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Physician Family Clinic Case Study

In 1980, Physician Family Clinic was opened in a growing family area. It is a small internal medicine medical practice. Dr. Ramos has been owner and manager of the medical practice. There are two nurses, Carlos and Marlene, in the office. Usually, while one nurse handles the front desk, the other nurse assists Dr. Ramos during patient visits.

The nurses rotate duties each day. Front desk duties include all administrative work from answering the phone, scheduling appointments, taking prescription refill requests, billing, faxing, etc. For example, if on Monday Carlos is helping Dr. Ramos, then Marlene takes care of the front desk and all office work. The two nurses are constantly busy and running around, and patients are accustomed to a minimum 1-2 hour wait before being seen. If one nurse is absent, the situation is even worse at the Clinic.

The Clinic has three examination rooms, so Dr. Ramos is now looking into bringing a new physician or nurse practitioner on board. This would help her grow her practice, provide better service to her patients, and maybe reduce the patients’ waiting time. Dr. Ramos knows that this would increase the administrative overhead, and the two nurses will not be able to manage any additional administrative work. She faces several challenges and cannot afford to hire any additional staff, so Dr. Ramos has to optimize her administrative and clinical operations. The practice is barely covering expenses and salaries at the moment.

Dr. Ramos’s practice operation is all paper-based with paper medical records filling her front office shelves. The only software the doctor has on her 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 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 Clinic, but the nurses open Internet Explorer to the URL of the medical billing company, 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 one PC with the scheduling software and an internet connection, it does not have a Web site or any other technology. Essentially, the Clinic still operates as it did in 1980.

One problem immediately noticeable is that there is no quick way to check patients in. If the nurse is on the phone while a patient tries to check in, then the patient has to wait until the call is completed. Dr. Ramos could also be waiting for the patient to be checked in, wasting valuable doctor time. Also, many patients experience long waits on the phone 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 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. Ramos, as is her inability to quickly and easily share patient data when she makes a referral to a specialist. She feels the she and her 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 she is away from the office. At the beginning of each day, the nurses pull files for all patients with appointments scheduled for that day. However, the Clinic also accepts walk-in patients.

At a recent medical conference Dr. Ramos 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., she realized how inefficiently her practice is running and realized all the opportunities that EHR systems can bring, including the benefits of moving to electronic medical records but feels very overwhelmed about how to start or what to do. She is also concerned about disruption to the Clinic, which may negatively affect the patients’ care experience. Moreover, no one in the office has any knowledge or experience when it comes to information technology. Upon the recommendation of a fellow doctor, Dr. Ramos has decided to hire a business analyst to assist with gathering requirements and documenting and analyzing the business needs.

Dr. Ramos has several strategic goals in mind. First, she would like to see her medical practice operate more efficiently and make some financial profit that she could reinvest into the Clinic in order to upgrade and expand. In a few years, she will need to invest some funds in a major renovation, primarily in the examination rooms and the waiting area. If she had extra money, she could also rent the apartment next to the Clinic and enlarge the Clinic. This would enable the Clinic to have a 3-physician group practice and maybe rent out some space to a physical therapy physician to generate some additional income. After much discussion with fellow MDs, she realizes that technology would improve the quality of care, safety, and financial management decisions of her practice, while also meeting the legal and regulatory requirements for health care and health care systems.

Your task is to help Dr. Ramos understand the process that occurs during a patient visit to the practice and how that process should be improved to make it more efficient through requirements gathering, design and solutions recommendations.

(derived from UMUC)