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umuc_family_clinic.docxUMUC
Family Clinic
Case Study
In 1980, the
UMUC Family
Clinic
was opened
in
a growing
family
area
near UMUC
,
Maryland,
by
Dr.
Tom
Martin
,
a University of Maryland
graduate
after he retired from the US
Navy
.
It
is a small internal
medicine medical practice.
Dr.
Martin
has been
the owner and manager of the medical practice
.
He has
two nurses, Vivian and Manuella, to help him.
Usually, o
ne
n
urse
takes care of the front desk while the
other
nurse
assists the doctor during the patient visits.
They rotate duties each day.
Front desk duties
include all admin
istrative
work from answering the phone, scheduling appointment
s
, taking prescription
refill
requests, billing,
faxing,
etc.
So if
on
Monday Vivian is helping the doctor, then
it is
Manuella
who
takes care of the front desk and all office work.
The two nurses are constantly busy and running around
and patients are now accustomed to a minimum 1
-
2
hour wait before being seen.
And
,
if
one nurse is
absent, the situation is even worse in the clinic.
The clinic has three
examination
rooms so the owner is
now
looking into bringing
a new
physician or nurse practitioner on board.
This would help him gr
ow his
practice
, provide better service to his patients,
and maybe reduce the patients
’
waiting time.
Dr.
Martin
knows that this will increase the admin
istrative
overhead
and the two
nurses will not be able to manage
any additional admin
istrative
work.
H
e faces several challenges and
cannot afford
to hire any
additional
staff
,
so
Dr. Martin
has to optimize his admin
istrative
and clinical operations.
The practice is barely
covering the exp
enses and salaries at the moment.
Dr.
Martin
’s
practice operation i
s all paper
-
based with paper medica
l records filling his front office
shelves. The only software the doctor has on his front office computer is a
stand
-
alone appointment
scheduling system
.
Even billing insurance companies is done in a quasi
-
manual way.
F
or billing
insurance, the front office nurse has to fax all the needed documentation to a
third
party medical billing
company at the end of the day.
The medical billing company then submits the claim to the insurance
company
and bills the patient.
The cl
inic checks the status of the claims by logging into the medical
billing system, through a login that the medical billing company has provided the clinic to access its
account.
There is no billing software installed at the practice, but the nurses open In
ternet Explorer to
the URL of the medical billing company and then use the login provided by the
third
party medical billing
company. Of course, the medical billing company takes a percentage of the amount that the clinic is
reimbursed by the insurance.
Although t
he medical practice
has the one PC with the scheduling software
and an internet connection, it
does not have a Web site
or any other technology
, and essentially still
operates the same as it did in 1980.
One problem that
is
immediately
noticeabl
e
is that
there is no quick way to check
patients
in
,
and if the
nurse is on the phone while
a patient tries
to check
in,
then the patie
nt has to wait until she has
completed her call
.
The doctor could be also waiting for the patient to be checked in
,
was
ting valuable
doctor time.
Also
many
patients experience long waits on the phone when they are trying to schedule an
appointment, while the nurse is checking in patients or responding to another patient’s request in the
office.
Every year, the clinic req
uires its pa
tients to complete a form with their personal and insurance
information
, rather than have them just verify what
is
on file.
T
his annoys some of the parent
s when
they have to fill
out
all this paperwork and take care of the
ir sick young child i
n the waiting room
.
When
a
patient
'
s laboratory test results are received in the office, the paper copy has to be filed in the
patient's folder. Lost and misfiled reports are a big concern to Dr. Martin, as is his inability to quickly and
easily share patient data when he makes a referral
to a specialist. He feels he and his staff are spending
too much time handling paper and not enough time improving patient care.
All of the
medical
records,
lab results
,
and financial and payroll accounts are kept on paper
, so there is not a quick way to
look up a
patient’s history or current prescriptions
during office visits or when
the doctor gets a call while he is
away from the office.
At the beginning of each day,
the nurses pull the files for all patients
who have
appointments scheduled for that d
ay.
But the clinic also accepts walk
-
in patients.
At a recent medical conference Dr.
Martin
learn
ed
about how
Electronic Health Records (
EHR
)
can be
shared among health care providers to improve patient outcomes.
After attending several
demonstrations
by the different vendors, ClinicalWorks, AthenaHealth, etc.
,
he
realize
d
how inefficient
ly
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IFSM 305
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Case Study
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2
his practice is running and realize
d
all the opportunities that EHR system
s
can bring.
He
recognizes
all
the benefits of moving to electronic medical records but
feels very overwhelmed on how to start, or what
to do
. He is also concerned about
disruption to his practice which may negatively affect his patients’
care
experience.
Moreover, neither the doctor nor the nurses have any knowledge or experience when it
comes to information technology.
Upon the recommendation of a fellow
doctor
, Dr.
Martin
has
decide
d
to hire an independent EH
R Consultant, to help him select the best E
HR
for his practice. His friend
also
advised him that he should not just buy any packag
e from a vendor but have the E
HR
consultant analyze
the workflow
processes
at the practice first, then optimize them, and then look at the EHR systems.
The
new
EHR
system needs to work with the optimized
processes
of his practice.
Dr.
Martin
needs to get
his
staff’s buy
-
in and involvement in the process from Day 1, if the E
HR
adoption process is to succeed.
