Information system management
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Midtown Family Clinic
Case Study
In 1990, Dr. Harold Thompson opened the Midtown Family Clinic, a small internal medicine practice, in an
area with an increasing number of new family residences. Dr. Thompson has been the owner and manager
of the medical practice. He has two registered nurses, Vivian Halliday, and Maria Costa, to help him.
Usually, one nurse 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 administrative work from answering the
phone, scheduling appointments, taking prescription refill requests, billing, faxing, etc. So if on Monday
Nurse Halliday is helping the doctor, then it is Nurse Costa 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. 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 grow his practice, provide better service to his patients, and
maybe reduce the patients waiting time. Dr. Thompson knows that this will increase the administrative
overhead and the two nurses will not be able to manage any additional administrative work. He faces
several challenges and cannot afford to hire any additional staff, so Dr. Thompson has to optimize his
administrative and clinical operations. The practice is barely covering the expenses and salaries at the
moment.
Dr. Thompsons practice operation is all paper-based with paper medical 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. For 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 clinic 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 Internet 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 the 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 1990.
One problem that is immediately noticeable 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 patient has to wait until she has completed
her call. The doctor could be also waiting for the patient to be checked in, wasting the doctor’s valuable
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 patients request in the office.
Every year, the clinic requires its patients to complete a form with their personal and insurance information,
rather than have them just verify what is on file. This annoys some of the parents when they have to fill
out all this paperwork, especially if they are taking care of their sick young child in 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. Thompson, 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 patients history or current prescriptions during office visits, or when the doctor gets a call while
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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 day. However, the clinic also accepts walk-in patients.
At a recent medical conference Dr. Thompson learned 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 realized how inefficiently his practice is
running and realized all the opportunities that EHR systems 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. Thompson has decided to hire
an independent EHR Consultant, to help him select the best EHR for his practice. His friend also advised
him that he should not just buy any package from a vendor but have the EHR 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. Thompson needs to get his
staffs buy-in and involvement in the process from Day 1, if the EHR adoption process is to succeed. Dr.
Thompson realizes that EHR adoption may add significant costs to his practice, which he cannot afford.
Therefore, he will go for the EHR adoption at this point only if he can find an affordable system.
Based on his fellow doctors recommendation, Dr. Thompson has contracted with an independent
consultant, who is not associated with any vendor, to advise him through this process. Throughout this
course you will be the professional medical consultant.
Strategic Goals
Dr. Thompson 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
some financial profit that he could reinvest into the clinic in order to upgrade and expand it. In a few
years, he will need to invest some 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 additional
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 care and health care systems. So, implementing an EHR system
for these purposes has now become another strategic goal for the practice.
Your task is to help Dr. Thompson 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 identified or address all
improvements that could be made at the Midtown Family Clinic.
The following is an example of how a process is identified and optimized using a technology solution: Last
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
patient name, phone number and other critical information. That was when Dr. Thompson 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 quickly search for an open time and enter the patient’s
appointment on the schedule. This has significantly improved the scheduling process, but has done 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.
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STAGED ASSIGNMENTS
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
Evaluate technology solutions in the health care industry to improve the quality of care, safety, and
financial management 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 concepts to a real world situation to:
Analyze an organization’s strategies and processes to determine how a technology solution could
help (Stage 1)
Analyze the data flow among a clinical practice and external organizations (Stage 2)
Identify and explain the legal, ethical and regulatory considerations for a system (Stage 3)
Propose an appropriate certified EHR technology solution (Stage 4)
As explained in the Stage 1 assignment, you will create a System Recommendation Report for Dr.
