data must be carefully
validated.
This is the final opportunity to catch errors, and is crucial to
avoiding
unpleasant surprises when the system goes live on Monday
morning.
Once the new EMR is up and running (but has not officially
gone live),
other centre staff are required to participate in the data
validation
process. This important step involves running and reviewing
reports
from the legacy CMS and the new EMR to compare and validate
data.
This can be a time-consuming activity requiring manual reviews
of
reports and client information. A data validation process
document will

be available in advance to help your centre plan for this
activity.
ACTIVITY START Three days before your EMR Go Live date
DURATION Three days
15
Step 9: Executive approval to Go Live
Executive director (and the executive project sponsor, if
different from
the executive director) approval is required for the new EMR
system to
go live at your centre. Go Live status conference calls will be
held

throughout Go Live weekend with a final call scheduled for
Sunday
evening. At this meeting, the centre's project manager will seek
consensus from all parties (the centre, AOHC and EMR vendor)
and
prepare a recommendation for the executive director (and the
executive
project sponsor, if different from the executive director) on
whether the
system is ready to go live the following morning.
Once the executive director or executive project sponsor
authorizes the
new EMR to go live, the legacy clinical management system
will be
deactivated. Communications will be sent to all users and
stakeholders
ensuring they are aware that the new EMR has been deployed
and is the
system of record for clinical information.
ACTIVITY START Go Live weekend
DURATION Three days

16
Step 10: Post-Go Live activities and support
Even after your new EMR is up and running and in active use,
there are
still a series of activities to undertake.
These typically include data validation by end users, such as
clinicians
conducting spot checks of client records to ensure they are
correct. The
centre's super users should be available to support users as they
grow
accustomed to the new system.

Support staff from both the AOHC and vendor project teams
will be
available for a specified period to address post Go-Live issues
and
augment standard supports that will be in place for the EMR. An
EMR
resource schedule listing super users and AOHC and vendor
project team
resources will be provided.
Peer leaders from centres already using the new EMR will also
be
available onsite or remotely to answer questions and provide
additional
support.
Prior to your Go Live date you will be provided with
information,
processes and contacts to address any issues or questions
regarding the
transition and ongoing use of the new EMR system.
ACTIVITY START As soon as your new EMR is live

DURATION Ongoing
Chapter 6
Exchange Economies
One of the significant advances in economic theory in the 20th
century has
been the development of general equilibrium analysis which
explores the
possibility of simultaneous equilibrium in multiple markets, as
opposed to
the older partial equilibrium analysis of Alfred Marshall which
studies the
possibility of equilibrium in a single market in isolation. Today,
much of
modern macroeconomic theory is developed in a general
equilibrium frame-
work. In this chapter, we take up the simplest possible general
equilibrium
model with two consumers and two goods. Because there is no
production,
the consumers may only choose to trade the available supplies
of the goods;
ergo, such an economic environment is called a pure exchange
economy.
6.1 The Edgeworth Box

Suppose there are only two consumers, a and b, and two goods,
1 and 2. We
will use the superscript i to refer to either individual, and the
subscript j to
refer to either good. Each consumer i has a characteristic ei
which consists
of two pieces of information specific to her, namely, her
preferences and her
individual endowment. Her preferences are represented by a
utility func-
tion, ui, over the two goods; her individual endowment, ωi, is a
commodity
bundle which shows the total amounts of the two goods that she
possesses
initially, i.e., ωi = (ωi1, ω
i
2). Then i’s characteristic is written as
ei = (ui, ωi) (6.1)
88
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Exchange Economies 89
which summarizes all the relevant information about this
consumer. Finally,
an economy, e, is a list of the characteristics of all consumers:
e = (ea, eb) = ((ua, ωa), (ub, ωb)). (6.2)
This economy e is our prototype of a two-person private goods
pure ex-
change economy.1
5
2
8
7Oa
x2

a
x1
a
Ob
x2
b
x1
b
ωa
ωb
Figure 6.1 Characteristics of consumers a and b
To make things more concrete, suppose consumer a’s
characteristic ea is
given by a Cobb-Douglas utility ua = xa1 x
a
2 and an endowment ω
a = (5, 2),
while eb is given by a linear utility ub = 2xb1 + x
b
2 and ω
b = (7, 8). The
left panel of Figure 6.1 shows consumer a’s origin, Oa, a couple
of her or-
ange indifference curves and her endowment bundle, ωa. The

right panel
of Figure 6.1 shows b’s origin, Ob, a couple of her linear green
indifference
curves and her endowment bundle, ωb. By adding the
endowment of each
consumer, we obtain the aggregate endowment, Ω (read as
‘capital omega’),
which shows the total supply of all goods in the economy:
Ω = ωa + ωb = (5, 2) + (7, 8) = (12, 10).
Any list of consumption bundles (xa, xb) for the two consumers
is called
an allocation. Suppose the total supplies of both goods are
divided between
1A good is said to be private if one person’s consumption of a
good precludes it being
consumed by someone else, and if others can be excluded from
consuming it. See Chapter 16
for more details.
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90 Chapter 6
x1
a
x2
b
x2
a
x1
b
Oa
Ob
5
7

