Stage 2: Sharing Data Overview Before you begin work on this assignment, be sure you have read the Case Study and reviewed the feedback received on your Stage 1 assignment. Refer to the System Recommendation Report Table of Contents below to see where you are in the process of developing this report. As a professional medical consultant, your next step in developing your recommendation for an EHR system is to determine what data will need to be shared with other organizations and how that data will be shared. System Recommendation Report Table of Contents Introduction (Stage 1) I. II. III. IV. Organizational Analysis and Requirements (Stage 1) A. Introduction B. Organizational Strategy C. Strategic Use of Technology D. E. F. Components of an Information System Requirements Summary Sharing Data (Stage 2) A. Introduction B. Need to Share Data C. Types of Data to be Shared D. Data Interchange Standards E. Summary Ethical, Legal and Regulatory Policy Issues (Stage 3) A. Introduction B. Table of Ethical, Legal and Regulatory Policy Issues C. D. Addressing the Most Difficult Issue Summary System Recommendation (Stage 4) A. Introduction B. Proposed IT solution C. How the Proposed IT Solution Meets the Requirements D. Improvements from Proposed IT Solution E. Implementation Considerations F. Summary Conclusion (Stage 4) References IFSM 305 Stage 2: Sharing Data 11/17/2017 1 System Recommendation Report (SRR), Section II – Sharing Data Section II of the SRR document addresses the need for the Midtown Family Clinic to share data with other organizations. As part of analyzing the requirements for the new system, one step is to consider how that system will enable the Midtown Family Clinic to exchange electronic data with other health organizations – such as other providers, pharmacies, insurance companies, and even patients themselves. The case study mentions several of these. For this assignment you will select two types of external organizations and describe what kind of data would flow between the Midtown Family Clinic and those organizations and how that can be done effectively. Stage 2 Assignment Instructions The first step is to incorporate the feedback you received on your Stage 1 assignment, making any needed corrections or adjustments. For this assignment, you will add Section II of the System Recommendation Report (SRR). Using the case study, the overview above, Course Content readings, and external resources, develop your Section II on Sharing Data. Approximate lengths for each section are provided as a guideline; be sure to provide all pertinent information. Apply specific information from the case study to address each area listed below. II. Sharing Data A. Introduction - Introduction to this section describing what is included. (3-4 sentences) B. Need to Share Data - Review the Midtown Family Clinic Case Study and identify two types of external organizations (e.g., hospitals, nursing homes, rehabilitation centers, laboratories, pharmacies, health insurance providers, etc.) with which the Midtown Family Clinic needs to communicate and the purpose of the communication. (Introductory sentence and list of two external organizations and the purpose of their communication with the Midtown Family Clinic, providing specifics from the Case Study.) 1. External Organization #1 and purpose of communication. 2. External Organization #2 and purpose of communication. C. Types of Data to be Shared – In Stage 1, Section C.3., Data, you took an initial look at the types of data the new EHR system will process. But now we’re going to take that a step further and add a layer of complexity by considering the needs and requirements of different external organizations. Using the two external organizations you listed in Section A above, list five data items, or data elements, that would be shared with each external organization, and explain whether that information is going out from the Midtown Family Clinic or coming in from each of the two external organizations. Feel free to consult the list you developed for Section C.3 of your Stage 1 assignment. Some of these data elements may come from that list if they are appropriate for this purpose; however, other, different, data elements may be listed here. Note: For full credit, a different list of data elements should be provided for each organization (no duplicates in the table below, although data elements may be repeated from Section C.3). (Provide an introductory sentence and copy the table and insert information within.) IFSM 305 Stage 2: Sharing Data 11/17/2017 2 Organization #1 (replace with your organization from above) Data Element or Item Data Goes TO/FROM Midtown Family Clinic 1. 2. 3. 4. 5. Organization #2 (replace with your organization from above) Data Element or Item Data Goes TO/FROM Midtown Family Clinic 1. 2. 3. 4. 5. D. Data Interchange Standards - Conduct some external research and identify a data interchange standard that would apply to the data that is exchanged with each external organization. The standard you select should apply to one or more of the data elements you listed above for each organization. Provide a brief description of what the standard is, what it requires, why it is important and how it applies to the data elements listed and the Midtown Family Clinic EHR system. Note: For full credit, two different data interchange standards are required. (There are some specific data interchange standards that apply to health data exchange; if the same standard applies to the data exchanged with both organizations, explain how it relates to each.) (Introductory sentence and list of two external organizations and the information shown about the Data Interchange Standard selected for each, providing specifics from the Case Study.) 