Automating Healthcare
Solving business problems with savvy automation

Integrated Clerkship Registry

Business problem
A pioneering program has revolutionized the way medical students are trained during their third year of medical school. Preceptors needed an automated way to select a panel of patients for each student and monitor the students' fulfillment of training requirements during the year, and students needed to be involved in all aspects of "their" patients' care during the year.

Academic pioneers
The third year of medical school ("clerkship") traditionally consists of a series of twelve-week "rotations" through several clinical services, including pediatrics, surgery, internal medicine, ob/gyn, and psychiatry. Each rotation is treated as a separate learning experience, and only patients being treated by that service are seen during a rotation. This results in a very fragmented experience for the students, very unlike the real world where they will live and work.

A revolutionary new approach to this third year blended all the rotations into a yearlong, "longitudinal" experience, in which the students work with a primary care preceptor who assigns a panel of patients to each student. The student follows all aspects of the care of these patients during the entire year. The panel of patients are carefully selected to include a mix of patients who are likely to expose the students to the same clinical services included in the traditional rotations. The advantage of the new approach is that it provides a much more realistic and holistic experience for the students.

Registering patients
The process begins by adding a patient to the Clerkship Registry (see "Search for Patients" below).

When an unassigned patient is selected, the patient can be "registered" with the Clerkship checkbox (shown below).

[Click the image above to see the full size image]

Each student who wishes to include a patient in his/her panel may do so. Each student encounter with that patient is documented using the same form (shown below). Each student may also configure their email and paging options for the patient (more about this later).

[Click the image above to see the full size image]

Core diagnoses for each patient are added by any student in the relevant discipline section. Each specialty can be expanded by clicking the discipline name (shown above), so the core diagnoses for that discipline are displayed (all specialties expanded below). The date of the encounter and any non-core diagnosis are also input.

[Click the image above to see the full size image]

In addition to selecting core diagnoses, a comment can be submitted, linked to discipline and location (ED, inpatient or outpatient).

[Click the image above to see the full size image]

Patient status may be changed to any of the valued shown below.

Each student may choose to be notified about events for this patient (more about this later) on a daily or weekly basis, or not at all.

Each student may choose to be notified by pager about events for this patient. Pages may be limited to specific times or unlimited.

Student Reports
Four reports are available for students, all shown below:

  • Panel report
  • Scheduled appointment list
  • Missed appointment list
  • Surgery log

The panel report (shown below) may be printed for one student or all students, and there are options (above).

[Click the image above to see the full size image]

The scheduled appointments list provides students with a complete picture of clinical activity for their panel.

Timeframe may be set to one of several options (shown below).

The report may be printed for all students or any specific student. A specific location may also be selected. Finally, the report may be sorted in one of three ways (shown below).

The report may be output to Excel or viewed in the browser (shown below).

[Click the image above to see the full size image]

The second report, for missed appointments, may be used by the students to call the patient to learn why they missed the appointment and whether any followup is indicated. the

A sample of the report is shown below:

[Click the image above to see the full size image]

The third report is a list of encounters since the beginning of the current academic year, and may be run for one student, all students, or a specific patient.

A sample of the encounter list is shown below:

[Click the image above to see the full size image]

The fourth report is the student surgery log, which may be run for all students or a specific student:

A sample of the student surgery log is shown below:

[Click the image above to see the full size image]

Preceptor/faculty reports
Seven reports are available for preceptors and program leaders to monitor student progress. All reports may be output to Excel for further manipulation:

The Logged Core Dx report is a simple count of the number of patients with whom each student has logged an encounter for each core diagnosis (shown below).

Non core diagnoses may be listed with a count of the number of patient encounters logged (shown below):

[Click the image above to see the full size image]

Total visits by student may be listed (shown below):

An audit report is available, listing any patients to whom no students have been assigned.

A different view of student activity counts core diagnoses by discipline and location (shown below):

[Click the image above to see the full size image]

A list of patient visit dates provides a chronological view of student activity (shown below):

[Click the image above to see the full size image]

Finally, a list of patients by discipline and location is available (shown below):

[Click the image above to see the full size image]

Automated Alerts
Once the patients are registered, the fun begins. Every day, each student receives an e-mail listing all scheduled appointments for their patients during the next week (shown below).

[Click the image above to see the full size image]

During the day, each student is alerted about any newly-scheduled outpatient appointments or any inpatient ADT (Admission/ Transfer/ Discharge) events for their patients. At minimum, an e-mail notification is sent (shown below).

[Click the image above to see the full size image]

If the patient is registered for paging with a student, automatic pages are sent as well as the standard e-mail alerts (examples shown below).

If a patient does not keep a scheduled appointment, the student is automatically notified with a daily e-mail list (shown below).

[Click the image above to see the full size image]

More information

The new clerkship program has been a significant success.

  • Students report very high levels of satisfaction with all aspects of the program, including the automated processes.
  • Academic outcomes are very positive, with test results proving that the new program is at least as effective as the traditional program.
  • The reputation of the new program spread very quickly, resulting in a high level of competition among prospective students.

Lessons learned

  • Not a new lesson, but this application reinforces the value of re-purposing automated processes for other applications. The clerkship registry leveraged automation originally developed for ADT event alerts, which in turn leveraged the clinical operations dashboard. The clerkship registry also leveraged extensive work done on chronic disease registries.

Posted 27 April 2008
Updated 24 July 2012


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People Profiles
Chronic Disease

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Mental Health Treatment
      Plan Tracking

Earned Time Calculator

Supervisory Tree
E-mail Distribution Lists
User Access Requests
HR Requests
Employee Health &

Interpreter Dispatching
Generic Patient Registry
Conference Room

Tuition Reimbursement
Equipment Rental
Code Cart Tracking
Nursing Audits

Show me the data
Growing a Data

Building a Data Portal
Reporting on Full Auto

Intranet Design
Driving With Databases
Speeding with Static

Transparent Security
      and Permissions

Redesigning the

Who works here?
Organizational buckets
System access: Who
      has what?

System access: Use
      it or lose it

Integrating Security

Integrating Provider

Creating A Supervisory

Data Quality Dashboard


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