Midtown Family Clinic

Case Study
In 1990, Dr. Harold Thompson opened the Midtown Family Clinic, a small internal medicine practice, in an
area with an increasing number of new family residences. Dr. Thompson has been the owner and manager
of the medical practice. He has two registered nurses, Vivian Halliday, and Maria Costa, 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
Nurse Halliday is helping the doctor, then it is Nurse Costa 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. 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. Thompson 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. Thompson has to optimize his
administrative and clinical operations. The practice is barely covering the expenses and salaries at the
Dr. Thompson’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 1990.
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 the doctor’s valuable
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, especially if they are taking 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. Thompson, 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
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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. However, the clinic also accepts walk-in patients.
At a recent medical conference Dr. Thompson 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. Thompson 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. Thompson 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.
Thompson 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. Thompson has contracted with an independent
consultant, who is not associated with any vendor, to advise him through this process. Throughout this
course you will be the professional medical consultant.
Strategic Goals
Dr. Thompson 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. Thompson 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 Midtown 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 re-scheduled,
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. Thompson 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 done 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.
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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