As identified in the UMUC Family Clinic Case Study, there are several clinical a

Question

As identified in the UMUC Family Clinic Case Study, there are several clinical and administrative processes that could us improvement, including: scheduling patients, checking patients in, ordering laboratory tests, submitting prescriptions to pharmacies, ordering office supplies, billing insurance companies, etc. Separate IT solutions could be implemented for each of the processes. However, you know that if you could combine these into an enterprise system, you would be able to significantly improve the operations of UMUC Family Clinic.

You begin your analysis by answering the following questions:

What opportunities would be missed if each area (scheduling, check-in, supply ordering, billing, etc.) maintained its own "stove piped" data? (Provide some examples.)  

What benefits will the UMUC Family Clinic realize if you implement an enterprise-wide system? Identify how Dr. Martin as the overall owner and manager will benefit from having additional information available.  

What types of decisions that he makes would be improved if he had all this information in one place?

Case Study

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, 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 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. Martin
knows that this will increase the administrative overhead and the two nurses will not be able to manage
any additional administrative work. He faces several challenges and cannot afford to hire any additional
staff, so Dr. Martin has to optimize his administrative 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 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 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 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 noticeable 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 has
completed her call. 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 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 fill out all this paperwork and take 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 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 day. But the clinic also accepts walk-in patients.
At a recent medical conference Dr. Martin learned 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 realized how inefficiently his practice is running and realized all the opportunities that EHR systems 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 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 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 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. Martin has contracted with an independent EHR
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
some 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 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 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 now become another strategic goal for the practice.
Your 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 identified 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 optimized 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 rescheduled, 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. 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 quickly 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.

Explanation / Answer

1. If each of the functional areas (scheduling, patient check-in, supply ordering and billing, etc) are maintained by using separate data, then we cannot streamline the information on hand. For instance, the patient schedule, and check in and her medical history, all of them if are managed at one platform, we can optimize patient schedule based on her past visit, and medical history, say the doctor prescribed her medicine for 15 days, then automatically we can get a scheduled appointment for the patient after 15 days. If maintained separately, then we might not even realize that patient missed her appointment, or even our schedule might delay the appointment.    

Hence, maintain separate data for functions will cause a lot of data redundancies, and will cause the clinic to lose on opportunities that could improve the practice.

2. UMUC family clinic will be benefitted if an enterprise-wide EHR system is implemented. Firstly, such a system can be handled from one point, we don’t need to buy, separate software to manage everything, and we don’t need to fill in data to all those software separately, so enterprise-wide system helps us save both investment capital and nurse’s valuable time.

Also, with a single system, all the data will be collected at one place; hence the biggest advantage is of information integration. Hence, the data redundancy will be decreased, so the chances of errors also decrease. So the doctor can access the patient record, medical history, lab reports, etc. easily either for himself or for forwarding for referrals.

Efficiency of the administrative work will also improve, as the data is available at one platform, and information integration implies administrative tasks like filling for insurance, billing, will be linked to the patients schedule and medical history. Hence, in the future no additional paper work will be need for the same patient’s entry into the system. Once patient information is added, and then the nurse only needs to access it in all of the patient’s future visits, and keep adding the additional data to the already existing patient’s file.

The money the clinic is spending on the third party organization for insurance filing will be saved. And the time spent on administration can be spent on improving the quality of medical care.

3. The additional information will help Dr. Martin as the owner, to forecast the future demand or the future business, hence will help him understand when to expand his clinic and how much to invest in the expansion.

As a manager, DR. Martin with this additional information, can streamline the administrative processes, and take out the time and train the nurses in tasks like administering medicines, etc. with his approval, which will help him improve the efficiency of patient care. He will also be able to manage nursing staff absenteeism more effectively.

With all the additional information, Dr. Martin could identify the expected patient numbers in advance, hence can more efficiently reduce the patient waiting time, both for check in and medical check-up. Also, the inventory of the supplies needed, can be managed more efficiently with EHR information, hence reducing the wastage and improving the prices at which the supplies are bought, as now Dr. Martin can establish what medicines, etc are needed more, hence can take advantage of volume purchases.

4. The decisions like supplies orders, patient’s future schedule and the suggested medicines, specialist referrals, business expansion, investment in medical technology, and the workforce required for the clinic, will be improved, if Dr. Martin has all the information in one place.

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