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Case Study Assignment Business Process In Ambulatory Setting

CaseStudy, Stage 1: Process Analysis

Before you begin this assignment, besure you have read the “UMUC Family Clinic Case Study” below and your Week 1 and Week2 syllabus readings, which discuss EHR functionality and Process WorkflowAnalysis and Mapping.  You will need torefer 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 theopportunity to apply your analysis skills to model a business process in anambulatory setting in the healthcare industry. Modeling the process as it exists (and as it will exist) will aid in theanalysis, selection and implementation of the EHR system for the medicalpractice. This assignment leads to the Stage 2 assignment which will give youthe opportunity to apply your knowledge of technology solutions and EHR systemsto improve the business process you select here. In this assignment, you willidentify a process (workflow) in need of improvement, and plan for a revisedand optimized workflow to improve the quality of care, safety, and financialmanagement incentives. You will develop 2 process maps (AS IS and TO BE) forthe clinical process workflow. This assignment addresses the following courseoutcome to enable you to:

  • Evaluate theorganizational environment in the health care industry to recognize howtechnology solutions enable strategic outcomes.
  • Analyzethe flow of data and information among disparate health informationsystems to support internal and external business processes.

Family Clinic Medical Practice

In order to apply technology to aprocess, the process must be thoroughly understood and models are used for thispurpose.  The model also supportsbusiness process analysis and redesign when the process is deemed to beinefficient or ineffective.  In addition,models are used to design the “to-be” process that describes the desired endstate after the technology solution is developed.

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

· Are administrative processes organized, efficient, and welldocumented?

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

· Are data collection and reporting processes well established anddocumented?

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

For yourStage 1 Project for the Case Study, youwill select a process used at the UMUC Family Clinic that needs to beimproved.  Then, you will create a modelof a current process that defines in detail the steps in the process as theyare done today. to aid in the analysis of the problem.  Then, you will create a model of the proposednew process, as it will be performed after an EHR system (IT solution) isimplemented.  To ensure you select aprocess that will be related to an EHR system implementation, refer to the“Certification Criteria” in Content>Course Resources, particularly sectionsa and b. 

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

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


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

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

In the textbook, Chapter 21“Fundamentals of Health Workflow Analysis Process and Redesign”, severaldifferent methods of modeling business processes are illustrated.  The model format should be a workflow diagramformat.  Examples of this format can befound in Chapter 21 under the heading “Workflow Diagram Example.” The process that you model must be clearlyidentified in the title of your Stage 1 Project and it needs to be appropriateto the UMUC Family Clinic.  Youmay 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 improvementusing a technology solution.

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

3.  Then you will model the way thatyou 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 specifictechnology in the TO BE Process.  Identifyingthe specific technology will be part of the Stage 2 assignment. 

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

Tools for Creating the Models

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


To create a flow chart in Word 2007 and2010:  http://www.youtube.com/watch?v=RkN0dekcsmw

To create a flow chart or process map inExcel:  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 fromanother industry:  If a grocery store had a need to reduce expenses and improvecustomer satisfaction, a process needing improvement might be improving theinventory process to ensure availability of products for customers as well asto reduce cost related to spoiled inventory. The model would include the stepsnecessary to record inventory information, update inventory when merchandise issold, place orders for additional inventory from suppliers, etc.

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

Your paper will beevaluated on whether or not you correctly incorporated the course concepts fromthe textbook and addressed all parts of the questions.  If you useexternal resources, be sure to cite and reference them correctly in APA format. Remember, this is an information systemsmanagement course, and your improved process must require an informationtechnology solution.  


In 1980, the UMUC Family Clinic was opened in a growing family area near UMUC, Maryland, by Dr. TomMartin, a University of Maryland graduate after he retired from the US Navy. It is a small internalmedicine medical practice. Dr. Martin has been the owner and manager of the medical practice. He hastwo nurses, Vivian and Manuella, to help him. Usually, one nurse takes care of the front desk while theother nurse assists the doctor during the patient visits. They rotate duties each day. Front desk dutiesinclude all administrative work from answering the phone, scheduling appointments, taking prescriptionrefill requests, billing, faxing, etc. So if on Monday Vivian is helping the doctor, then it is Manuella whotakes care of the front desk and all office work. The two nurses are constantly busy and running aroundand patients are now accustomed to a minimum 1-2 hour wait before being seen. And if one nurse isabsent, the situation is even worse in the clinic. The clinic has 3 examination rooms so the owner is nowlooking into bringing a new physician or nurse practitioner on board. This would help him grow hispractice, provide better service to his patients, and maybe reduce the patients’ waiting time. Dr. Martinknows that this will increase the admin overhead and the 2 nurses will not be able to manage anyadditional admin work. He faces several challenges and cannot afford to hire any additionaladministrative staff so the owner has to optimize his admin and clinical operations. The practice is barelycovering 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 tofax all the needed documentation to a third party medical billing company at the end of the day. Themedical billing company then submits the claim to the insurance company and bills the patient. The clinicchecks the status of the claims by logging into the medical billing system, through a login that themedical billing company has provided the clinic to access its account. There is no billing softwareinstalled at the practice, but the nurses open Internet Explorer to the URL of the medical billing companyand then use the login provided by the third party medical billing company. Of course, the medical billingcompany takes a percentage of the amount that the clinic is reimbursed by the insurance. The medicalpractice 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 onthe phone while a patient tries to check in, then the patient has to wait until she is done. The doctorcould be also waiting for the patient to be checked in, wasting valuable doctor time. Also many patientsexperience long waits on the phone when they are trying to schedule an appointment, while the nurse ischecking in patients or responding to another patient’s request in the office. Every year, the clinicrequires its patients to fill their information and insurance information anew, rather than have them justverify what they have on file. This annoys some of the moms when they have to complete thepaperwork and take care of their sick child in the lobby. All of the medical records, lab results andfinancial and payroll accounts are kept on paper, so there is not a quick way to look up a patient’s historyor current prescriptions if the doctor gets a call while he is away from the office. At the beginning ofeach day, the nurses pull the files for all patients who have appointments scheduled for that day. But theclinic also accepts walk-in patients. 