Thompson, using each stage to develop a section of the report. The staged assignments are designed to
follow the relevant readings in the course content, and are due on the dates as assigned in the class
schedule. 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 opportunity for you to apply critical
thinking skills and think like a professional medical consultant. Running Head: MIDTOWN FAMILY HEALTH CLINIC CASE STUDY 1
MIDTOWN FAMILY HEALTH CLINIC CASE STUDY 6
Midtown Family Health Clinic Case Study
Professors Name
Students Name
Course Title
Date
Introduction
Dr. Thompson has been operating the Midtown Family Health Clinic with two other nurses since 1990. Over the last 25 years and over, from the case study, it’s evident that minor changes have taken place in the sector of medical practice. According to the Midtown Family Clinic setting, there is a front desk, waiting room central place, and three rooms for patient examinations. There is a vision of expanding the clinic. However, the existing condition doesn’t allow such expansion to take place. This makes it necessary for an upgrade via a verified technology, which will act as a stable platform if this clinic has to meet its expansion goals. If the expansion is achieved, the clinic will offer quality care for the patients (Barak-Corren et al. 2017).
I. Organizational Analysis and Requirements
A. Introduction
An Electronic Health Record system will be specifically be discussed in detail in this paper. The way it will impact the organization’s strategic goals will also be looked at besides the requirements that will be necessary for accomplishing the set organizational goals. The various components that will be necessary for implementing the EHR system to meet the clinic goals. Therefore, it must be noted that the implementation of the EHR system is explicitly in line with the SMART goals process.
Specific Achieving the goal would make a difference for our patients and our practice.
Measurable We can quantify the current level and the target goal
Attainable Although the goal may be a stretch, we can achieve it
Relevant This is worth the effort
Time-bound There are deadlines and opportunities to celebrate success.
B. Strategic Use of Technology
1. Strategic Goal 1: Financial profit/savings
The current system that is being utilized by the clinic is ineffective and hence unworthy. However, it must be noted that the EHR system will enhance the process’s effectiveness, hence making the clinic increase its profitability and service delivery.
2. Strategic Goal 2: Quality of care
This is another goal that must be achieved by using the EHR system. The levels of healthcare must be up to the required standard besides being faster in service delivery to patients. This is one of the goals that this newly introduced system will have to meet.
3. Strategic Goal 3: Legal and regulatory requirements
This is the most critical regulatory requirement which every health facility must adhere to. For instance, the EHR ensures that the practice is always following the HITECH of 2009, HIPAA of 2012, and HIPAA of 1996.
C. Components of an Information System
As far as the information system is concerned, there are four main components: data, Information system, technology, and people. These components particularly share a common link to the technology component. The three main components that tend to affect this clinic in one way or the other areas are described below.
1. People
The three main groups of people who will be affected by the introduction of the EHR system in one way or the other include the following.
A. Person 1: Doctors: The providers are affected by receiving a fast and complete medical record of the patient that is easily updated on the spot. This gives the provider an overall snapshot of the patients health to provide the best care possible (Kruse et al. 2017).
B. Person 2: Nurses: The nurses work in both an administrative role and patient care role. An EHR system that is user friendly provides advantages to the administrative role by automating time-consuming functions. Nurses also interact with the EHR system by inputting current data from patient screenings before being seen by them.
C. Person 3: Patient: The patient is affected through an easy to access scheduling process, a line of communication, and the ability to access a personal health record (PHR). A PHR can increase patient participation in their care, helping to educate and create a more informed patient.
2. Organizational Processes
Three main processes will be improved via the introduction of the EHR system in the clinic include;
A. Process 1: Billing: Claims and billing information will automatically be sent to the insurance office for the claim, or whoever is to be billed, and does not require the use of a third-party vendor that garnishes the insurance payments. An overall cost for the EHR system rather than each claim being charged a percentage will improve the current system (Cantor, & Thorpe, 2018).
B. Process 2: Appointment scheduling: An EHR system can improve the scheduling process by reducing the number of times Nurses must spend on the phone to schedule appointments, providing an online portal for the patient to access. An EHR system can also automatically send reminders for upcoming appointments, which can reduce the number of no-show appointments in the clinic.
C. Process 3: Patient Records: Electronic Health Records are real-time patient records that can be created and managed across a network of clinics and providers from more than one health care organization. This is a vast improvement to being forced to update records manually on paper and only have access to records kept in the clinic (Cowie et al. 2017).
3. Data
The primary elements of data are required to ensure that the EHR system gives the best overall experience areas listed in the table below.
