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   

http://asq.org/learn-about-quality/process-analysis-tools/overview/flowchart.html

To create a flow chart in Word 2007 and 2010:  http://www.youtube.com/watch?v=RkN0dekcsmw

To create a flow chart or process map in Excel:  http://www.youtube.com/watch?v=9_R73RVfHl0

To create a flow chart in PowerPoint:  http://www.youtube.com/watch?v=s8erOL-3Bho

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.