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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 day 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 staff for
admin 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 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. The medical
practice does not have a Web site, and essentially still operates the same as it did in 1980.
One problem that you notice immediately 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 fill all this
paperwork and take care of their sick young 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 realized all the opportunities that EHR systems can bring. The owner 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 EMR 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 | 1 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 2014 is the last year to begin
participation in the Medicare Incentive Program and that beginning in 2015, Medicare eligible
professionals who do not successfully demonstrate meaningful use will be subject to a payment
adjustment according to CMS. To add to his confusion even more, he also learned that there is also a
Medicaid Incentive Program and is confused on which one to pursue. For the Medicaid Incentive
Program the last year however is 2016. Time is running out. He needs to act before it is too late.
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
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 3physician 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 incentives
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.
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. 01/23/2014 IFSM 305 – Case Study Description Page | 2 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.
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 to qualify for the financial
incentives (Stage 3)
Identify and explain the considerations in implementing the solution proposed in Stage 2 (Stage
4)
The staged assignments are designed to follow the relevant chapters of the textbook in the class
schedule, and are due on the dates as assigned. Assignments for stages 2 and 3 require external
research, outside of the textbook and other materials provided in the classroom. The grading rubric is
included with each assignment.
These assignments are designed to help you identify how to effectively analyze and interpret information
to improve a medical practice using technology. This is an opportunity for you to apply critical thinking
skills and think like a professional medical consultant. 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
through your individual Assignments Folder in LEO. No credit will be given for assignments
submitted in file formats other than those stated in the assignment instructions.
Do not wait until the last minute to begin an activity. You should read through all the assignments
in advance to ensure you (1) understand what is expected, and (2) allow enough time to effectively
create the information being requested. 01/23/2014 IFSM 305 – Case Study Description Page | 3
Case Study, Stage 3: EHR Technology Solution Proposal
Before you begin this assignment, be sure you have read the “UMUC Family Clinic Case Study”, all class
readings assigned to date, and feedback on your graded Stage 1 and Stage 2 assignments.
Purpose of this Assignment
This assignment gives you the opportunity to apply your analysis and research skills and your knowledge
of technology solutions and EHR systems to evaluate technology solutions in the health care industry.
You will identify and Electronic Health Record (EHR) system that would improve the processes and the
quality of care at the UMUC Family Clinic. This assignment specifically addresses the following course
outcomes to enable you to:
• Evaluate technology solutions in the health care industry to improve the quality of care, safety,
and financial management decisions. UMUC Family Clinic Medical Practice
In your Stage 1 Project, you analyzed the patient visit process and modeled the AS-IS process. You then
optimized the process/workflow and modeled the TO-BE process.
For your Stage 2 Project for the Case Study, you examined the need for information exchange between
the UMUC Family Clinic and other organizations.
For this Stage 3 Project, you will evaluate EHR system solutions and propose a technology solution that
will improve the patient visit process you modeled in Stage 1 and improve the quality of care, safety, and
financial management decisions for the UMUC Family Clinic.
INSTRUCTIONS for ASSIGNMENT 3
For this assignment you will:
Follow the same instructions as to client relations formality in assignment 1. Review the UMUC Family
Clinic Case Study. As the EHR consultant to UMUC Family Clinic (Dr. Martin), you will write a paper to
propose to UMUC Family Clinic which EHR system you recommend; what it will do; what hardware,
software and telecommunications components he will need to acquire; whether the system will be hosted
locally or in the cloud; and explain how the proposed technology solution will improve the patient visit
process, and the quality of care, safety, and/or financial management decisions at the UMUC Family
Clinic. Create a document that includes the following:
1. Select and propose a specific EHR system for the UMUC Family Clinic. The system
should be one that would improve the patient visit process as described in the case study and as
modeled in the Stage 1 assignment. You will want to propose a system that has been certified to
perform certain functions, and is listed as a "complete" EHR system (vs. one that focuses on only
one or two of the processes). Focus on a single EHR system solution that would help to improve
the patient visit process.
o To accomplish this, you will need to look up the up-to-date list of certified complete EHRs
on the ONC (Office of the National Coordinator for Health IT) website at the following
URL and then complete the steps that follow: http://oncchpl.force.com/ehrcert/ o Select "View All Products" (located just under the search bar). On the page that comes
up, you will want to search using the following search criteria: 11/29/2015 ▪ Certification Edition: 2014 ▪ Select Practice Type: Ambulatory ▪ Select Classification: Complete EHR ▪ Select one or more Certification Criteria to find EHR systems that support the
patient visit process. (Note that not all EHR systems address all process areas.)