Data Items Needed for EHR System
1. Patient Name
2. Patient phone number
3. Billing data
4. Health/ medical history
5. Medication
6. Vaccinations
7. Any allergies
8. Radiology Scans
9. Laboratory as well as Tested Results
10. Patients visit reasons
D. Functional Requirements:
The essential needs which the EHR system has to undertake to give a full technology solution to the Midtown clinic areas are highlighted in the table below. It must be noted that there are many other requirements. However, the top most essential requirements are as listed in the table below.
Functional Requirements
1. Reducing paperwork in the clinic.
2. Reducing patients waiting times
3. Improving the current check-ins
4. Reducing the phone handling duration for the nurse
5. Accurate storage of hospital data
6. Maintaining the necessary regulations.
7. Creating a real-time response clinic record
8. Streamlining billing processes
9. Improving clinic profitability
10. Patient quality care improvement
E. Summary:
In the assessment of the Midtown Family Clinic’s needs, there was a comprehensive, efficient approach that related to the current situation of the clinic and synchronized it with the Electronic Health Record system. This was mainly considered when developing the outlined points. Its important to note that an EHR system will offer better quality care to the patients while maintaining the clinic profits. Through the technology solution, this clinic will re-shape the business to give an overall enhancement to the many current processes as well as protocols within the facility (Rajkomar et al. 2018).
References:
Barak-Corren, Y., Castro, V. M., Javitt, S., Hoffnagle, A. G., Dai, Y., Perlis, R. H., … & Reis, B. Y. (2017). Predicting suicidal behavior from longitudinal electronic health records. American journal of psychiatry, 174(2), 154-162. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2016.16010077
Cantor, M. N., & Thorpe, L. (2018). Integrating data on social determinants of health into electronic health records. Health Affairs, 37(4), 585-590. Retrieved from https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1252
Cowie, M. R., Blomster, J. I., Curtis, L. H., Duclaux, S., Ford, I., Fritz, F., … & Michel, A. (2017). Electronic health records to facilitate clinical research. Clinical Research in Cardiology, 106(1), 1-9. Retrieved from https://link.springer.com/content/pdf/10.1007/s00392-016-1025-6.pdf
Kruse, C. S., Smith, B., Vanderlinden, H., & Nealand, A. (2017). Security techniques for electronic health records. Journal of medical systems, 41(8), 127. Retrieved from https://link.springer.com/article/10.1007/s10916-017-0778-4
Rajkumar, A., Oren, E., Chen, K., Dai, A. M., Hajaj, N., Hardt, M., … & Sundberg, P. (2018). Scalable and accurate deep learning with electronic health records. NPJ Digital Medicine, 1(1), 18. Retrieved from https://www.nature.com/articles/s41746-018-0029-1/ Stage 2: Sharing Data
Overview
Before you begin work on this assignment, be sure you have read the Case Study and reviewed the feedback received on your Stage 1 assignment. Refer to the System Recommendation Report Table of Contents below to see where you are in the process of developing this report.
As a professional medical consultant, your next step in developing your recommendation for an EHR system is to determine what data will need to be shared with other organizations and how that data will be shared.
System Recommendation Report
Table of Contents
Introduction (Stage 1)
I. Organizational Analysis and Requirements (Stage 1)
A. Introduction
B. Organizational Strategy
C. Strategic Use of Technology
D. Components of an Information System
E. Requirements
F. Summary
II. Sharing Data (Stage 2)
A. Introduction
B. Need to Share Data
C. Types of Data to be Shared
D. Data Interchange Standards
E. Summary
III. Ethical, Legal and Regulatory Policy Issues (Stage 3)
A. Introduction
B. Table of Ethical, Legal and Regulatory Policy Issues
C. Addressing the Most Difficult Issue
D. Summary
IV. System Recommendation (Stage 4)
A. Introduction
B. Proposed IT solution
C. How the Proposed IT Solution Meets the Requirements
D. Improvements from Proposed IT Solution
E. Implementation Considerations
F. Summary
Conclusion (Stage 4)
References
System Recommendation Report (SRR), Section II Sharing Data
Section II of the SRR document addresses the need for the Midtown Family Clinic to share data with other organizations. As part of analyzing the requirements for the new system, one step is to consider how that system will enable the Midtown Family Clinic to exchange electronic data with other health organizations such as other providers, pharmacies, insurance companies, and even patients themselves. The case study mentions several of these. For this assignment you will select two types of external organizations and describe what kind of data would flow between the Midtown Family Clinic and those organizations and how that can be done effectively.