1. External Organization #1 a. Data Interchange Standard and description b. What the Data Interchange Standard requires c. Why the Data Interchange Standard is important d. How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system 2. External Organization #1 a. Data Interchange Standard and description b. What the Data Interchange Standard requires c. Why the Data Interchange Standard is important d. How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system E. Summary - briefly summarize the content of this section and tie the information together for the reader. (3-4 sentences) Formatting Your Assignment For academic writing, the writer is expected to write in the third person. In third person, the writer avoids the pronouns I, we, my, you, your, and ours. 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. The Report is to be written for the IFSM 305 Stage 2: Sharing Data 11/17/2017 3 Midtown Family Clinic, and reference should not be made by name to individuals who own or work in the Clinic. • • • • • • • Include the Introduction and Section I, revised according to any feedback received, and add to it Section II. Write a short concise paper: Use the recommendations provided in each area for length of response. Content areas should be double spaced; table entries should be single-spaced. It’s important to value quality over quantity. Section II should not exceed 4 pages. Ensure that the table is preceded by an introductory sentence that explains what is contained in the table, so the reader understands why the table has been included. Use at least two resources with APA formatted citation and reference. Use at least one external reference and one from the course content. Compare your work to the Assignment Instructions above and the Evaluation Criteria/Grading Rubric below to be sure you have met content and quality criteria. Do not overlook this step. Read your work out loud or have your computer read it to you. Fix the grammar and other areas identified. Submit your paper as a Word document, or a document that can be read in Word. Your submission filename should be as follows: Lastname_firstname_Stage_2 EVALUATION CRITERIA/GRADING RUBRIC: Criteria Section Introduction and Summary Need to Share Data Two external organizations and the purpose of their communication 90-100% Far Above Standards 80-89% Above Standards 70-79% Meets Standards 60-69% Below Standards < 60% Well Below Standards Possible Points 9-10 Points 8.5 Points 7.5 Points 6.5 Points 0-5 Points 10 Provides effective introduction and summary to Section II; is clear, logical, derived from the Case Study; demonstrates a sophisticated level of writing. 9-10 Points Provides an introduction and summary to Section II; is clear, logical, and derived from the Case Study. Not clear, logical and/or derived from the Case Study. Or, either the introduction or summary is not included. Not included, or demonstrates little effort. 8.5 Points 7.5 Points 6.5 Points 0-5 Points Organizations and communication are clearly appropriate and explained in detail using course vocabulary; demonstrates understanding of course concepts, analysis, and/or critical thinking. Organizations and communication are appropriate and well explained using course vocabulary; demonstrates understanding of course concepts and critical thinking. Organizations and communication are provided. Fewer than two organizations are identified, or are incorrect; and/or explanation of the communication between them and the Midtown Family Clinic may lack demonstration of understanding of course concepts, analysis, and/or critical thinking. Identification of external organizations and/or explanation of communication is incomplete or inadequate. IFSM 305 Stage 2: Sharing Data 11/17/2017 Provides an introduction and summary to Section II; is adequate, and derived from the Case Study. 10 4 Types of Data to be Shared 5 data elements for each organization and direction of flow Data Interchange Standards Two standards with description, requirement, importance and applicability Research Two or more sources--one source from within the IFSM 305 course content and one external (other than the course materials) Format 27-30 Points 24-26 Points 21-23 Points 18-20 Points 0-17 Points Data elements are correctly identified and are different for each organization; the direction of the data flow is appropriate to the case study; strongly demonstrates understanding of course concepts, analysis, and critical thinking. Data elements are correctly identified; the direction of the data flow is appropriate to the case study; demonstrates understanding of course concepts, analysis, and critical thinking. Data elements are identified; direction of the flow of data is appropriate to the case study. Fewer than 5 data elements may be presented for each of the two external organizations; flow of data may be less than correct, or not appropriate to the case study. Data elements and flows are not presented or are not appropriate to the case study, or are otherwise inadequate. 