Midtown Family Clinic Case Study
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3/5/2018 IFSM 305 – Case Study Page | 1
Midtown Family ClinicCase Study
In 1990, Dr. Harold Thompson opened the Midtown Family Clinic, a small internal medicine practice, in anarea with an increasing number of new family residences. Dr. Thompson has been the owner and managerof 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 patientvisits. They rotate duties each day. Front desk duties include all administrative work from answering thephone, scheduling appointments, taking prescription refill requests, billing, faxing, etc. So if on MondayNurse Halliday is helping the doctor, then it is Nurse Costa who takes care of the front desk and all officework. The two nurses are constantly busy and running around, and patients are now accustomed to aminimum 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 nursepractitioner on board. This would help him grow his practice, provide better service to his patients, andmaybe reduce the patients’ waiting time. Dr. Thompson knows that this will increase the administrativeoverhead and the two nurses will not be able to manage any additional administrative work. He facesseveral challenges and cannot afford to hire any additional staff, so Dr. Thompson has to optimize hisadministrative and clinical operations. The practice is barely covering the expenses and salaries at themoment.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 a stand-alone appointmentscheduling 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 atthe end of the day. The medical billing company then submits the claim to the insurance company andbills 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 nobilling software installed at the practice, but the nurses open Internet Explorer to the URL of the medicalbilling company and then use the login provided by the third party medical billing company. Of course, themedical 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, itdoes 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 thenurse is on the phone while a patient tries to check in, then the patient has to wait until she has completedher call. The doctor could be also waiting for the patient to be checked in, wasting the doctor’s valuabletime. Also many patients experience long waits on the phone when they are trying to schedule anappointment, while the nurse is checking in patients or responding to another patient’s 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 fillout 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 thepatient’s folder. Lost and misfiled reports are a big concern to Dr. Thompson, as is his inability to quicklyand easily share patient data when he makes a referral to a specialist. He feels he and his staff arespending too much time handling paper and not enough time improving patient care. All of the medicalrecords, lab results, and financial and payroll accounts are kept on paper, so there is not a quick way tolook up a patient’s history or current prescriptions during office visits, or when the doctor gets a call while3/5/2018 IFSM 305 – Case Study Page | 2he is away from the office. At the beginning of each day, the nurses pull the files for all patients who haveappointments 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 beshared among health care providers to improve patient outcomes. After attending several demonstrationsby the different vendors, ClinicalWorks, AthenaHealth, etc., he realized how inefficiently his practice isrunning and realized all the opportunities that EHR systems can bring. He recognizes all the benefits ofmoving to electronic medical records but feels very overwhelmed on how to start, or what to do. He isalso 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 toinformation technology. Upon the recommendation of a fellow doctor, Dr. Thompson has decided to hirean independent EHR Consultant, to help him select the best EHR for his practice. His friend also advisedhim that he should not just buy any package from a vendor but have the EHR consultant analyze theworkflow processes at the practice first, then optimize them, and then look at the EHR systems. The newEHR system needs to work with the optimized processes of his practice. Dr. Thompson needs to get hisstaff’s 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 doctor’s recommendation, Dr. Thompson has contracted with an independentconsultant, who is not associated with any vendor, to advise him through this process. Throughout thiscourse you will be the professional medical consultant.Strategic GoalsDr. Thompson has several strategic goals in mind that he shares with you during your first meeting withhim as his consultant. For one, he would like to see his medical practice operate more efficiently and makesome financial profit that he could reinvest into the clinic in order to upgrade and expand it. In a fewyears, he will need to invest some funds in a major renovation, primarily in the examination rooms and thewaiting area. If he had extra money, he could also rent the apartment next to his clinic and open up thespace to make a larger clinic. If he did that, he could also expand the clinic into a 3-physician grouppractice and maybe rent out some space to a physical therapy physician and generate some additionalincome. After much discussion with fellow MDs, he realizes that he can use technology to improve thequality of care, safety, and financial management decisions of his practice, while also meeting the legaland regulatory requirements for health care and health care systems. So, implementing an EHR systemfor 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 EHRsystem for him to implement. You are not expected to solve all of the problems identified or address allimprovements 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: Lastyear, the medical practice had no effective way to schedule appointments. The front desk nurse used apaper 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 thepatient name, phone number and other critical information. That was when Dr. Thompson and his nursesdecided to implement the scheduling system on the PC. Now, the patients are all listed in the system, withthe pertinent information, and the scheduler can quickly search for an open time and enter the patient’sappointment on the schedule. This has significantly improved the scheduling process, but has done nothingto 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 ownexperiences with a medical practice. Making a trip to a small medical practice may help you think aboutthe processes, challenges, and opportunities.3/5/2018 IFSM 305 – Case Study Page | 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 technologysolutions enable strategic outcomesAnalyze the flow of data and information among disparate health information systems to supportinternal 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 informationsystems.
Upon completion of these assignments you will have performed an array of activities to demonstrate yourability to apply the course concepts to a “real world situation” to:
Analyze an organization’s strategies and processes to determine how a technology solution couldhelp (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 tofollow the relevant readings in the course content, and are due on the dates as assigned in the classschedule. These assignments are designed to help you identify how to effectively analyze and interpretinformation to improve a medical practice using technology. This is an opportunity for you to apply criticalthinking skills and think like a professional medical consultant.
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