8
2
ω
C
Figure 6.2 The Edgeworth box
the two consumers so that a receives the bundle x̄ a = (4, 7)
while b receives
the remainder, x̄ b = (8, 3). Then we say that the pair of
consumption bun-
dles (x̄ a, x̄ b) = ((4, 7), (8, 3)) is a feasible allocation, meaning
that this al-
location is actually possible given the total supply of the goods.
In fact any
pair (xa, xb) is a feasible allocation so long as xa + xb ≤ Ω.
In order to better understand allocations, take the right panel of
Figure
6.1, rotate it counterclockwise by 180◦, and place it over the
left panel so that
the bundles ωa and ωb coincide as shown by the point ω in
Figure 6.2. The
rectangle contained between the origins Oa and Ob is known as
an Edge-
worth box named after Francis Edgeworth.2
Any point inside this box represents a feasible allocation, where
the con-
sumption bundle for individual a is read from her origin, Oa,
while that of
b is read (upside down!) from the perspective of b’s origin, Ob.
For exam-

ple, the point ω = (ωa, ωb) is the allocation ((5, 2), (7, 8)). This
is called the
initial endowment for this Edgeworth box economy; it shows
the consump-
tion bundle each person starts out with before any trade takes
place. The
allocation corresponding to Ob is ((12, 10), (0, 0)) where
individual a gets
everything while b gets nothing. Conversely, the allocation
corresponding to
Oa is ((0, 0), (12, 10)).
2It is also known as an Edgeworth-Bowley box, after the
English statistician and economist
Arthur Bowley who popularized it.
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To illustrate, suppose both consumers have Cobb-Douglas
preferences,
where a’s utility function is ua(xa1, x
a
2) = x
a
1 x
a
2 while b’s utility is u
b(xb1, x
b
2) =
(xb1)
2 xb2. Suppose that there are 10 units of each good in this
economy, i.e.,
Ω = (10, 10). Then from step 1, we get
xa2
xa1

=
2xb2
xb1
.
From step 2, xb1 = 10 − x
a
1 and x
b
2 = 10 − x
a
2. Substituting these into the
equation above and solving, we get the contract curve ¶b
xa2 =
20xa1
10 + xa1
,
where 0 ≤ xa1 ≤ 10.
Finally, to end this section on Pareto efficiency, note that in
moving from
one Pareto efficient allocation to another, there will typically be
a change in
the distribution of the goods that makes one person better off at
the expense
of another. In other words, no Pareto efficient allocation can be
Pareto supe-
rior to another Pareto efficient allocation. For example, the

extreme situation
where consumer a gets the aggregate endowment (at the point
Ob) or its
polar opposite where consumer b gets everything (at the point
Oa) are both
Pareto efficient. Thus, the notion of Pareto efficiency is
insensitive to distri-
butional concerns.
6.3 Walras Equilibrium
We will now consider the possibility of the two consumers
trading goods 1
and 2 in markets at a per-unit price of p1 and p2. Even though
there are only
two consumers for now, we will assume that each takes the
market prices
as given and outside of their control.5 Given these prices, each
consumer
decides how much she wishes to buy or sell of each good. The
markets are
said to clear if the quantity demanded of good 1 by both
consumers equals its
supply, and likewise for good 2. Then the question that Léon
Walras asked
in the 1870s in the context of our Edgeworth box economy is:
does there exist
a price pair (p̂ 1, p̂ 2) for which both markets clear? We explore
this question
graphically to uncover the basic insights and then fill in the
more technical
details.
5This assumption would of course be more plausible if there
were a very large number of
consumers.

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98 Chapter 6
6.3.1 Graphical representation
We begin with a definition. A Walras equilibrium (or a
competitive equilib-
rium) consists of prices (p̂ 1, p̂ 2) and an allocation (x̂ a, x̂ b) =

