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…
