Clinical Workflow Patterns
RPMS clinical workflows represent decades of hard-won operational knowledge from resource-constrained, high-stakes healthcare settings. These patterns are worth understanding and replicating — not the specific MUMPS implementation, but the operational logic underneath.
Pattern: Pre-Visit Preparation
Diabetes Clinic scenario — scheduling through patient arrival
Appointment list generated from Outpatient Scheduling
Medical records technician pulls tomorrow's Diabetes Clinic list. For each patient, the Diabetes Standard Health Summary is printed — a pre-computed snapshot of the patient's current status, active problems, medications, and outstanding preventive care.
Nurse coordinator pre-stages care
Reviews each Health Summary. Completes lab slips and referral forms. Orders immunizations. Everything is ready before patients arrive — reducing appointment time and clinical cognitive load.
Domain Pattern: The Health Summary is a pre-computed patient snapshot — not a live query, but a generated document representing the patient's state at a point in time. This pattern works well in low-bandwidth, offline-capable environments and reduces per-encounter query load. Modern equivalent: a patient card or care gap report generated nightly.
Pattern: Encounter-at-Arrival
Walk-in / urgent care workflow
Walk-in arrives — PCC Health Summary printed immediately
As the chart is pulled, the Health Summary generates automatically. The triage nurse checks it for: chief complaint context, overdue immunizations, outstanding preventive care, current medications and allergies.
Triage nurse orders labs
Lab orders placed at triage — before the provider sees the patient. Results will be ready by the time the provider encounters the patient.
Provider accesses results at point of care — no phone call needed
Lab results print at the lab printer the moment they are reported. The physician accesses radiology results at a terminal — not by calling the radiologist. Updates Problem List and adds Related Notes in the same workflow.
Domain Pattern: The encounter begins at arrival, not when the provider enters the room. Data collection, order entry, and care gap identification happen in parallel — distributed across triage nurse, lab, and provider without duplication. This is a pull-based, event-driven workflow long before those terms existed in software design.
Pattern: Cohort Query at Point of Care
Q-Man / population health query — finding patients who share a condition
Clinician identifies a care gap for one patient — suspects others have the same gap
A 38-year-old woman with dysfunctional uterine bleeding has not had tissue sampling ordered. The nurse clinician recalls two similar recent cases — but can't name them.
Q-Man query returns the cohort in minutes
Using PCC Query (Q-Man), the clinician enters criteria: diagnosis, missing order type, date range. Within minutes: two patients identified who need tissue sampling. The care gap becomes an actionable list.
Domain Pattern: Population health queries available to clinicians at the point of care — not just to administrators or analysts. Q-Man is a proto-population-health tool: define criteria, find a cohort, act. Modern equivalent: care gap lists, risk stratification dashboards, panel management tools. The key insight is that the same data used for individual care should also be queryable across the population.
Pattern: External Clinical Decision Support
Public health integration — connecting to CDC at point of care
Confirmed meningococcal case — public health nurse retrieves CDC guidelines in-workflow
Rather than switching context to a browser, the nurse accesses the CDC Prevention Guidelines directly through RPMS's Network Communication capability. Guidelines retrieved, printed, and orders placed — without leaving the patient encounter workflow.
Domain Pattern: Clinical decision support sourced from authoritative external references, surfaced in-workflow. The pattern predates modern CDS Hooks by decades. The principle is the same: the right guidance, at the right moment, without leaving the care workflow.
BPMN Diagram: Diabetes Clinic Visit Flow
BPMN diagram placeholder — Diabetes Clinic visit flow
Swimlanes: Medical Records · Nurse Coordinator · Triage Nurse · Provider · Lab
Key events: Appointment list generated → Health Summary printed → Pre-visit prep → Patient arrival → Triage → Lab orders → Provider encounter → Result access → Problem list update → Notes documented