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Midtown Family ClinicCase StudyIn 1990, Dr. Harold Thompsonopened the MidtownFamilyClinic, a small internal medicine practice,in an area with an increasing number of new family residences.Dr. Thompsonhas beenthe owner and manager of the medical practice.He has two registered nurses, VivianHalliday, and MariaCosta, to help him. Usually, onenursetakes 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 administrativework from answering the phone, scheduling appointments, taking prescription refill requests, billing,faxing,etc. So ifonMonday Nurse Hallidayis helping the doctor, then it is Nurse Costawho 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 1-2hour wait before being seen. Ifone nurse is absent,the situation is even worse in the clinic.The clinic has threeexaminationrooms so the owner is now looking into bringing a newphysician 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. Thompsonknows that this will increase the administrativeoverheadand the twonurses will not be able to manage any additional administrativework. He faces several challenges and cannot affordto hire any additional staff,so Dr. Thompsonhas to optimize his administrativeand clinical operations.The practice is barely covering the expenses and salaries at the moment.Dr. Thompson’s practice operation is all paper-based with paper medical records filling his front officeshelves. The only software the doctor has on his front office computer is astand-alone appointment scheduling system. Even billing insurance companies is done in a quasi-manual way. For billing insurance, the front office nurse has tofax 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 insurancecompanyand 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 practicehas the one PC with the scheduling software and an internet connection, itdoes not have a Web siteor 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 patientsin,and if the nurse is on the phone while a patient triesto checkin, 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 patient’s request in the office. Every year, theclinic requires its patients to complete a form with their personal and insurance information, rather than have them just verify what ison file. This annoys some of the parents when they have to fill out all this paperwork, especially if they are takingcareof 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 patient’s history or current prescriptions during office visits,or whenthe doctor gets a call while 3/5/2018IFSM 305 –Case StudyPage | 2he 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. Thompsonlearnedabout 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 realizedhow inefficientlyhis practice is running and realizedall the opportunities that EHR systemscan bring. Herecognizes 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 aboutdisruption 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. Thompsonhas decidedto hire an independent EHR Consultant, to help him select the best EHRfor his practice. His friend also advised him that he should not just buy any package from a vendor but have the EHRconsultant analyze the workflowprocessesat the practice first, then optimize them, and then look at the EHR systems. The new EHRsystem needs to work with the optimized processesof his practice. Dr. Thompsonneeds to get his staff’s buy-in and involvement in the process from Day 1, if the EHRadoption process is to succeed. Dr. Thompsonrealizes that EHRadoption may add significant costs to his practice, which he cannotafford. Therefore, he will go for the EHRadoption at this pointonly if he can find an affordable system.Based on his fellow doctor’s recommendation, Dr. Thompsonhas contractedwith an independentconsultant, who is not associated with any vendor,to advise him through this process.Throughout this course you willbe the professional medicalconsultant. Strategic GoalsDr. Thompsonhas several strategic goals in mindthat he shares with you during your firstmeetingwith himas his consultant. For one, he would like to see his medical practice operate more efficiently and make some financial profit that he couldreinvest into the clinic in order to upgrade and expandit. In a few years, he will need to invest some funds ina 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 largerclinic. 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 physicianand generate some additional income.After much discussion with fellow MDs, he realizesthat 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 nowbecome another strategic goal for the practice. Your task is tohelp Dr. Thompsonunderstand 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 MidtownFamilyClinic. The following is an exampleof how a processis identified and optimized using a technology solution: Last year, the medical practicehad 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. Thompsonand 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 approachthe case studyassignments, you will find it helpful to think about your own experiences with a medical practice. Making a trip to a small medical practicemay help you think about the processes, challenges, and opportunities.3/5/2018IFSM 305 –Case StudyPage | 3STAGED ASSIGNMENTSThe 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 outcomesAnalyze the flow of data and information among disparate health information systems to support internal and external business processesEvaluate technology solutions in the health care industry to improve the quality of care, safety, andfinancial management decisionsExamine 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 conceptsto a “real world situation” to:Analyzean organization's strategies and processes to determine how a technology solution could help(Stage 1)Analyze the data flow among a clinical practiceand external organizations (Stage 2)Identify and explainthelegal, 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 readingsin the course content, and are due on the dates as assignedin 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 aprofessionalmedicalconsultant.More InformationLess InformationCloseEnter the password to open this PDF file.OKCancelFile name:-File size:-Title:-Author:-Subject:-Keywords:-Creation Date:-Modification Date:-Creator:-PDF Producer:-PDF Version:-Page Count:-Close
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