27-30 Points 24-26 Points 21-23 Points 18-20 Points 0-17 Points Two different data interchange standards are listed and explained, and are applicable to the case study, with complete explanations of the standards, what they require and why they are important. At least one data interchange standard is explained, along with how it applies to the data interchange with both external organizations, is applicable to the case study, with a complete explanation of the standard, what it requires and why it is important. At least one data interchange standard is explained, along with how it applies to the data interchange with both external organizations, is applicable to the case study, with an explanation of the standard, what it requires and why it is important. At least one data interchange standard is explained, but how it applies to the data interchange with both external organizations or to the case study is incomplete; and/or explanation of the standard, what it requires and why it is important may be incomplete. Data interchange standard is not identified; only one organization/data standard are identified; or explanation is severely lacking. 9-10 Points 8.5 Points 7.5 Points 6.5 Points 0-5 Points Required resources are incorporated and used effectively. Sources used are relevant and timely and contribute strongly to the analysis. References are appropriately incorporated and cited using APA style. 9-10 Points At least two sources are incorporated and are relevant and somewhat support the analysis. References are appropriately incorporated and cited using APA style. Only one resource is used and properly incorporated and/or reference(s) lack correct APA style. A source may be used, but is not properly incorporated or used, and/or is not effective or appropriate; and/or does not follow APA style for references and citations. No course content or external research incorporated; or reference listed is not cited within the text. 8.5 Points 7.5 Points 6.5 Points 0-5 Points Well organized and easy to read. Very few or no errors in sentence structure, grammar, and spelling; doublespaced, written in third person and Effective organization; has few errors in sentence structure, grammar, and spelling; doublespaced, written in third person and Some organization; may have some errors in sentence structure, grammar and spelling. Report is double spaced and Not well organized, and/or contains several grammar and/or spelling errors; and/or is not double-spaced and Extremely poorly written, has many grammar and/or spelling errors, or does not convey the information. IFSM 305 Stage 2: Sharing Data 11/17/2017 30 30 10 10 5 presented in a professional format. presented in a professional format. written in third person. written in third person. TOTAL Points Possible IFSM 305 Stage 2: Sharing Data 11/17/2017 100 6 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 nurses, Vivian and Maria, 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 Vivian is helping the doctor, then it is Maria 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 moment. 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 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. 3/5/2018 IFSM 305 – Case Study Page | 1 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. 3/5/2018 IFSM 305 – Case Study Page | 2 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 an organization's strategies and processes to determine how a technology solution could help (Stage 1) Analyze the data flow among a clinical practice and external organizations (Stage 2) Identify and explain the legal, ethical and regulatory considerations for a system (Stage 3) Propose an appropriate certified EHR technology solution (Stage 4) As explained in the Stage 1 assignment, you will create a System Recommendation Report for Dr. Thompson, using each stage to develop a section of the report. The staged assignments are designed to follow the relevant readings in the course content, and are due on the dates as assigned in the class schedule. 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. 3/5/2018 IFSM 305 – Case Study Page | 3 Running head: CASE STUDY Midtown Family Case Study: Organizational Analysis and Requirements (Stage 1) Student’s Name Professor’s Name Course Title Date CASE STUDY 2 Organizational Analysis and Requirements Introduction As much as Dr. Harold Thompson’s Midtown Family Clinic is a small internal medicine practice that one would expect to be served efficiently and within the short time, it is highly inefficient as it operates the same way it did in 1990 when it started. As such, the workflow processes at this clinic have to be analyzed and optimized before the selection of the most appropriate electronic health records systems vendor for prompt implementation of the same. The facility has only two nurses who alternate between administrative duties at the front desk and nursing duties with the doctor. Dr. Thompson needs to hire additional staff but this may not be a sustainable move because of the various challenges he faces and so the only solution he has as at now is to optimize his operations at the facility. To begin with, most of his operations are manual or rather paper based with a standalone appointment scheduling system as the only software being used. All the other operations like insurance company billing, checking in patients and updating patient information on a yearly basis and each time there is a new report that needs to be stored. From this, Dr. Thompson feels that the nurses are spending less time on patient care and a lot of time just handling paper. Also, patient information is bound to be misfiled or lost because there is a lot to be done by the two nurses and they can sometimes be overwhelmed. Strategic Use of Technology Technology in form of an appropriate Electronic Health Record (EHR) System can be used at the Midtown Family Clinic to attain a number of goals as can be deducted from the case. The first strategic goal is to increase the