Case Study 1

3/5/2018 IFSM 305 – Case Study Page | 1

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 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 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. 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 admin istrative

overhead and the two nurses will not be able to manage any additional admin istrative work. He 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. This 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. In 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.

You 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 ncepts 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 (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

thinking skills and think like a professional medical consultant .