Refer to the “Certification Criteria,” in Content>Course Resources for a list that IFSM 305 – Stage 3 Page | 1 corresponds to the numbers provided; or mouse-over the number to see the
corresponding criterion.
o o You will then provide in your paper the following bulleted information on the certified
EHR that you have selected:
▪ Product: ___________________ ▪ Version: ___________________ ▪ Vendor: ___________________ ▪ CHPL Product Number: ___________________ Describe the system in one paragraph. Go to the vendor's website and research what
the system does and some of its selling points. Your description should demonstrate that
the selected system fits the UMUC Clinic's needs and will improve the patient visit
process. 2. List the major hardware, software and communications (including local connectivity and internet
access, if appropriate) components that will be needed, and the number of each needed for the
implementation at the UMUC Family Clinic. The vendor’s website should list the major hardware/
software requirements for implementing the system. How many of each you list is dependent on
the solution you propose, but the important components needed to implement your proposed
solution should be included. For example, you may have one PC for the front desk and one for
each of the three examination rooms, and they will have to connect to some system somewhere.
Or you may decide to have one PC for the front office, and a tablet or laptop each for the doctor
and the two nurses, also connected to some system somewhere. Your list should be applicable
to your proposed solution, should improve the patient visit process, and be appropriate for the
UMUC Family Clinic. (Remember, there is currently no information technology implemented at
the clinic other than the outdated scheduling software on the single front desk PC.)
3. You will also need to specify whether your EHR system will be hosted (installed) on computer
equipment to be located in the clinic or if it will run as “Software as a Service” (SaaS) via the
Internet (i.e., "in the cloud"). (For a definition of SaaS, please see the note in the box below.)
You will need to evaluate the clinic’s needs and the vendor’s offering. Some vendors offer only
one or the other, some offer both methods of access. There are advantages to selecting SaaS for
smaller clinics, like reducing the need for an IT staff, but it also comes with a price tag. You will
need to provide the reasoning behind your selection.
4. Explain how the proposed technology solution will improve the patient visit process, and the
quality of care, safety, and/or financial management decisions at the UMUC Family Clinic. Note
that a significant percentage of the overall grade is based on this explanation. 11/29/2015 IFSM 305 – Stage 3 Page | 2 SaaS: Software-as-a-Service (SaaS) is a software delivery model, where the actual
software and the data are hosted at the location of the software provider. The users
access the software or the data using a ‘thin client’ such as a web-browser. That way the
actual users of the software do not need to install the entire software and save the data
on their own hardware. The provider of the software is the one who incurs all the
responsibility of making the software and data available, backing it up, and restoring from
backup when needed. Hence, the users don’t need to incur hardware costs or hire IT
staff. This model is becoming more and more popular especially for small businesses
when it is not in their business model to hire an IT staff. Software delivered in this way is
said to run "in the cloud."
Example: An example of a common business accounting software that is offered in more
than 1 delivery model is Intuit’s Quickbooks. A small business owner can buy the software
for a one-time fee (cost of purchase is about $300) at Office Depot, install it on his own
PC and start entering his financial data. In this delivery model, the software and data
reside on the PC. If the PC crashes, all the data is lost unless the entrepreneur was ITsavvy and backed up his data on a CD or USB. The data can only be accessed on that
computer.
