Administrative Workflow Patterns
Healthcare administration is often treated as a secondary concern in open-source health IT. RPMS takes it seriously — registration, credentialing, billing, and resource management are first-class domain operations. These patterns are as worth replicating as the clinical ones.
Pattern: Concurrent Multi-Clerk Registration
Patient Registration (AG) — multiple departments, one record
Three clinic clerks access the same patient record simultaneously
Registration clerks in the Diabetes, Urgent Care, and Family Practice clinics are all using Patient Registration at the same time. Each accesses: medical record number, demographics, tribal membership, and insurance eligibility. No duplicate data entry. No scheduling conflicts. One source of truth.
Medical records clerk establishes new chart from earlier capture
New-patient data captured earlier (at the point of first contact) is used to establish a formal chart record. Data collection and record formalization are decoupled — capture happens first, reconciliation follows.
Domain Pattern: A single patient record shared across all departments in real time — no department-specific silos. The patient identity data model includes fields specific to the IHS context: tribal membership, IHS eligibility, and Contract Health Services authorization. These are domain objects that don't exist in generic EHR frameworks.
Pattern: Credential Tracking with Expiration Alerts
Medical Staff Credentials — workforce compliance as a domain operation
Administration clerk runs credential status report
Medical Staff Credentials produces an updated report on all credential files. Automated alerts are sent to providers whose licenses are due for renewal or who need to re-apply for privileges. The system initiates the compliance action — staff don't need to remember.
Domain Pattern: Credential expiration as a time-based event that triggers a notification workflow. The domain objects are: Provider, Credential, Privilege, ExpirationDate, Alert. Modern equivalent: scheduled jobs that check credential state and dispatch notifications — but in RPMS this was built as a first-class healthcare administration operation, not an afterthought.
Pattern: Administrative Request Routing
Administrative Resource Management System (ARMS) — travel and resource requests
Travel request entered — system auto-computes per diem and routes for approval
Staff member requests to attend a training session. ARMS automatically computes the approved per diem and lodging rates for the training location. Clerk enters remaining travel information. Request is electronically routed for approval — no paper forms, no manual rate lookup.
Domain Pattern: Request → auto-computation of derived values → electronic approval routing. The domain objects are: Request, Location, PerDiemRate, ApprovalWorkflow, Approver. This is a general approval workflow pattern applied to healthcare administration. The auto-computation of rates from location data is a rules engine embedded in the domain model.
The IHS-Specific Patient Data Model
RPMS's patient registration data model includes fields that generic EHR frameworks don't have. These are not edge cases — they are core domain objects for this population:
Tribal Membership
Tribal affiliation determines eligibility for IHS services and Contract Health Services.
IHS Eligibility
Determines which services the patient may receive under the federal Indian Health program.
Contract Health Authorization
Authorization status for services referred outside the IHS facility network.
Medical Record Number
Facility-scoped identifier, with Master Patient Index (AGMP) handling cross-facility identity resolution.
Pattern: Domain models must reflect the actual population being served — not a generic patient model that ignores context. The IHS patient model is a lesson in domain-driven design applied to a specific, underserved population.
BPMN Diagram: Patient Registration Flow
BPMN diagram placeholder — Patient Registration flow
Swimlanes: Patient · Registration Clerk · Medical Records · Insurance Verification
Key events: First contact → Demographic capture → Tribal eligibility check → Insurance eligibility → Chart establishment → Record available to all departments