((x̂ a1, x̂
a
2), (x̂
b
1, x̂
b
2))
such that:
(a) the consumption bundle x̂ a maximizes ua subject to the
budget con-
straint p̂ 1 xa1 + p̂ 2 x
a
2 ≤ p̂ 1ω
a
1 + p̂ 2ω
a
2;
(b) the consumption bundle x̂ b maximizes ub subject to the
budget con-
straint p̂ 1 xb1 + p̂ 2 x
b
2 ≤ p̂ 1ω
b
1 + p̂ 2ω

b
2; and
(c) the markets for goods 1 and 2 clear:
x̂ a1 + x̂
b
1 = ω
a
1 + ω
b
1 and x̂
a
2 + x̂
b
2 = ω
a
2 + ω
b
2.
Therefore a Walras equilibrium is a pair of prices and a pair of
consumption
bundles at which each consumer maximizes her utility given her
budget con-
straint, and the total demand for each good equals its supply.
Note that the right hand side of consumer i’s budget constraint
in (a) and
(b) above represent her income which is merely the value of i’s

endowment
at the equilibrium prices, i.e.,
m
̂ i = p̂ 1ωi1 + p̂ 2ω
i
2.
Therefore (a) and (b) are an alternative way of saying that x̂ i is
the bundle
demanded by consumer i when the prices are the equilibrium
ones and her
income is m
̂ i:
x̂ i = hi(p̂ 1, p̂ 2, m
̂ i).
Before we see what happens in equilibrium, consider an
arbitrary pair of
prices (p̄ 1, p̄ 2) set by a mythical Walrasian auctioneer whose
job is to find
the equilibrium prices. In Figure 6.6, the blue budget line with
slope −p̄ 1/ p̄ 2
is shown passing through the initial endowment, ω. Viewed
from origin Oa,
this is the endowment budget6 for consumer a, while the same
line is the
endowment budget for consumer b when viewed from origin Ob.
Note that
the slope of this budget line is −p̄ 1/ p̄ 2 irrespective of whether
you view it
using Oa as your origin, or whether you turn the page upside
down and
view it with Ob as your origin.
6See section 2.3.1 and Figure 2.5.

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x1
a
x2
b
x2

a
x1
b
Oa
Ob
S1
a
D2
a
D1
b
A
B
p2
–
p1
ω
S2
b
Figure 6.6 Demand and supply at (p̄ 1, p̄ 2)
Given this budget, consumer a demands the bundle at point A.
In other
words, starting from ω, she is willing to supply Sa1 units of

good 1 (shown
by the solid magenta arrow) in exchange for Da2 units of good 2
(shown by
the dashed magenta arrow) to move to the bundle at A.
Likewise, consumer
b would like to move from ω to point B, supplying Sb2 units of
good 2 in
exchange for Db1 units of good 1. But the market for good 1
does not clear
at these prices: consumer a would like to supply Sa1 units but
consumer b
demands more, Db1. Similarly, the market for good 2 does not
clear either as
the demand for good 2, Da2, is less than its supply, S
b
2.
Assume now that the Walrasian auctioneer raises p1 which
makes con-
sumer a wish to supply more and consumer b to demand less of
good 1,
and/or lowers p2 which makes consumer a demand more of good
2 and
consumer b supply less of it. In other words, beginning with the
initial dot-
ted blue budget line in Figure 6.7, the auctioneer can raise the
relative price
ratio, p1/ p2, to find a set of prices (p̂ 1, p̂ 2) shown by the
steeper, solid blue
budget line. Note that this new budget pivots around the
endowment ω
as the relative price ratio increases, and equates Sa1 = D
b
1 for good 1, and

Sb2 = D
a
2 for good 2. Then, (p̂ 1, p̂ 2) are the Walras prices, the prices at
which
the consumers attain the Walras allocation, E = (x̂ a, x̂ b), where
each per-
son is maximizing her utility given her budget (at the Walras
prices) and the
demand for each good equals its supply.
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100 Chapter 6
x1
a
x2
b
x2
a
x1
b
Oa
Ob
S1
a
D2
a
D1
b
S2
b
E

—
p1
p2
ˆ
ˆ
ω
Figure 6.7 Walras equilibrium
There are three insights regarding Walras equilibria that can be
gleaned
from Figure 6.7:
(1) whenever the market for one good is in equilibrium, the
other must
also be in equilibrium;
(2) what matters for bringing about equilibrium is the relative
price ratio,
not the absolute price levels; and
(3) the Walras allocation is both individually rational and
Pareto efficient.
Insight (1) follows from the fact that in moving from the initial
endow-
ment ω to the Walras allocation E in Figure 6.7, the quantities
that each
consumer wants to buy and sell are opposite sides of a rectangle
(shown
with the solid and dashed magenta arrows). It is not possible,
for example,
for the market for good 1 to clear but not that of good 2.
Mathematically,