The other model is the SaaS, where the entrepreneur can decide that he prefers to pay a
monthly fee (roughly $50) and access Quickbooks via an internet browser such as
Internet Explorer or Firefox. In this model, the software and the data are stored at the
software vendor, Intuit. An advantage of this model is that the business owner does not
need to worry if his PC crashes or if he works from home or the office. He can access the
system and his data from anywhere and Intuit takes care of securing and backing up the
data, etc. 5. Formatting. As this is to be a formal document or deliverable to your client, it must include a
full outline (see the rubric below for relevant sections), to include an Introduction or Background,
and Conclusion. These are your opportunities to lead the thinking of your client. This is gradable
under Report Format. For academic writing, the writer is expected to write in the third person. In
third person, the writer avoids the pronouns I, we, my, our, you and your. The third person is
used to make the writing more objective by taking the individual, the “self,” out of the writing.
This method is very helpful for academic writing, a form in which facts, not opinion, drive the
tone of the text. Writing in the third person allows the writer to come across as unbiased and
thus more informed.
• Your paper should be about two pages, single spaced. Add a title page, and a reference
page.
• You should include at least one external source. These are sources other than those
provided in the classroom. Sources should be scholarly or professional in nature, rather than
random websites. Sources should include the vendor's website. NOTE: More than one
external source is required to earn full points.
• Use APA formatted citations and references for all external sources used.
• Compare your final work to the rubric to be sure you have met content and quality criteria.
• Submit your paper via your Assignment folder as a Word document, or a document that can
be read in Word, with your last name included in the filename(s)
(LASTNAME_Stage3).
Your paper will be evaluated on whether or not you correctly incorporated the course concepts from the
textbook and readings, and have addressed all parts of the assignment. What, exactly, you propose as a
technology solution will be evaluated as to whether it is appropriate for the UMUC Family Clinic and could
actually improve the patient visit process, and whether it is fully thought-out and supported with
application of course concepts and research. Remember, this is an information systems management 11/29/2015 IFSM 305 – Stage 3 Page | 3 course, and your solution must be an information technology solution – specifically an EHR system. Use
the Rubric below to be sure you have covered all aspects.
GRADING RUBRIC and EVALUATION CRITERIA:
Criteria Proposed
Technology
Solution 11/29/2015 90-100%
Far Above
Standards 80-89%
Above
Standards 70-79%
Meets
Standards 60-69%
Below
Standards < 60%
Well
Below
Standards Possible
Points 18-20 Points 16-17 Points
Proposed
technology
solution is
identified and
well described
using course
vocabulary
and is
appropriate to
the case study
and to
improve the
patient visit
process; and
demonstrates
understanding
of course
concepts,
analysis, and
critical
thinking. 12-13
Points 0-11
Points 20 Proposed
technology
solution is
identified and
convincingly
described in
detail using
course
vocabulary, is
appropriate to
the case study
and to improve
the patient
visit process;
strongly
demonstrates
understanding
of course
concepts,
analysis, and
critical
thinking. 14-15
Points
Proposed
technology
solution is
identified
and
described
using
course
vocabulary
and is
appropriate
to the case
study and
to improve
the patient
visit
process. Proposed
technology
solution is not
adequately
identified or
described,
and/or not
appropriate to
the case
study, and/or
not
appropriate to
improve the
patient visit
process; may
be lacking in
demonstratio
n of
understanding
of course
concepts,
course
vocabulary,
analysis, and/
or critical
thinking. Proposed
technology
solution is
not included
or not
described;
or is not
appropriate
to the case
study and
improving
the patient
visit
process. IFSM 305 – Stage 3 Page | 4 Solution
Components Explanation
of SaaS vs.
