Encounter Management is a Tableau dashboard application in Edifecs product that helps regulate the Encounter flow of payer organization. For more info, click on the product details page here.

An Encounter is summation of patient claim and payment information. It is generated by payer organization and is triggered when a patient seeks help from healthcare provider such as physician, nurse practitioner or physician assistant. Payer orgs. are required to assemble encounters in standard format and send it to CMS (Center for medicare and medicaid services) periodically for inspection. They are also required to handle errors and exceptions during the process.

Typically, a medium to large sized payer organization has to deal with hundreds and thousands of encounters every month. It is crucial to keep track of every single encounter until its CMS approved. Different user roles within a payer org. have different responsibilities related to the encounter management process like encounter generation, error resolution and CMS compliance check. There was a real need to design dashboard view for each of these users to help them regulate the process better.

1. Brainstorming session with the Product Manager

Product manager and I started the project by doing a brainstorming session in which we determined the overall system so that we get a good understanding of the context we are designing for.

We determined the entities involved in encounter management i.e Hospitals, Payer Organization and CMS.gov The system diag. was based on the expertise knowledge of the product manager and literature review. We also determined the flow (input/output) of the encounters and validation steps in the process.

2. User Profiles

With the help of product manager and business analyst, we identified three user roles of payer organization that have unique responsibilities of managing encounters.

Director - To oversee encounter performance of the organization
Encounter Manager - To ensure CMS compliance is met every time
Encounter analyst - To analyse and resolve errors and exceptions

Final design is an interactive tableau dashboards that is linked with rest of the Edifecs product.Dashboard order (in subsequent pages):
1. Overview DB
2. Exception DB
3. Inbound Recon DB
4. Outbound Recon DB
Interaction Link: Here

(Click on the individual pages to see them full screen)

The dashboards were incrementally developed. They are being used by over 7 clients of Edifecs as a part of Encounter Management product. Total number of users using these dashboards design is more than 20 and it is likely to increase.

Encounter Management is one of the first product designs that I did at Edifecs from end to end. I was responsible for creating the prototype, doing research and sharing the progress with stakeholders on regular basis. One strong realization I had during the project was the importance of defining the goal/outcome before working on the design. The project took longer time to complete because the requirements, constraints kept changing and I was accommodating that into my design every time. Thus, a time specific goal was needed. It is useful to have incremental approach to design and strategizing changes at regular interval of time.