Dr.
Martin
realizes that E
HR
adoption
may
add
significant
costs to his practice, which he can
not
afford.
Therefore, he will go for the E
HR
adoption
at this point
only
if he can
find an affordable system.
Based on his fellow doctor’s recommendation,
Dr.
Martin
has
contract
ed
with
an independent E
HR
consultant, who is not associated
with
any vendor,
to advise him through this process.
Throughout this
course you will
be the EHR consultant.
Dr.
Martin
has several strategic goals in mind
that he shares with you during your first
meeting
with him
as his consultant
.
For one, he would like to see his medical practice operate more efficiently and make
som
e financial profit that
he could
reinvest into the clinic in order to
upgrade and expand
it.
I
n a few
years,
he will need to invest s
ome funds
in
a major renovation, primarily
in
the examination rooms and
the waiting area. If he had extra money, he could
also rent the apartment next to his clinic and open up
the space to make a
larger
clinic.
If he did that, he could also expand the clinic into a 3
-
physician group
practice and maybe rent out some space to a physical therapy physician
and generate some add
itional
income.
After much discussion with fellow MDs, he realizes
that he can use technology to improve the
quality of care, safety, and financial management decisions of his practice, while also meeting the legal
and regulatory requirements for health ca
re and health care systems.
So
,
implementing an EHR system
for these purposes
has now become another strategic goal for the practice.
Y
ou
r task is to
help Dr.
Martin
understand the process that occurs during a patient visit to the practice,
how that process should be improved to make it more efficient, and then recommend a certified EHR
system for him to implement.
You are not expected to solve all of the problems ide
ntified or address all
improvements that could be made at the
UMUC Family
Clinic
.
The following is an
example
of how a
process
is identified
and
optimize
d using a technology solution
:
L
ast year, the
medical practice
had no effective way to
schedule
appointments
.
The front desk nurse
used a paper calendar to write in appointments. Obviously, as appointments were cancelled and re
-
scheduled, the paper calendar became almost unreadable. It was also taking a long time for the nurse to
record the patien
t name, phone number and other critical information. That was when Dr. Martin and his
nurses decided to implement the scheduling system on the PC. Now, the patients are all listed in the
system, with the pertinent information, and the scheduler can quick
ly search for an open time and enter
the patient's appointment on the schedule. This has significantly improved the scheduling process, but
has nothing to help with all of the other activities involved with a patient visit to the Clinic.
Note:
As you approach
the case study
assignments, you will find it helpful to think about your own
experiences with
a
medical practice
. Making a trip to a
small medical practice
may help you think about
the processes, challenges, and opportunities.
STAGED ASS
IGNMENTS
The case study and assignments address the Course Outcomes to enable you to:
Evaluate the organizational environment in the health care industry to recognize how technology
solutions enable strategic outcomes
Analyze the flow of data and information among disparate health information systems to support
internal
and external business processes
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IFSM 305
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Evaluate technology solutions in the health care industry to improve the quality of care, safety,
and
financial manageme
nt decisions
Examine the implications of ethical, legal, and regulatory policy issues on health care information
systems.
Upon completion of these assignments you will have performed an array of activities to demonstrate your
ability to apply the course co
n
cepts
to a “real world situation” to:
Analyze
a clinical process and diagram the steps (Stage 1)
Analyze the data flow among
a clinical practice
and external organizations (St
age 2)
Propose an appropriate
certified
EHR
technology solution (Stage
3
)
Ident
ify and explain the requirements and legal, ethical and regulatory cons
iderations for a
system (Stage 4
)
The staged assignments are designed to follow the relevant chapters of the textbook
and other readings
in the
course content
, and are due on the dates
as assigned
in the class schedule
.
The
grading rubric
is included with each assignment.
These assignments are designed to help you identify how to effectively analyze and interpret information
to improve
a medical practice using technology
.
This is an o
pportunity for you to apply critical t
hinking
skills and think like a
professional
medical consultant
.
When you are writing a paper or developing a
presentation,
prepare it as if it is going to
the
o
wner
,
D
r.
Martin
,
whom
you want to impress with your
knowledge and abilities.
Don't just go through the mechanics of pulling together information
--
think
about what you are doing,
why you're doing it, whether it make sense, whether the information seems
realistic, and what the
results show.
It’s important that you identify relevant, timely resources that
specifically support the points or information you provid
e
in your assignment. You should read the
source and assimilate the information first, and then put it into your own
words and incorporate
it
into
the flow of your writing (with an appropriate in
-
text APA citation
and a list of references at the end of
your paper
). Direct quotes should be used very sparingly
—
only when the author’s own words uniquely
present a concept th
at would be lost if paraphrased by you.
One of the prerequisites for this course is that you have a fundamental working knowledge of word
processing and presentation software. Detailed instructions for each Staged Project, 1 through
4
, are
posted in the
A
ssignments
area of the classroom
. You
are to
prepare each assignment in the indicated
format (i.e.,
table
,
outline,
report, presentation or other specified format) and submit it as an attachment
through your individual Assignments Folder in
LEO
.
It is
the student's responsibility to ensure the
assignment submission can be read using the specified file format
.
D
o not wait until the last minute
to begin an activity.
You should read through all the assignments
in advance to ensure you (1) understand what is expected, and (2)
allow enough time to effectively
create the information being requested.
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