in-house
solution 11/29/2015 23-25 Points 20-22 Points 17-19
Points 15-16
Points 0-14
Points Major
hardware,
software, and
telecommunications
components
needed to
implement the
proposed
solution are
fully listed and
the number of
each is
specified; are
highly
appropriate to
the proposed
solution and
clearly
appropriate to
the case study. Major
hardware,
software, and
telecommunications
components
needed to
implement the
proposed
solution are
fully listed and
the number of
each is
specified; are
clearly
applicable to
the proposed
solution and
appropriate to
the case
study. Major
hardware,
software,
and
telecommu
n-ications
component
s to
implement
the
proposed
solution are
listed and
the number
of each is
specified;
are
applicable
to the
proposed
solution
and
appropriate
to the case
study. Major
hardware,
software, and
telecommunications
components
listed may be
incomplete,
number of
each may not
be provided;
may not apply
to the
proposed
solution and/
or may not be
appropriate
for the case
study. Component
list is not
provided or
is lacking
major
components
and/or
number of
each
required. 9-10 Points 8 Points 7 Points 6 Points 0-5 Points Explanation of
SaaS vs. inhouse
implementation
of the solution
is clear and
convincing. Explanation of
SaaS vs. inhouse
implementation of the
solution is
clear and
complete. Explanation
of SaaS vs.
in-house
implementa
-tion of the
solution is
presented. Explanation of
SaaS vs. inhouse
implementatio
n of the
solution is
incomplete or
unclear. Explanation
of SaaS vs.
in-house
implementa
-tion of the
solution is
not
provided. IFSM 305 – Stage 3 25 10 Page | 5 23-25 Points Explanation
of selection
of certified
EHR system External
Research 11/29/2015 A clear and
convincing
explanation is
provided for
how the
proposed
certified EHR
system will
improve the
patient visit
process,
quality of care,
safety, and/or
financial
management
decisions;
demonstrates
understanding
of course
concepts,
sophisticated
analysis, and
critical
thinking. 9-10 Points
More than
one source
other than the
course material
is incorporated
and used
effectively.
Sources used
are relevant
and timely.
References are
appropriately
incorporated
and cited using
APA style. 20-22 Points 17-19
Points
A clear and
An
correct
explanation is explanation
of how the
provided for
proposed
how the
certified
proposed
EHR system
certified EHR
will improve
system will
the patient
improve the
visit
patient visit
process,
process,
quality of
quality of
care, safety,
care, safety,
and/or
and/or
financial
financial
manageme
management
nt decisions
decisions;
demonstrates is provided
understanding using
course
of course
vocabulary
concepts,
and
analysis, and
concepts.
critical
thinking. 8 Points
At least one
source other
than the
course
material is
incorporated
and used
effectively.
Source(s)
used are
relevant and
timely.
References
are
appropriately
incorporated
and cited
using APA
style. 15-16
Points 0-14
Points The
explanation of
how the
proposed
certified EHR
system will
support the
patient visit
process,
quality of
care, safety,
and/or
financial
management
decisions is
incomplete
and/or not
convincing;
may be
lacking in
demonstratio
n of
understanding
of course
concepts,
analysis, and/
or critical
thinking. Explanation
of how the
proposed
certified
EHR system
can improve
the patient
visit
process,
quality of
care, safety,
and/or
financial
manageme
nt decisions
is not
provided or
is
incomplete
or
inadequate. 7 Points 6 Points 0-5 Points At least one
source
other than
the course
material is
incorporate
d correctly.
Reference
is cited
using APA
style. A source
other than
the course
material may
be used, but
is not
properly
incorporated
or used; and/
or is not
effective or
appropriate;
and/or is not
relevant or
timely; and/or
does not
follow APA
style for
references
and citations. No external
research is
incorporate
d or
reference
listed is not
cited within
text. IFSM 305 – Stage 3 25 10 Page | 6 Report
Format 9-10 Points
Report is very
well organized
and is easy to
read. Very few
or no errors;
demonstrates
correct
sentence
structure,
grammar, and
spelling;
written in third
person and
presented in a
professional
and formal
format. 8 Points 7 Points 6 Points 0-5 Points Report reflects
effective
organization;
may have few
errors in
sentence
structure,
grammar, and
spelling;
written in
third person
and presented
in a
professional
format. Report is
organized
and may
have some
errors in
sentence
structure,
grammar
and
spelling.
Report is
written in
third
person. Report is not
well
organized,
and/or
contains
several
grammar and/
or spelling
errors; and/or
report is not
written in
third person. Report is
extremely
poorly
written;
and/or
contains
many
grammar
and/or
spelling
errors; and/
or does not
convey the
information. TOTAL