Designing a scalable, FHIR-aligned Emergency Department patient administration workflow under tight constraints
Telstra Health PAS MVP
[insert image: ED Board overview as hero visual]
Context
Telstra Health set out to build a modern Patient Administration System to replace the fragmented and retrofitted products commonly used in Australian hospitals. Many existing PAS systems are difficult to adapt, hard to integrate, and not aligned with contemporary interoperability standards. Many hospitals also continue to rely on paper-based workflows for essential administrative tasks, which increases risk and slows data capture during high-pressure periods.
The new PAS needed to integrate with Telstra Health’s EMR and Bed Management modules and support modern FHIR-based data exchange.
For the MVP, the team focused on the Emergency Department patient journey. ED is the hospital’s main entry point and the most critical stage for capturing accurate administrative data that feeds into downstream clinical and operational systems.
[insert image: existing PAS examples blurred or abstracted for comparison]
Existing PAS products across Australia range from outdated terminal interfaces to fragmented web systems with little standardisation.
Problem
Hospitals needed a PAS that captured essential ED administrative details quickly and accurately, without forcing staff through scattered or inconsistent screens. Current workflows often rely on a mix of legacy systems and paper notes, creating delays, inconsistencies, and avoidable risk.
Common issues included:
Fragmented workflows across multiple screens
Ongoing reliance on paper-based notes causing inconsistent data capture
Slow data entry that disrupted triage flow
Limited visibility of patient status and movement
Inconsistent or unclear patient identifiers
Weak alignment with FHIR structures
Difficulty integrating with EMR and Bed Management systems
A modern MVP needed to demonstrate reliability, speed, interoperability, and a scalable foundation rather than full hospital coverage.
Most existing PAS systems do not support rapid decision making or shared understanding under pressure.
Before: Industry baseline
Most PAS systems remain inaccessible for direct reference, but examples found in the sector show consistent challenges:
[insert image: legacy PAS example 1]
[insert image: terminal/DOS-style interface]
Common patterns:
Fragmented information across multiple screens
Dense tables with minimal hierarchy
Minimal support for rapid scanning
Limited visibility of patient flow or priorities
Variable layouts across departments, increasing training burden
Heavy reliance on memory and manual coordination
These limitations create significant risk in ED, where clinicians need continuous awareness of patient status and departmental capacity.
After: The new design direction
The new PAS design provides a structured, predictable ED experience built around patient movement, clinical priority, and real-time coordination.
[insert image: ED board or patient card]
Key improvements:
One consolidated view showing all ED patients and statuses
Clear hierarchy supporting rapid scanning and team alignment
Reusable components that scale across PAS modules
Reduced cognitive load through structured grouping
Visibility into risks, bottlenecks, and next actions
A scalable foundation for a modern PAS ecosystem
This comparison shows the shift from scattered, outdated systems to a coherent, contemporary design shaped around clinical needs.
Constraints
The project operated under tightly limited conditions:
Six-month deadline to deliver a stakeholder-ready MVP
Small cross-functional team
Limited access to frontline ED users for research
PAS domain complexity, especially around identifiers, encounters, and movement
FHIR compliance requirements
Mandatory coordination with EMR and Bed Management systems
No pre-existing design system
High stakeholder expectations for clarity and modernisation
These constraints shaped both the solution and the prioritisation strategy.
Design judgement
Before defining the MVP, I evaluated whether we could design PAS holistically across ED, inpatient, and outpatient workflows. Given time and team size, this was not feasible.
I proposed a focused MVP on the ED journey because:
ED is the most complex administrative entry point
Clean administrative data at ED arrival improves downstream safety
ED captures the core FHIR Patient and Encounter events
ED demonstrates whether the architecture is viable
The workflow exposes almost every key PAS function
It allows a strong showcase without overextending the team
This approach delivered the maximum value in the shortest time and established the backbone for future modules.
Why FHIR?
FHIR (Fast Healthcare Interoperability Resources) informed many of the structural design decisions.
Key advantages:
Consistent data model: FHIR Patient, Encounter, and Location resources aligned well with PAS workflows and simplified field design.
Interoperability: Clean and predictable data exchange with EMR and Bed Management systems.
Reduced duplication and error: A single, authoritative patient record improves safety and reduces manual re-entry.
Future scalability: FHIR compliance decreases integration overhead as future modules are added.
Operational clarity: Encounter status and transitions map directly to ED movement, improving hospital visibility.
For a modern PAS, FHIR wasn’t optional—it was essential.