this follows from Walras’ Law7 which states that the value of
everyone’s
consumption expenditures must always add up to the value of
the aggre-
gate endowment. A consequence of Walras’ Law is that if there
are ℓ goods
with prices p̂ 1, p̂ 2, . . . , p̂ ℓ so that every market but one is in
equilibrium, then
that remaining market must also be in equilibrium. Since here
there are two
goods (ℓ = 2), this corollary to Walras’ Law guarantees that
finding prices
7Section 6.5.1 below presents a formal statement and proof.
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to bring about equilibrium in one market ensures that the other
market is
automatically in equilibrium.
Insight (2) follows from the fact that in going from the initial
prices of
(p̄ 1, p̄ 2) to the Walras equilibrium prices of (p̂ 1, p̂ 2), what
equilibrates the
two markets is the steeper slope of the latter budget. If the slope
of the bud-
get at the Walras prices is −2 for example, there are infinitely
many price
combinations that give rise to this slope. Therefore, the absolute
levels of the
prices is indeterminate at a Walras equilibrium. To peg the level
of the Wal-
ras prices, we normalize the price of one good to $1; this good
is then called
the numéraire good and the prices of all other goods are
measured in terms
of this numéraire. For instance, if a pack of chewing gum is the
numéraire,
then the price of a shirt worth $30 would be priced at 30 packs
of gum —
packs of gum are the unit of account.
Finally, regarding insight (3), individual rationality holds since

each con-
sumer is on a higher indifference curve at E as compared to ω.
Indeed, since
trade is voluntary, neither consumer would wish to move to the
Walras allo-
cation from ω unless they are at least as well off as initially.
Pareto efficiency
of the Walras allocation follows from the tangency of the
consumers’ indif-
ference curves at E. This result, known as the First Welfare
Theorem, is one
of the key insights of microeconomic theory and is a precise
modern restate-
ment of the idea attributed to Adam Smith that the greatest
social good arises
when individuals follow their self-interest in free markets.
6.3.2 Algebraic derivation
Consider a two-person economy where the utilities are Cobb-
Douglas and
given by
ua = xa1 x
a
2 and u
b = (xb1)
2 xb2
and endowments are
ωa = (6, 4) and ωb = (2, 8).
Then the demand functions for each consumer (using the
formulas in equa-

tion (4.11)) are
ha(p1, p2, ma) =
!
ma
2p1
,
ma
2p2
"
and hb(p1, p2, mb) =
!
2mb
3p1
,
mb
3p2
"
,
where ma = 6p1 + 4p2 and mb = 2p1 + 8p2 are the values of
each consumer’s
endowment.
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The length of an Edgeworth box shows the total supply of good
1, while
the height shows the total supply of good 2. Given the
Edgeworth box and
the initial endowment, any exchange of goods between the
consumers en-
tails a movement to another allocation inside the box. Starting

from any
allocation inside the Edgeworth box — say, the center, C = ((6,
5), (6, 5))
— to an allocation to its northeast makes consumer a better off
and b worse
off because both consumers’ preferences are strictly monotonic.
Conversely,
any allocation to the southwest of the box makes b better off
and a worse off.
6.2 Properties of Allocations
Given the preferences of the individuals and the initial
endowment, we can
now discuss properties of allocations. Some allocations may be
more desir-
able than others. We explore two different notions of
desirability.
6.2.1 Individually rational allocations
Individual rationality embodies the idea that if two people trade
voluntar-
ily, that trade must leave each person at least as well off as
before they trade;
if trade hurts either consumer, they will have no incentive to
engage in such
an exchange of goods.
We define an allocation (xa, xb) to be individually rational if
ua(xa) ≥ ua(ωa) and ub(xb) ≥ ub(ωb), (6.3)
i.e., each person’s utility at her consumption bundle xi is at
least as great as
her utility from her endowment ωi, where i = a, b. Thus, the

movement from
the endowment bundle ωa to the bundle xa leaves consumer a no
worse off
than initially, and similarly for consumer b.
In Figure 6.3, the individually rational allocations lie in the
blue lens-
shaped area (labeled IR) between the indifference curves of
each consumer
that pass through the initial endowment. For example, in
moving from ω
to A, both consumers are better off than initially because A lies
on a higher
indifference curve for each consumer. At an allocation such as
B, consumer
a remains on her initial indifference curve and so remains as
well off, but
consumer b is on a higher indifference curve. You can verify
this by drawing ¶b
b’s indifference curve through point B. At C, consumer b is as
well off as
initially but a is better off.
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92 Chapter 6
x1
a
x2
b
x2
a
x1
b
Oa
Ob
IR
A

B
C
E
F
D
ω
Figure 6.3 Individually rational allocations
Note that any allocation inside the Edgeworth box but outside
of the IR
area places at least one consumer behind her indifference curve,
signifying
that she is worse off than at ω. For example, at D, consumer a is
worse off;
at E, b is worse off, and at F, both consumers are worse off. If
we expect
the consumers to barter and trade with each other starting at ω,
the only
allocations that they would agree to move to voluntarily must
lie within the
IR area since neither is made worse off by such a move; indeed,
it is quite
possible for one or even both of them to be better off.
Individually rational allocations inside the Edgeworth box can
be found
by following the three steps summarized below.
1. Identify the initial endowment, ω, in the Edgeworth box.

