Community Medical Associates (case study), writing homework help

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Instructions:

1) Read case study: Community Medical Associates, attached below

2) Answer the following questions:

  1. Explain how CMA used the four principles of lean operating systems to improve performance.
  2. Using information from the case, sketch the original paper-based value chain and compare it to a sketch of the modern electronic value chain that uses a common database. Explain how the performance of both systems might compare?
  3. What is a total annual record retrieval cost savings with the old (paper-based) versus new (electronic) systems?
  4. Does this CMA improvement initiative have any effect on sustainability? If so, how? If not, why?
  5. Using lean principles, can you simultaneously improve the speed and quality while reducing waste and costs? What are the tradeoffs? Justify.

4) Limit: 4 pages, excluding computations.

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Community Medical Associates Case Study S18199920 Today, CMÅ uses an integrated operating system that consolidates over 50 CMA databases into one. Community Medical Associates (CMA) is a large health care system with 2 hospitals, 25 satellite health centers, and 56 outpatient clinics. CMA had 1.5 million outpatient visits and 60,000 inpatient admissions the previous year. Just a few years ago, CMA's health care delivery system was having significant problems with quality of care. Long patient waiting times, uncoordinated clinical and patient information, and medical errors plagued the system. Doe- tors, nurses, lab technicians, managers, and medical stu- dents in training were very aggravated with the labyrinth of forms, databases, and communication links. Account- ing and billing were in a situation of constant confusion constantly correcting medical bills and insurance pay- ments. The complexity of the CMA information and com- munication system overwhelmed its people. Prior to redesigning its systems, physicians were faced with a complex array of appointments and schedules in order to see patients in the hospital, centers, and clinics. For example, an elderly patient with shoulder pain would get an X-ray at the clinic but have to set up an appointment for a CAT scan in the hospital. Furthermore, the patient's blood was sent to an off-site lab, and physician notes were transcribed from tape recorders. Radiology would read and interpret the X-rays and body scans in a consultant report. Past and present medication records were kept in the hospital and off-site pharmacies. Physicians would write paper prescriptions for each patient. Billing and patient insurance information was maintained in a sepa- rate database. The patient's medical chart was part paper based and part electronic. The paper medical file could be stored at the hospital, centers, or clinics. Nurses hand wrote their notes on each patient, but their notes were seldom input into the patient's medical records or chart. "We must access one database for lah results, then log off and access another system for radiology, then log off and access the CMA pharmacy system to gain an in tegrated view of the patient's health. If I can't find the pa tient's records within five minutes or so, I have to abandon my search and tell the patient to wait or make another ap pointment," said one doctor. The doctor continued, "You have to abandon the patient because you have to move on to patients you truly can diagnose and help. If you don't abandon the patient, you might make clinical decisions about the patient's health without having a complete set of information. Not having all the medical information fast has a direct impact on quality of care and patient satisfaction. Today, CMA uses an integrated operating system that consolidates over 50 CMA databases into one. Health care providers in the CMA system now have access to these records through 7,000 computer terminals. Using many levels of security and some restricted databases, all patient information is acressible in less than two minutes. For ex ample, sensitive categories of patient records such as psy chiatric and AIDS problems were kept in super-restricted databases. It cost CMA $4.46 to retrieve and transport a single patient's paper-based medical chart to the proper lo cation, whereas the more complete and quickly updated electronic medical record costs $1.32 to electronically re trieve and transport once. A patient's medical records are retrieved on average 1.4 times for outpatient services and 4.8 times for inpatient admissions. In addition, CMA has spent more money on database security, although it has not been able to place a dollar value on this. Electronic security audit trails show who logs on, when, how long he or she views a specific file, and what information has been viewed. The same doctor who made the previous comments two years ago now said, “The speed of the system is what I like. I can now make informed clinical decisions for my patients. Where it used to take several days and sometimes weeks to transcribe my patient medical notes, it now takes no more than 48 hours to see them pop up on the CMA sys tem. Often my notes are up on the system the same day. I'd say we use about one-half the paper we used with the old system. I also find myself editing and correcting transcrip tion errors in the database—so it is more accurate now." The next phase in the development of CMA's inte- grated system is to connect it to suppliers, outside labs and pharmacies, other hospitals, and to doctors' home computers. Case Questions for Discussion 1. Explain how CMA used the four principles of lean operating systems to improve performance. 2. Using the information from the case, sketch the original, paper-based value chain and compare it to a sketch of the modern, electronic value chain, which uses a common database. Explain how the performance of both systems might compare. 3. What is the total annual record retrieval cost savings with the old (paper-based) versus new (electronic) systems? 4. Does this CMA improvement initiative have any effect on sustainability? If so, how? If not, why? 5. Using lean principles, can you simultaneously improve speed and quality while reducing waste and costs? What are the trade-offs? Explain your reasoning.
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Surname 1

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CMA case study
Lean operating systems refers to systems which majorly apply approaches geared
towards elimination of wastes in all forms while enhancing smooth and efficient transmission of
information and materials from different segments of a system while reducing costs incurred,
higher quality services and increased customer satisfaction.
CMA adopted the four lean operation principles to enhance their performance. This
included; Quality improvement, speed and response enhancement, waste elimination and cost
reduction. To improve quality, CMA improved clinical quality by basing physician diagnosis on
a complete set of information, highly enhanced database security and quality of information
(Buckley, Grant, and Glazener). This incorporation of lean system reduced patients wait time and
minimized cases of non-diagnosis due to missing data of patients since data could easily be
retrieved from the database by the Doctor in charge, unlike the earlier case where it could take
several days to transcribe patients' medical notes. Similarly, physician diagnosis made it easier to
do physician audit of electronic records, eliminate incoherent records not attached to particular
files and as well made it easier to track the use of documents.
The database played a fundamental role in increasing speed and response time. Initially,
it could take several days or weeks to transcribe patients' medical notes. With the introduction of

Surname 2
the new system, however, it could now take less than two days. The developed system reduced
the complex set of appointments and schedules that physicians had to attend to patients in
hospitals, centers, and clinics that was time-consuming. The time that was spent by doctors to log
in and off on a different database was much reduced since retrieval of data was made easier from
the system.
CMA immensely minimized waste of resources and reduction of cost by consolidating 50CMA
database into one thereby reducing paperwork by one-half. This move cut on expenses on
patient’s medical chart access and transportation from $4.46 using the paper-based system to
$1.32 with the adoption of the electronic-based system. The new database regime led to
minimization of hand-written physician notes, space required for filing cabinets and shelves for
data storage was reduced and resulted in labor reduction thus saving on wages.
A comparison of the original paper-based value chain and the modern electronic-based value
chain is shown in the table below.
PAPER-BASED VALUE
CHAIN

MODERN ELECTRONICBASED VALUE CHAIN

DATA RETRIEVAL

Billing and patient insurance
were filed in separate database
systems leading to confusions
and constant corrections on
the bills. Patients’ data were
recorded in hospital and offsite pharmacies.

50 CMA Database integrated
into a single database system
that can be accessed through
7000 computer terminals.
Accurate data record resulting
in minimized editing and
corrections of bills.

COST...


Anonymous
I was having a hard time with this subject, and this was a great help.

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