Stage 2 Assignment Instructions
The first step is to incorporate the feedback you received on your Stage 1 assignment, making any needed corrections or adjustments. Although the incorporation of feedback will not be graded until the final Report is submitted in Stage 4, it will assist you going forward to incorporate feedback at each stage. For this assignment, you will add Section II of the System Recommendation Report (SRR).
Using the case study, the overview above, Course Content readings, and external resources, develop your Section II on Sharing Data. Approximate lengths for each section are provided as a guideline; be sure to provide all pertinent information. Apply specific information from the case study to address each area listed below.
II. Sharing Data
A. Introduction – Introduction to this section describing what is included. (3-4 sentences)
B. Need to Share Data – Review the Midtown Family Clinic Case Study and identify two types of external organizations (e.g., hospitals, nursing homes, rehabilitation centers, laboratories, pharmacies, health insurance providers, etc.) with which the Midtown Family Clinic needs to communicate and the purpose of the communication. (Introductory sentence and list of two external organizations and the purpose of their communication with the Midtown Family Clinic, providing specifics from the Case Study.)
1. External Organization #1 and purpose of communication.
2. External Organization #2 and purpose of communication.
C. Types of Data to be Shared In Stage 1, Section C.3., Data, you took an initial look at the types of data the new EHR system will process. But now were going to take that a step further and add a layer of complexity by considering the needs and requirements of different external organizations. Using the two external organizations you listed in Section A above, list five data items, or data elements, that would be shared with each external organization, and explain whether that information is going out from the Midtown Family Clinic or coming in from each of the two external organizations. Feel free to consult the list you developed for Section C.3 of your Stage 1 assignment. Some of these data elements may come from that list if they are appropriate for this purpose; however, other, different, data elements may be listed here. Note: For full credit, a different list of data elements should be provided for each organization (no duplicates in the table below, although data elements may be repeated from Section C.3). (Provide an introductory sentence and copy the table and insert information within.)
Organization #1 (replace with your organization from above)
Data Element or Item
Data Goes TO/FROM Midtown Family Clinic
1.
2.
3.
4.
5.
Organization #2 (replace with your organization from above)
Data Element or Item
Data Goes TO/FROM Midtown Family Clinic
1.
2.
3.
4.
5.
D. Data Interchange Standards – Conduct some external research and identify a data interchange standard that would apply to the data that is exchanged with each external organization. The standard you select should apply to one or more of the data elements you listed above for each organization. Provide a brief description of what the standard is, what it requires, why it is important and how it applies to the data elements listed and the Midtown Family Clinic EHR system. Note: For full credit, two different data interchange standards are required. (There are some specific data interchange standards that apply to health data exchange; if the same standard applies to the data exchanged with both organizations, explain how it relates to each.) (Introductory sentence and list of two external organizations and the information shown about the Data Interchange Standard selected for each, providing specifics from the Case Study.)
1. External Organization #1
a. Data Interchange Standard and description
b. What the Data Interchange Standard requires in order to be able to use it in an information system
c. Why the Data Interchange Standard is important
d. How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system
2. External Organization #1
a. Data Interchange Standard and description
b. What the Data Interchange Standard requires
c. Why the Data Interchange Standard is important
d. How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system
E. Summary – briefly summarize the content of this section and tie the information together for the reader. (3-4 sentences)
Formatting Your Assignment
For academic writing, the writer is expected to write in the third person. In third person, the writer avoids the pronouns I, we, my, you, your, and ours. The third person is used to make the writing more objective by taking the individual, the self, out of the writing. This method is very helpful for academic writing, a form in which facts, not opinion, drive the tone of the text. Writing in the third person allows the writer to come across as unbiased and thus more informed. The Report is to be written for the Midtown Family Clinic, and reference should not be made by name to individuals who own or work in the Clinic.
