Case study assignment: Business process in ambulatory setting

Case
Study, Stage 1: Process Analysis

Before you begin this assignment, be
sure you have read the “UMUC Family Clinic Case Study” below and your Week 1 and Week
2 syllabus readings, which discuss EHR functionality and Process Workflow
Analysis and Mapping.  You will need to
refer to three of the HealthIT.gov documents available in Content>Course Resources:  Overview of Steps to Implement an EHR System,
Step 1, and Step 2.

Purpose of this Assignment

This assignment gives you the
opportunity to apply your analysis skills to model a business process in an
ambulatory setting in the healthcare industry. 
Modeling the process as it exists (and as it will exist) will aid in the
analysis, selection and implementation of the EHR system for the medical
practice. This assignment leads to the Stage 2 assignment which will give you
the opportunity to apply your knowledge of technology solutions and EHR systems
to improve the business process you select here. In this assignment, you will
identify a process (workflow) in need of improvement, and plan for a revised
and optimized workflow to improve the quality of care, safety, and financial
management incentives. You will develop 2 process maps (AS IS and TO BE) for
the clinical process workflow. This assignment addresses the following course
outcome 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.

Family Clinic Medical Practice

In order to apply technology to a
process, the process must be thoroughly understood and models are used for this
purpose.  The model also supports
business process analysis and redesign when the process is deemed to be
inefficient or ineffective.  In addition,
models are used to design the “to-be” process that describes the desired end
state after the technology solution is developed.

In the Step 1 document, under
“Assess Your Current Practice,” you will see the following questions to be
answered:

· 
Are administrative processes organized, efficient, and well
documented?

· 
Are clinical workflows efficient, clearly mapped out, and
understood by all staff?

· 
Are data collection and reporting processes well established and
documented?

In the Step 2 document, read the section “Clarify and
Prioritize” and the first two steps under “Steps in the Planning Process.”  These sections demonstrate how process
review, mapping and improvement fit with the selection of an EHR System, and
are the standard starting point for EHR implementation.

For your
Stage 1 Project for the Case Study, you
will select a process used at the UMUC Family Clinic that needs to be
improved.  Then, you will create a model
of a current process that defines in detail the steps in the process as they
are done today. to aid in the analysis of the problem.  Then, you will create a model of the proposed
new process, as it will be performed after an EHR system (IT solution) is
implemented.  To ensure you select a
process that will be related to an EHR system implementation, refer to the
“Certification Criteria” in Content>Course Resources, particularly sections
a and b. 

Be sure to read the instructions
for the remaining projects in this Case Study (Stages 2-4) to get an
understanding of the future projects that build on the proposed solution and to
help you in deciding upon your process.

When you have chosen a process to improve, please get it
approved by your faculty member, as directed in the classroom.

Assignment

For this assignment you will identify
a process in need of improvement and develop the models.  

Business Process Analysis – Models of the AS IS Process and the TO BE Process with
a brief explanation of how a technology solution can help improve the
process. 

In the textbook, Chapter 21
“Fundamentals of Health Workflow Analysis Process and Redesign”, several
different methods of modeling business processes are illustrated.  The model format should be a workflow diagram
format.  Examples of this format can be
found in Chapter 21 under the heading “Workflow Diagram Example.” The process that you model must be clearly
identified in the title of your Stage 1 Project and it needs to be appropriate
to the UMUC Family Clinic.  You
may use Microsoft Word, Excel or Power Point.  

1.  First, you will provide a brief (approx.
½ page single-spaced) explanation of why this process can benefit from improvement
using a technology solution.

2.  Then you will model the process as
it is currently performed at the UMUC Family Clinic; this is the AS IS Process. 

3.  Then you will model the way that
you expect the new process to function after a technology solution (EHR System)
is implemented and the process is improved; this is the TO BE Process.  NOTE: We are NOT specifying the specific
technology in the TO BE Process.  Identifying
the specific technology will be part of the Stage 2 assignment. 

Note:  A process is defined as “a series of actions that produce something
or that lead to a particular result” (http://www.merriam-webster.com/dictionary/process).  An example would be the sign-in process at
the UMUC Family Clinic.

Tools for Creating the Models

The
following are two URL’s that have a more detailed description of Flow Charting
and its uses: http://www.hci.com.au/hcisite2/toolkit/flowchar.htm   

To create a flow chart in Word 2007 and
2010: 

To create a flow chart or process map in
Excel: 

To create a flow chart in PowerPoint: 

Business Process Example from
another industry:  If a grocery store had a need to reduce expenses and improve
customer satisfaction, a process needing improvement might be improving the
inventory process to ensure availability of products for customers as well as
to reduce cost related to spoiled inventory. The model would include the steps
necessary to record inventory information, update inventory when merchandise is
sold, place orders for additional inventory from suppliers, etc.

Note:  Your models will be evaluated on whether they
are applicable to the process identified, all major steps in the AS-IS and
TO-BE processes are included and correctly modeled, and they are appropriate to
the UMUC Family Clinic.