operations efficiency at the facility. The EHR system CASE STUDY 3 will see to it that some services are automated and that patient waiting and service time is significantly reduced to at most 30 minutes. As a result, less doctor time will be wasted hence more patient care. The second strategic goal is to increase the revenue generated at the facility so as to ultimately generate enough revenue that will enable him to re-invest into the clinic. It is due to the financial problems the facility has that the doctor cannot hire more nurses or physicians to help the current nurses who seem to be overwhelmed. The EHR system will, for instance, take care of insurance company billing processes to cut on the costs that are currently being incurred by the medical billing company and other third party companies As a result, the doctor will be able to comfortably expand the facility by renting the apartment next to his clinic to make it a 3physician group practice, hence generating more revenue. The third strategic goal is ‘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’. The EHR system will basically reduce patient service time, improve record keeping processes and save costs. As such, nurses will focus more on quality patient care. Components of an Information System People: The new EHR system to be implemented in the clinic will be used by the doctor and nurses, patients and insurance service providers. The doctor and nurses will use the system to enter patient information and updates for easier referrals to specialists, patients will use the system to book appointments and fill out their insurance details each time they visit the facility and any other time their information needs to be updated. Lastly, the insurance companies will use the EHR system to check for any claims and pay as per the patient requests. CASE STUDY 4 Organizational Processes: The three organizational processes that would be improved by the implementation of the EHR include insurance company billing, conducting patient referrals to specialists and checking in patients and updating patient information on a yearly basis and each time there is a new report that needs to be stored. Medical billing will be made easier and more efficient because the clinic will no longer have to use a medical billing company. For this reason, costs will have been significantly minimized. As for the next process which is conducting patient referrals to specialists, the doctor will be better placed to easily and quickly share patient data when he makes a referral to a specialist. Lastly, the nurses will quickly check in patients using the HER through a system that will call in patients to see the doctor whether or not a nurse is available at the moment. Data: The data that the new EHR system will be needed to collect regarding the patients are as outlined in Table 1. The data is meant to be stored for reference each time the patient visits the facility. With this, it is easier for the doctor to trace the patient’s medical history hence provide the best service and care. Data Items Needed for EHR System 1. Patient’s Name 2. Phone Number 3. Gender 4. Age 5. Marital Status 6. Insurance Provider 7. Appointment 8. Transcriptions 9. Prescription 10. Referrals Table 1: Data Items needed for EHR system Functional Requirements CASE STUDY The essential requirements for the EHR system as per the organizational processes and data items needed for the EHR system are outlined in Table 2. Functional Requirements of the EHR System 1. Providing fast and real time access to patients’ medical health records. 2. Acts as a primary source of patient information during patient care provision for instance gender, age and marital status among other vital information. 3. Foster efficient work planning for the nurses through automating patient check ins and appointment scheduling. 4. Safe data storage for future reference and use by patients, the doctor, and nurses. 5. Enable efficient resource planning by providing the number of daily appointments and the average number of patients per day in time. 6. Automate medical billing hence save on costs. 7. Capture the patient health-related information needed for medical records and reimbursement 8. Shorten the payment period from the insurance providers by filing prompt claims on a real time basis. 9. Safely store patient laboratory results hence minimize the probability of information loss. 10. Enable the doctor to easily share patient data when making referrals to a specialist. Table 2: Functional Requirements Summary In summary, Dr. Harold Thompson’s Midtown Family Clinic is currently inefficient and thus needs operational optimization and the implementation of an EHR that is specifically customized to address the needs of the clinic. There is, therefore, need for setting strategic goals of the intended EHR, and analysis of its components alongside the systems functional 5 CASE STUDY requirements as has been done in this document. This will, therefore, act as a guide towards the selection and implementation of the appropriate EHR system for the clinic. 6 CASE STUDY 7 References Ajami, S., & Bagheri-Tadi, T. (2013). Barriers for adopting electronic health records (EHRs) by physicians. Acta Informatica Medica, 21(2), 129. Midtown Family Clinic Case Study Vimalachandran, P., Wang, H., Zhang, Y., Heyward, B., & Whittaker, F. (2016, December). Ensuring data integrity in electronic health records: A quality health care implication. In Orange Technologies (ICOT), 2016 International Conference on (pp. 20-27). IEEE.
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