2. Draw an indifference curve for consumer a that passes
through ω, us-
ing arrows to show the direction in which her utility is
increasing. Do
the same for consumer b.
3. The area between the indifference curve for consumer a and
that for
consumer b (including the indifference curves themselves) is
the set of
individually rational allocations.
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6.2.2 Pareto efficient allocations
Pareto efficiency (or more traditionally, Pareto optimality)
embodies the
idea of non-wastefulness in allocating the total supply of goods
at our dis-
posal among consumers.3 Given an allocation, if it is possible
to reallocate
the goods so as to make at least one person happier and no one
worse off,
then the original allocation is wasteful in the sense that there is
scope for im-
proving on it. At a Pareto efficient allocation, it is not possible
to reallocate
the goods so as to make one consumer better off without hurting
someone
else, so it is non-wasteful.
To illustrate this idea simply, suppose we have an apple and a
banana to
allocate between two persons. Consumer a is indifferent
between an apple
and a banana, but consumer b has an aversion to bananas and
strictly prefers
apples over bananas. Then the allocation that gives a the apple
and b the
banana is wasteful because it is possible to make at least one
person better
off without hurting the other. Simply give the banana to
consumer a and the

apple to b; then a is as well off, but b is better off. Giving the
banana to a
and the apple to b is a Pareto efficient allocation because it is
not possible to
reallocate the goods and make at least one person happier
without hurting
the other.
Before we can define what a Pareto efficient allocation is
formally, we
need another definition. Starting from an allocation (xa, xb), the
allocation
(x̄ a, x̄ b) is said to be Pareto superior to (or a Pareto
improvement over)
(xa, xb) if nobody is worse off at (x̄ a, x̄ b) and at least one
person is better off.
In other words, if we started with the initial allocation (xa, xb)
and moved
to (x̄ a, x̄ b), then that would constitute an improvement because
nobody is
hurt and someone is happier. An allocation (x̂ a, x̂ b) is Pareto
efficient if there
is no other allocation that is Pareto superior to (x̂ a, x̂ b). In
other words, at a
Pareto efficient allocation, it is not possible to make at least one
person hap-
pier without hurting anyone else — any reallocation of goods
either hurts
somebody, or leaves everyone as well off.
Graphical representation
Typically an Edgeworth box will have many Pareto efficient
allocations. These
Pareto efficient allocations can be found by following this
algorithm.

3Pareto efficiency is named after Vilfredo Pareto, an influential
economist and sociologist.
The phrase “non-wastefulness” was coined by Leonid Hurwicz.
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94 Chapter 6
1. Fix the utility of one consumer, say individual b, at some

arbitrary level
ūb inside the Edgeworth box.
2. Maximize the utility of consumer a while keeping b on the
indifference
curve ūb. Then the allocation reached is a Pareto efficient
allocation.
3. To find other Pareto efficient allocations, repeat the process
by picking
a different utility level for b in step 1.
To find one Pareto efficient allocation and understand how this
algorithm
works, arbitrarily fix b’s utility at ūb shown by the green ūb
indifference curve
in Figure 6.4. Maximize a’s preferences while keeping b on her
green indiffer-
ence curve, yielding the allocation A. Then A is a Pareto
efficient allocation.
To check this, consider the different regions of the Edgeworth
box where an
x1
a
x2
b
x2
a
x1
b
Oa

Ob
A
I
II
III
IV
ub
ua
Figure 6.4 A Pareto efficient allocation
alternative allocation could be picked. Any allocation in region
I (which lies
to the southwest of the green indifference curve) makes
consumer a worse
off. In regions II and III, both a and b are worse off as they are
behind their
indifference curves ūa and ūb. In region IV (which lies to the
northeast of the
orange indifference curve ūa), b is worse off. Therefore,
beginning with A,
there is no Pareto superior allocation in the Edgeworth box, and
hence A is
Pareto efficient.
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Two remarks are in order. First, the fact that we fix the utility
of b in step 1
is totally arbitrary. In other words, the same set of Pareto
efficient allocations
can be found by reversing the roles of a and b, namely, fixing
the utility of a
instead in step 1, and maximizing b’s utility while keeping a at
this utility in
step 2.

Second, unlike individually rational allocations, Pareto efficient
alloca-
tions do not depend on the initial endowment as a reference
point. They
only depend on the consumers’ preference and the aggregate
supplies of the
goods, Ω. In other words, given the consumers’ preferences and
the dimen-
sions of the Edgeworth box, the set of Pareto efficient
allocations would re-
main unchanged if the initial endowment were to be some other
point inside
the Edgeworth box.
Algebraic derivation
The algorithm to find the Pareto efficient allocations
graphically is tedious
since there are infinitely many utility levels that could be
picked in the first
step. The alternative algebraic method presented here holds the
promise of
finding many, if not all, the Pareto efficient allocations in the
interior of the
Edgeworth box at once.
The algebraic derivation is motivated by Figure 6.4 which
suggests that
at an interior Pareto efficient allocation, the tangency of the
consumers’ in-
difference curves is a necessary condition, i.e., if (x̄ a, x̄ b) is
Pareto efficient,
then MRSa(x̄ a) = MRSb(x̄ b). When preferences are strictly
monotonic and
convex, the tangency of the indifference curves is also

