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Understanding Concurrency Checks in GraphiumEMR

Our system automatically checks for concurrency violations to help ensure compliance with anesthesia concurrency rules. This article explains how concurrency checks work and what information you’ll see if a violation occurs.

When We Run Concurrency Checks

We only run a concurrency check when all of the following are true:

  • The provider has entered a start time for themselves (Note: Anesthesia Case Start and Stop times are NOT a part of any concurrency check.)
  • A care model has been selected for the case
  • The case type is Standard (eg. Not an OB Case which are not checked for concurrency issues.)

If these conditions aren’t met, the concurrency check won’t run.

If no Provider specific end time is entered, we assume the case is still in progress and use the current time as the "end".

How We Detect Overlapping Cases

Once a case meets the above rules, we look for overlapping cases as follows:

  • The two cases must overlap by at least one minute
  • Only cases on the same day (or within 1 day) are compared
  • Providers can appear in the same case multiple times — this doesn’t count as a violation

Concurrency Rules by Care Model

Concurrency rules depend on the care model of the case:

Care Model

Rule

CRNA Only

A CRNA can only be in 1 case at a time

Physician Only

A physician can only be in 1 case at a time

Team

An anesthesiologist can be involved in up to 4 cases at once

Both Full

Same rule as Team: up to 4 cases at once

Supervised

No concurrency limit

Mixed

No concurrency limit because the care model changed mid-case

What You’ll See for Violations

When a concurrency violation occurs, we show:

  • The number of violations for each provider
  • The overlapping case details:
    • Case number
    • Provider name and ID
    • Encounter ID and Encounter Form ID

This helps you quickly see which cases and which providers are affected.

Example

This case is causing 1 concurrency issue. Specifically, the Provider ID with the concurrency is "MD1-11111". Furthermore, the "conflicting case" has an Encounter Number of "TEST_OVERLAP". In this case, provider MD1-11111 needs to either (1) change their individual start time on this form, or (2) navigate out of this form to the "TEST_OVERLAP" EN, find the conflicting form, open it, and change their individual times. Of note, this new form they have navigated to will show a similar "concurrency violation" which identifies the EN they just navigated away from.

Limitations

We do not check for Anesthesia Assistant concurrency issues.We do not yet have a dashboard visualization identifying conflicting forms.