At a recent medical conference Dr. Martin learned of the government’s financial incentives for ElectronicHealth Records (EHR) and meaningful use adoption. After attending several demonstrations by thedifferent vendors, ClinicalWorks, AthenaHealth, etc., he realized how inefficiently his practice is runningand all of the opportunities that EHR systems can provide. The owner recognizes the benefits of movingto electronic medical records but does not know where to begin and feels overwhelmed. He is alsoconcerned 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. Martin has decided to hire anindependent EHR Consultant, to help him select the best EHR for his practice. His friend also advised himthat 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 new01/23/2014 IFSM 305 – Case Study Description Page | 2EHR system needs to work with the optimized processes of his practice. Dr. Martin needs to get hisstaff’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 financialincentives for achieving meaningful use1. This extra money will help reduce the burden of the cost on aclinic 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 theform 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, toadvise 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 withhim as his consultant. For one, he would like to see his medical practice operate more efficiently andmake some financial profit that would allow him to reinvest into the clinic in order to upgrade andexpand. In a few years, he will need to invest some funds in a major renovation, primarily in theexamination rooms and the waiting area. If he had extra money, he could also rent the apartment nextto his clinic and open up the space to make a larger clinic. If he did that, he could also expand the clinicinto a 3-physician group practice and maybe rent out some space to a physical therapy physician andgenerate some additional income. After much discussion with fellow MDs, he realizes that it is in his bestinterest to actively start the process of EHR adoption and take advantage of the incentives providedthrough 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 thelevel of IT-awareness among his staff. Dr. Martin also wants to use technology to improve the quality ofcare, safety, and financial management decisions of his practice, while also meeting the legal andregulatory 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 incentiveprogram to qualify for, how to achieve meaningful use by adopting a certified EHR system and how tomeet meaningful use reporting requirements. You are not expected to solve all of the problems identifiedor address all improvements that could be made at the UMUC Family Clinic. Note: We’re looking for atechnology solution. While installing a TV in the waiting room may attract new patients, it is not atechnology solution. 

The following is an example of how you will identify a process and optimize it using an EHR system: Lastyear, the medical practice had no effective way to check its members in when they arrived. Sign-insheets were used at the front desk, and the nurse had to check off the name on the sheet againstexisting medical records in the filing cabinet. Some of the patients were walk-ins, so the nurses had notpulled their files off the shelf when they started the day. The nurse had to leave the desktop go searchfor the file on the shelf. This caused patients a long wait at the front desk, and several had complainedto Dr. Martin about this situation. To address the business need of quickly checking members in, theappointment scheduling system was modified to allow the clinic office to quickly lookup patients by lastname 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 ownexperiences with a medical practice. Making a trip to a small medical practice may help you think aboutthe processes, challenges, and opportunities.1 From the CMS.gov website: “The Medicare and Medicaid EHR Incentive Programs provide financial incentivesfor the “meaningful use” of certified EHR technology to improve patient care. To receive an EHR incentivepayment, providers have to show that they are “meaningfully using” their EHRs by meeting thresholds for a numberof 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 becovered in the course materials.


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 technologysolutions enable strategic outcomes 

 Analyze the flow of data and information among disparate health information systems to supportinternal 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 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 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 (Stage4) 

When you are writing a paper or developing apresentation, prepare it as if it is going to the owner, Dr. Martin, whom you want to impress with yourknowledge and abilities. Don’t just go through the mechanics of pulling together information — thinkabout what you are doing, why you’re doing it, whether it make sense, whether the information seemsrealistic, and what the results show. It’s important that you identify relevant, timely resources thatspecifically support the points or information you provide in your assignment. You should read thesource and assimilate the information first, and then put it into your own words and incorporate it intothe flow of your writing (with an appropriate in-text APA citation and a list of references at the end ofyour paper). Direct quotes should be used very sparingly—only when the author’s own words uniquelypresent 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 wordprocessing and presentation software. Detailed instructions for each Staged Project, 1 through 4, areposted in the Assignments area of the classroom. You are to prepare each assignment in the indicatedformat (i.e., table, outline, report, presentation or other specified format) and submit it as an attachment. No credit will be given for assignmentssubmitted in file formats other than those stated in the assignment instructions.