sufficient to guaran-
tee Pareto efficiency, i.e., if MRSa(x̄ a) = MRSb(x̄ b), then (x̄ a,
x̄ b) is Pareto
efficient. Therefore, the tangency of the indifference curves is
often a way to
find (interior) Pareto efficient allocations algebraically, or to
verify whether
a given allocation in the interior of the Edgeworth box is Pareto
efficient.
To find the interior Pareto efficient allocations algebraically for
the econ-
omy in section 6.1, set the marginal rate of substitution for a
equal to that for
b to obtain
MRSa = xa2/x
a
1 = MRS
b = 2.
Then xa2 = 2x
a
1, which means that when the two consumers’ indifference
curves are tangent, person a consumes twice as much of good 2
as good 1.
Plot the equation xa2 = 2x
a
1 in Figure 6.5 beginning from O
a, joining interior
Pareto efficient allocations such as R and S where the
consumers’ indiffer-

ence curves are tangent as shown.
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96 Chapter 6
x1
a
x2

b
x2
a
x1
b
Oa
Ob
R
T
S
PE
Figure 6.5 The Pareto set or contract curve
However, there are other Pareto efficient allocations in addition
to the
allocations that lie along the line xa2 = 2x
a
1. For instance, verify by inspec-b·
tion that a point like T = ((9, 10), (3, 0)) which is on the edge
(and not
the interior) of the Edgeworth box is also Pareto efficient.
Generally, the
tangency condition will not hold at Pareto efficient allocations
along the
edges of the Edgeworth box. For instance, at T, MRSa(9, 10) =

0.9 while
MRSb(3, 0) = 2.4 The set of all Pareto efficient allocations
(often called the
contract curve) for this economy is labeled PE.
When the contract curve consists of allocations in the interior of
the Edge-
worth box, it is possible to find an equation for it by following
these three
steps.
1. Set MRSa = MRSb.
2. From the supply constraints for the two goods, xa1 + x
b
1 = Ω1 and x
a
2 +
xb2 = Ω2, derive x
b
1 = Ω1 − x
a
1 and x
b
2 = Ω2 − x
a
2. Use these to eliminate
xb1 and x
b
2 in the equation from step 1.

3. Solve the equation from step 2 to write xa2 as a function of x
a
1. Then this
is the equation for the contract curve with Oa as the origin.
4In general, at a Pareto efficient allocation that lies on the left
hand or top edge of the
Edgeworth box, it will be the case that MRSa ≤ MRSb; the
inequality will be reversed for a
Pareto efficient allocation that lies on the right hand or bottom
edge of the Edgeworth box.
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1)
a) Show an Edgeworth box for a general case of two agents who
both have Cobb-Douglas preferences. (Make sure to label axis
and curves.)
b) Briefly explain what the contract curve is.
2) For two agents, a and b, with the following utility functions
over goods x and y
a) Determine the slope of the contract curve in the interior of an
Edgeworth box that would show this two-person two-goods
situation.
b) For initial endowments ωa=(12,7) and ωb=(9,10), what is the
Walras allocation between the two agents a and b? (Remember
that it is the relative price of the goods that matters in this
consideration. Also remember that all the units of goods that
exist here are will end up with one or the other agent; so, the
overall 21 units of x and the 17 units of y will be fully allocated
between the two. )

c) Calculate the utility level before and after trading.
over goods x and y
situation.
Walras allocation between the two agents a and b?
over goods x and y
situation.

Walras allocation between the two agents a and b? (Remember
that it is the relative price of the goods that matters in this
consideration.)
Running Head: PROJECT MANAGEMENT
1
PROJECT MANAGEMENT

4
Project Management Assignment #1
1. Provide a short description of each job title's tasks (you may
have to do research). There are a total of eight different titles
shown above.
a. Physicians
They responsibly diagnose and treat conditions in patients.
b. Office manager
Conducting different roles that make sure the operations of an
office are smooth, effective and efficient.
c. Medical assistants
Plays a supporting role to the physician and medical
professionals in care settings.
d. Receptionists/ Intake coordinators
Handling the process of registering patients and clients as they
come to seek services.
e. Billers
Doing calculations as well as the collection of payments for
medical services offered to patients and done so accurately.
f. Coders
The main role is documentation of the medical details of
patients in code form.

