Case study

11/29 /2015 IFSM 305 – Case Study Page | 1

UMUC 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 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 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. He 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. 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 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. This 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 11/29 /2015 IFSM 305 – Case Study Page | 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. 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 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.

You 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 :

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 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 11/29 /2015 IFSM 305 – Case Study Page | 3

 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 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 owner , Dr. 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 Assignments 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 .

Do 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.