Include the Introduction and Section I, revised according to any feedback received, and add to it Section II.
Write a short concise paper: Use the recommendations provided in each area for length of response. Content areas should be double spaced; table entries should be single-spaced. Its important to value quality over quantity. Section II should not exceed 4 pages.
Ensure that the table is preceded by an introductory sentence that explains what is contained in the table, so the reader understands why the table has been included.
Use at least two resources with APA formatted citation and reference. Use at least one external reference and one from the course content.
Compare your work to the Assignment Instructions above and the Evaluation Criteria/Grading Rubric below to be sure you have met content and quality criteria. Do not overlook this step. Read your work out loud or have your computer read it to you. Fix the grammar and other areas identified.
Submit your paper as a Word document, or a document that can be read in Word.
Your submission filename should be as follows: Lastname_firstname_Stage_2
EVALUATION CRITERIA/GRADING RUBRIC:
Criteria
90-100%
Far Above Standards
80-89%
Above Standards
70-79%
Meets Standards
60-69%
Below Standards
< 60% Well Below Standards Possible Points Section Introduction and Summary 9-10 Points Provides effective introduction and summary to Section II; is clear, logical, derived from the Case Study; demonstrates a sophisticated level of writing. 8.5 Points Provides an introduction and summary to Section II; is clear, logical, and derived from the Case Study. 7.5 Points Provides an introduction and summary to Section II; is adequate, and derived from the Case Study. 6.5 Points Not clear, logical and/or derived from the Case Study. Or, either the introduction or summary is not included. 0-5 Points Not included, or demonstrates little effort. 10 Need to Share Data Two external organizations and the purpose of their communication 9-10 Points Organizations and communication are clearly appropriate and explained in detail using course vocabulary; demonstrates understanding of course concepts, analysis, and/or critical thinking. 8.5 Points Organizations and communication are appropriate and well explained using course vocabulary; demonstrates understanding of course concepts and critical thinking. 7.5 Points Organizations and communication are provided. 6.5 Points Fewer than two organizations are identified, or are incorrect; and/or explanation of the communication between them and the Midtown Family Clinic may lack demonstration of understanding of course concepts, analysis, and/or critical thinking. 0-5 Points Identification of external organizations and/or explanation of communication is incomplete or inadequate. 10 Types of Data to be Shared 5 data elements for each organization and direction of flow 27-30 Points Data elements are correctly identified and are different for each organization; the direction of the data flow is appropriate to the case study; strongly demonstrates understanding of course concepts, analysis, and critical thinking. 24-26 Points Data elements are correctly identified; the direction of the data flow is appropriate to the case study; demonstrates understanding of course concepts, analysis, and critical thinking. 21-23 Points Data elements are identified; direction of the flow of data is appropriate to the case study. 18-20 Points Fewer than 5 data elements may be presented for each of the two external organizations; flow of data may be less than correct, or not appropriate to the case study. 0-17 Points Data elements and flows are not presented or are not appropriate to the case study, or are otherwise inadequate. 30 Data Interchange Standards Two standards with description, requirement, importance and applicability 27-30 Points Two different data interchange standards are listed and explained, and are applicable to the case study, with complete explanations of the standards, what they require and why they are important. 24-26 Points At least one data interchange standard is explained, along with how it applies to the data interchange with both external organizations, is applicable to the case study, with a complete explanation of the standard, what it requires and why it is important. 21-23 Points At least one data interchange standard is explained, along with how it applies to the data interchange with both external organizations, is applicable to the case study, with an explanation of the standard, what it requires and why it is important. 18-20 Points At least one data interchange standard is explained, but how it applies to the data interchange with both external organizations or to the case study is incomplete; and/or explanation of the standard, what it requires and why it is important may be incomplete. 0-17 Points Data interchange standard is not identified; only one organization/data standard are identified; or explanation is severely lacking. 30 Research Tw