g. Check out Schedulers
They make appointments for inpatients to leave the medical
facility and help them through the process,
h. Customer Service/Phone Callers
Their main role is responding to callers, answering their
questions, listening to their concerns and needs and also
addressing them.
2. In a paragraph of at least 10 - 20 sentences, discuss what the
objective for the new EMR is.
The main and overall objective of the new EMR is to facilitate
better storage of medical information (Huang, Shea, Qian,
Masurkar, Deng & Liu, 2019). The EMR will help store
information in a manner which is a lot easier to access and one
which is a lot less cumbersome. As noted, medical records are
currently stored on paper and one can only imagine how hard it
can be to retrieve any record as one has to browse through many
papers and access to since one can only access the information
in the physical location where has been stored. By integrating
the EMR, the hope is to have one central location of storing
data which is easy to access as one only needs to have a
computer to access it. Further access will be easier as a
physician as well as the patient will be able to remotely access
the information (Gosnell, Minnie, Yu, Liao & Cain, 2019). By
computerizing the medical record, the medical practitioners will
also not have to search for records as much since retrieving
information from a computer database becomes a lot easier.
The second objective is to make medical data at the centre a lot
more organized. Handling paper records can be very
cumbersome since they even taking up a lot more physical
space. The EMR will make the management of records easier by
removing this inconvenience. Having data stored virtually will

take up less space and less effort to manipulate. In this way,
records can be a lot more organized for easier retrieval.
References
Gronsbell, J., Minnier, J., Yu, S., Liao, K., & Cai, T. (2019).
Automated feature selection of predictors in electronic medical
records data. Biometrics, 75(1), 268-277.
Huang, L., Shea, A. L., Qian, H., Masurkar, A., Deng, H., &
Liu, D. (2019). Patient clustering improves efficiency of
federated machine learning to predict mortality and hospital
stay time using distributed electronic medical records. Journal
of Biomedical Informatics, 99, 103291.
Sheet1StepTaskResponsible Person(s)DateDuration1:
Establishing the project teamMeeting with potential "executive
sponsor"Senior Management1/1/171 Day1: Establishing the
project teamMeeting with potential " project manager"Senior
Management1/2/171 Day1: Establishing the project
teamMeeting with team player: "medical assistant"Project
Manager & Executive sponser1/3/171 Day1: Establishing the
project teamMeeting with team player: "physician"Project
Manager & Executive sponser1/3/171 Day1: Establishing the
project team1: Establishing the project team1: Establishing the
project team1: Establishing the project team1: Establishing the
project team1: Establishing the project teamFirst team
meetingExecutive sponsor, project manager, and team
members1/8/171 Day2: Project Activities and phases
Sheet2
Sheet3
Running Head: PROJECT PLAN ASSIGNMENT
1

PROJECT PLAN ASSIGNMENT
5
Project Plan Assignment #2
Project Plan Assignment
EPIC & Allscripts EMR Systems
EPIC offers implementation services in the form of working
together with the teams in the hospitals to help tailor a system
to a specific facility and more importantly identify and manage
any risks (Epic Website, 2020). In terms of training the offers
programs which are end to end by nature run by trainers who are
well-credentialed as well as certified. For technical services
EPIC offers 24 hours support throughout the week with regular
monitory and check to ensure the proper running of their
systems (Epic Website, 2020). They have a very good
reputation of being very responsive to the users whenever they
are called on to ensure that systems work effectively and one of
offering technical support that is of high quality. For the on-
going services, the company calls themselves a user’s BFF who
stays close to make sure that the user enjoys the use of the
systems and can optimize its use. Finally, for continuous
improvement, the staff of the company offers users advice
assistance and support to help foster improvement.
For the implementation of the systems, Allscripts provides its
services in the form of consultancy whereby they have a
consultant that guides facilities on how to go about fitting the
technologies in their facilities (Allscripts Website, 2020). They

provide training to practitioners through resources and on-site
training in three major ways which are helping them to better
make use of their products, enhancing the skills of the experts
who maintain the systems and providing general training to all
practitioners to help them understand the systems (Allscripts
Website, 2020). In terms of technical services, they have a
technical support team which through its environmental
evaluation can identify issues that can contribute to a lack of
optimal performance of systems and solve them. All these are
technical services related to the running of healthcare facilities
and they achieve this through their various products. In terms of
their on-going services they provide support for the
infrastructure of the clients and offer service desk support for
all their clients. They finally ensure continuous improvement by
constantly upgrading their products to better and more
innovative versions which are more effective and efficient for
the users.
Then, based on your information on both companies, you
determine which company you will use to implement the new
EMR system. Also, explain why you chose that company based
on the five items listed above (implementation, training,
technical services, on-going services, and continuous
improvement). There is no right or wrong answer on which
system you choose.
Based on the aspects discussed above, I would choose EPIC as
the company of choice. This is because based on these featured;
it seems to be offering a more personalized experience to the
users. Right from the implementation, they take the trouble to
tailor their products to the systems of the facility. More
impressively, however, their technical services are highly user-
friendly, and they are more likely to make sure that one derives
the most value from the system. This is because technology and
its implementation are generally not so easy, and it is further
very sensitive when used in the health care setting. Based on