Objectives
Capture essential ED administrative data rapidly and accurately
Build a modular component system scalable to inpatient/outpatient flows
Use FHIR-aligned structures for interoperability
Improve visibility of patient movement
Simplify administrative workflows under pressure
Design an MVP that demonstrated feasibility to stakeholders
Create an architectural foundation for future PAS modules
Research and insights
Given limited access to ED staff, research combined:
Conversations with clerical staff where possible
Input from internal clinical SMEs
Analysis of existing PAS products used locally
Examination of international PAS patterns and limitations
Detailed mapping of FHIR resources (Patient, Encounter, Location)
Key insights:
1. Speed and clarity drive ED admin
Clerical staff need to stabilise patient data as quickly as possible.
2. Fragmented workflows create delays
Switching across multiple PAS screens leads to errors and re-checking.
3. Patient movement is poorly represented in most PAS tools
Hospitals supplement systems with whiteboards and spreadsheets.
4. Terminology varies across hospitals
The UI needed to be adaptable without enforcing rigid structures.
5. FHIR clarified what belonged to PAS vs EMR
This reduced scope confusion and prevented feature creep.
[insert image: affinity map or insight breakdown]
Strategy
The design strategy focused on defining a stable, scalable structure:
Use ED as the foundational workflow for future expansion
Create a patient card as the core component and data anchor
Build reusable patterns for forms, tables, boards, and status indicators
Represent movement clearly to support ED operations
Ensure all key data structures align with FHIR resources
Use progressive disclosure to minimise cognitive load
Deliver a polished MVP within six months without overextending scope
This strategy balanced usability, interoperability, and feasibility.
Key design decisions
Patient arrival and registration workflow
A streamlined, linear flow captured essential identifiers, arrival mode, triage category, and encounter creation.
[insert image: ED arrival / registration mid-fidelity screen]
Patient card as a reusable foundation
The patient card modelled the FHIR Patient and Encounter structures, supporting consistent updates and quick actions.
[insert image: patient card component]
ED board representing real-time movement
A board view showed patients moving through ED (Arrival → Triage → Waiting → Seen → Transfer).
This visual clarity improved team alignment and reduced reliance on manual tracking.
[insert image: ED board mockup]
Component-based UI system
Buttons, tables, cards, and forms were designed as reusable components to accelerate delivery across future modules.
[insert image: small grid of core components]
Prioritising visibility and speed
Administrative details and status changes were surfaced at the right moments with progressive disclosure built in.
Architecture diagram
+-----------------------+ | External Systems | | (Health Services, GP) | +-----------+-----------+ | | FHIR API (REST) v +------------------------------------+ | PAS (MVP) | | Patient Arrival | | Registration | | Encounter Admin | | Status & Movement | +-----------------+------------------+ | | HL7 + FHIR Events v +------------------------------------+ | Telstra Health EMR | | Clinical Documentation | | Medications | | Orders & Results | +-----------------+------------------+ | | FHIR Encounter Updates v +------------------------------------+ | Bed Management System | | Occupancy | | Transfers | | Unit Capacity | +------------------------------------+Prototype and validation
With limited access to ED frontline staff, validation cycles relied on:
Scenario walkthroughs with internal SMEs
Feasibility checks with engineering
Iterative flow and component refinement
BA reviews against hospital requirements and FHIR rules
Key findings:
Movement needed clearer visual cues
Some terminology differed between hospitals
ED clerical users needed rapid access to patient state changes
Filtering and sorting were essential for real-world volume
Minor layout refinements significantly reduced cognitive load
[insert image: refined prototype screen]
Impact
The PAS MVP delivered:
A modern, scalable workflow for ED administration
A FHIR-aligned data structure ready for integration
A reusable component library
Improved visibility of patient status and movement
Faster and cleaner data capture
A credible demonstration to stakeholders
A stable foundation for inpatient and outpatient development
The six-month goal was met, and the MVP shaped the roadmap for the broader PAS product.
My role
As the sole designer on the project I was responsible for:
Discovery and synthesis
Workflow and interaction design for ED
Component architecture and early design system foundations
Prototyping across ED scenarios
Alignment work with BAs, engineering, and clinical SMEs
Translating domain and technical constraints into clear UI decisions
Contributing to MVP scope and prioritisation
Reflection
This project required clear prioritisation and disciplined decision making. The accelerated timeline, limited research access, and interoperability complexity shaped the approach. Focusing on the ED workflow proved effective, as it demonstrated the system architecture, confirmed FHIR alignment, and gave stakeholders a concrete view of how a modern PAS could function. The work reinforced the need to design for long term system evolution while delivering immediate value.