Your paper will be
evaluated on whether or not you correctly incorporated the course concepts from
the textbook and addressed all parts of the questions.  If you use
external resources, be sure to cite and reference them correctly in APA format.
 Remember, this is an information systems
management course, and your improved process must require an information
technology solution.  

FAMILY 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, one 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 administrative work from answering the phone, scheduling appointments, 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 3 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. Martin
knows that this will increase the admin overhead and the 2 nurses will not be able to manage any
additional admin work. He faces several challenges and cannot afford to hire any additional
administrative staff so the owner has to optimize his admin and clinical operations. The practice is barely
covering the expenses and salaries at the moment. 

Dr. Martin’s practice operation is all paper-based with paper medical records filling his front desk shelves.
The only software the doctor has on his front office computer is an appointment scheduling software.
Even insurance billing 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 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. The medical
practice does not have a Web site, and essentially still operates the same as it did in 1980. 

One problem immediately noticed 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 patient has to wait until she is done. The doctor
could be also waiting for the patient to be checked in, wasting 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
requires its patients to fill their information and insurance information anew, rather than have them just
verify what they have on file. This annoys some of the moms when they have to complete the
paperwork and take care of their sick child in the lobby. 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 if 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 day. But the
clinic also accepts walk-in patients. 

At a recent medical conference Dr. Martin learned of the government’s financial incentives for Electronic
Health Records (EHR) and meaningful use adoption. After attending several demonstrations by the
different vendors, ClinicalWorks, AthenaHealth, etc., he realized how inefficiently his practice is running
and all of the opportunities that EHR systems can provide. The owner recognizes the benefits of moving
to electronic medical records but does not know where to begin and feels overwhelmed. 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 decided to hire an
independent EHR Consultant, to help him select the best EHR for his practice. His friend also advised him
that he should not just buy any package from a vendor but have the EHR consultant analyze the
workflow processes at the practice first, then optimize them, and then look at the EHR systems. The new
01/23/2014 IFSM 305 – Case Study Description Page | 2
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 EHR adoption process is to succeed. Dr.
Martin realizes that EHR adoption will 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 expect to qualify for the financial
incentives for achieving meaningful use1
. This extra money will help reduce the burden of the cost on a
clinic that is barely able to sustain any more costs at this time. 

Dr. Martin, the owner of the UMUC Family Clinic, has just learned that he will start being penalized in the
form of payment adjustments in 2015 according to CMS. Based on his fellow doctor’s recommendation,
Dr. Martin has contracted with an independent EHR consultant, who is not associated to 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 consultation with
him as his consultant. For one, he would like to see his medical practice operate more efficiently and
make some financial profit that would allow him to reinvest into the clinic in order to upgrade and
expand. In a few years, he will need to invest some 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 it is in his best
interest to actively start the process of EHR adoption and take advantage of the incentives provided
through the meaningful use program1
. So this has now become another strategic goal for the practice.
By implementing an EHR system, he will be able to fulfill another strategic objective, which is to raise the
level of IT-awareness among his staff. Dr. Martin also wants to 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. 

Your task is to help Dr. Martin decide which of his clinical processes can benefit from an IT solution,
which processes should be automated first, how an EHR system could help his practice, which incentive
program to qualify for, how to achieve meaningful use by adopting a certified EHR system and how to
meet meaningful use reporting requirements. You are not expected to solve all of the problems identified
or address all improvements that could be made at the UMUC Family Clinic. Note: We’re looking for a
technology solution. While installing a TV in the waiting room may attract new patients, it is not a
technology solution. 

The following is an example of how you will identify a process and optimize it using an EHR system: Last
year, the medical practice had no effective way to check its members in when they arrived. Sign-in
sheets were used at the front desk, and the nurse had to check off the name on the sheet against
existing medical records in the filing cabinet. Some of the patients were walk-ins, so the nurses had not
pulled their files off the shelf when they started the day. The nurse had to leave the desktop go search
for the file on the shelf. This caused patients a long wait at the front desk, and several had complained
to Dr. Martin about this situation. To address the business need of quickly checking members in, the
appointment scheduling system was modified to allow the clinic office to quickly lookup patients by last
name and date-of-birth (DOB) on the computer as they sign in. 

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.
1 From the CMS.gov website: “The Medicare and Medicaid EHR Incentive Programs provide financial incentives
for the “meaningful use” of certified EHR technology to improve patient care. To receive an EHR incentive
payment, providers have to show that they are “meaningfully using” their EHRs by meeting thresholds for a number
of objectives. CMS has established the objectives for “meaningful use” that eligible professionals, eligible hospitals,
and critical access hospitals (CAHs) must meet in order to receive an incentive payment.” Meaningful use will be
covered in the course materials.

STAGED ASSIGNMENTS 

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 management 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 concepts to a “real world situation” to: 

 Analyze a clinical process and diagram the steps (Stage 1) 

 Propose an appropriate EHR technology solution (Stage 2) 

 Identify and explain the meaningful use reporting requirements (Stage 3) 

 Identify and explain the considerations in implementing the solution proposed in Stage 2 (Stage
4) 

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 provide 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 that 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. No credit will be given for assignments
submitted in file formats other than those stated in the assignment instructions.