this one would want a company that can be trusted in offering
the best technical support to avoid facing the downside of
technology as a result of it being ineffective. This choice is
more reliable on that basis.
As a project manager, you will also need to determine if you
need PCs or laptops and how many for XYZ Physician’s group.
You make the “call” as to why you should have PCs or laptops
(or both); but, you must explain why you made the decision.
Also, research the cost for PCs and/or laptops (Bestbuy is a
good source). You will need to provide two different companies'
cost for the PCs and/or laptops. Then, come up with a grand
total for the total cost for the PCs and/or laptops for each
company. Lastly, you make the "call" which company you will
buy the PCs and/or laptops from.
For this project, PCs will be needed not only because they will
be used in an office setting thus no need for portable devices
but also because their hardware specifications are in most cases
more superior than those of the laptop and thus will allow for
more efficiency. The PCs will be purchased from either Dell or
HP because these are two of the best Microsoft companies
which offer market-tested products at reasonable prices. The
price for HP pc is about $1000 and the price for a similar dell
one $1400. The price for Dell pcs will there be more expensive
than the HP ones but Dell computers will be the preferred
choice for this project because they have a more reliable
processor and a stronger one and therefore it is more likely to
do the job effectively.
References
Allscripts Website. (2020). From:
https://www.allscripts.com/services/
Epic Website. (2020). From: https://www.epic.com/services

Running Head: WORKFLOWS
1
5
WORKFLOWS
Project Plan Assignment 3
Introduction
Workflows play a significant role in the continuity of operations
in the organization (Da Silva, Filgueira, et al ., 2017). This
paper shall focus on workflow in the Physician's office in the
process of administration of medication to the patients.
Workflows involves the recording of a health issue from the
patient by various individuals in the Physician's office. The
medical information of the patient is added effectively from one
person to the next, after which the information is filed into the
filling cabinet. The workflow in the Physician's office is
coordinated by the Physician, office manager, medical
assistants, receptionists intake coordinators, billers, coders,
check out schedules, and customer service/ phone callers. The
paper shall focus on their various roles in the administration of
medication to the patients.
Receptionists / Intake coordinators
Their main responsibility is to guide the patients to the relevant
department for examination and treatment. They ensure that the
patients access the right department upon arrival. Once the
patient with hypertension arrives at the facility, he or she is
directed to the Physician by the receptionist.
Physician
The Physician shall diagnose the patient to ascertain whether he
or she is suffering from hypertension or not. The Physician

plays a significant role in the examination of the patients. After
the examination, he or she takes the medical history of the
patient to ascertain the possibility of occurrence of the similar
medical condition in the past. This enhances effective
administration of medication minimizing the chances of
medication errors that is rampant among the health practitioners
(Lin, Deng et al., 2018). For our case, the Physician shall
diagnose the patient for a possible case of hypertension, after
which he shall refer the patient to the next department after
recording the patient's condition.
Medical assistants
The primary role of the medical assistants is to update the
medical records of the patients upon diagnosis by the Physician
for future reference. After the diagnosis of the patient with
hypertension, the Physician passes the record to the medical
assistant on duty who records the results in the patient's health
record. The medical assistant may schedule for hospital
admission for the patient if the condition requires continuous
treatment within the healthcare facility.
Billers
The biller processes the medical bill of the patient to enhance
payment for the service received from the health practitioners.
For instance, the patient with a case of hypertension should pay
for the services offered to the biller, after which a receipt is
issued as evidence of the payment that has been made.
Coder
The coder in the Physician's office stores the health records of
the patient in the health records information system for
increased safety of the confidential information of the patient.
The health information about the patient from the Physician is
recorded professionally to enhance future medication.
Check out schedulers

Their primary role is to clear the patients ready to leave the
hospital after the admission period is over. They record the
duration spend by the patient in the healthcare facility for future
medication purposes.
Customer service
After the patient is done with the treatment, the customer care
service department obtains the feedback from the patient
regarding their feeling concerning the service they have been
given at the facility. Their feedback is recorded to report.
Office manager
All the reports regarding various medications administered to
the patients are submitted to the office manager for approval.
The office manager monitors the performance of all the health
practitioners.
References
Da Silva, R. F., Filgueira, R., Pietri, I., Jiang, M., Sakellariou,
R., & Deelman, E. (2017). A characterization of workflow
management systems for extreme-scale applications. Future
Generation Computer Systems, 75, 228-238.
Lin, A. C., Deng, Y., Thaibah, H., Hingl, J., Penm, J., Ivey, M.
F., & Thomas, M. (2018). The impact of using an intravenous
workflow management system (IVWMS) on cost and patient
safety. International journal of medical informatics, 115, 73-79.

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