ifsm 302 assignment

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Midtown Family Clinic
Case Study
In 199
0,
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, 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
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.
I
f
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 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  an
y
additional  staff
,
so
Dr.
Thompson
has  to  optimize  his
admin
istrative
and  clinical  operations.
The  practice  is  barely  covering  the  exp
enses  and  salaries  at  the
moment.
Dr.
Thompson
’s
practice  operation  is  all  paper

based  with  paper  medica
l  records  fillin
g  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 o
pen 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 insuran
ce.
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 op
erates the same as it did in 199
0.
One problem that
is
immediately
noti
ceable
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
,
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 patient’s request in the office.
Every year, the
clinic requires 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
, especially if they are taking
care
of the
ir 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 inab
ility 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 financia
l 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

3/5/2018
IFSM 305

Case Study
Page |
2
he is away from the office.
At the beginning of each day,
the nurses p
ull 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
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
his  practice  is
running and realize
d
all the opportun
ities 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 pat
ients’
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
decide
d
to hire
an independent EH
R Consultant, to h
elp him select the best E
HR
for his practice. His friend
also
advised
him  that  he  should  not  just  buy  any  package  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 s
ystems.
The new
EHR
system needs to work with the optimized
processes
of his practice.
Dr.
Thompson
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.
Thompson
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.
Thompson
has
contract
ed
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.
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  additional
income.
After  much  discussion  with  fellow  MDs,  he  realizes
that  he  can  use  techn
ology  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.
Y
ou
r 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 ide
ntified 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
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.
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 qui
ckly 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.

3/5/2018
IFSM 305

Case Study
Page |
3
STAGED ASSIGNM
ENTS
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 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
n 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 (St
age 2)

Identify
and explain
the
legal, ethical and regulatory cons
iderations 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
t
hinking skills and think like a
professional
medical
consultant
.

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