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Running Header: System Recommendation Report
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System Recommendation Report
System Recommendation Report
Table of Contents
Introduction 3
I. Organizational Analysis and Requirements 4
A. Introduction 4
B. Strategic Use of Technology 4
C. Components of an Information System 6
D. Functional Requirements 7
E. Summary 8
II. Data Sharing 9
A. Introduction 9
B. Need to Share Data 9
C. Types of Data to be Shared 9
D. Data Interchange Standards 9
E. Summary 9
III. Ethical, Legal and Regulatory Policy Issues 9
A. Introduction 9
B. Table of Ethical, Legal and Regulatory Policy Issues 9
C. Addressing the Most Difficult Issue 9
D. Summary 9
IV. System Recommendation 9
A. Introduction 9
B. Proposed IT solution 9
C. How the Proposed IT Solution Meets the Requirements 9
D. Improvements from Proposed IT Solution 9
E. Implementation Considerations 9
F. Summary 9
Conclusion 9
References 10
Introduction
Midtown Family Clinic is small-sized practice for internal medicine and is located at an area that has increasing trends in newer family residences. The owner of this practice is Dr. Thompson and he also acts as the manager for this medical practice. Dr. Thompson is aided by two nurses, both registered, for running this practice. At present, the practice operation of Dr. Thompson is completely paper-based and the sole software which is used is a stand-alone system for appointment scheduling. Billing to the insurance companies is also undertaken in mostly manual way.
The manual and paper-based approach in addition to limitation of staff size is evidently a significant problem to the practice. In addition, Dr. Thompson has various strategic goals which include the following – to make this medical practice to operate in a more efficient manner as well as to make financial profit which could be reinvest in the clinic for the purposes of upgrading and expanding it. Other major plans include the expansion of the clinic to larger capacity with three physicians as well as to rent out space for a physician to offer physical therapy sessions.
In this context, this report presents the analysis undertaken, system requirements as well as proposes Electronic Health Records (“EHR”) system for the purposes of improving the processes at Midtown Family Clinic.
Data Sharing
Introduction
This section presents a detailed organizational analysis of the different types of data that flows in and out of Dr. Thompson’s Midtown Family Clinic specifying the need for proper EHR system that can help Dr. Thompson’s clinic to provide better facilities to the patients. The idea is to make his medical practice to more profitable by making it more efficient manner so that the profit can be reinvestment for upgrades and expansion. The section shall also identify data and the functional requirements with respect to the EHR system in the Midtown Family clinic and to improve of the exchange standards if necessary.
Need to Share Data
The Midtown Family Clinic faces various challenges when catering to the needs of the patients. With the limited number of nurses to attend to the reception and tend to the needs of both the doctor and the patients, the entire process has become quite time consuming and laborious. Patients often complain that the waiting time is too long while the nurses are overwhelmed with the various needs of the clinic. Apart from the patients records, The clinic needs to regularly verify the credentials of the patients to check their insurance. In the absence of a proper billing system, the Clinic has become inefficient in it’s operations. The pathological reports generated from the labs are also filed manually making the entire process very laborious. While Dr. Thompson is absent the clinic the nurses face a lot of difficulties in locating appropriate medical records of the patients. The paper based system has made the due process of storing medical history very problematic of the Nurses.
In terms of communications with the external organisations, Dr. Thompson and his Midtown Family clinic faces a challenge. The two of the major external organisation that the Clinic needs to contact on a regular basis are – [1] The Insurance and the billing Company that checks the credentials of the patients and verifies their claim for insurance, [2] The pathological laboratories that generate the test results of the various clinical tests that Dr. Thompson has prescribed to his patients.
The purpose of communication between the external organisations mentioned above and the Midtown Family Clinic are as follows –
[1] The Insurance Billing Company:
· The Billing system needs proper inputting or retrieval of all forms of records in a paper-less manner stating the different expenses that the patient has.
· The third party medical billing company verifies the claim with the insurance companies of the patients and enters the registered information of the patients to their own website providing a login key to the Clinic.
· The Nurse at the front desk of the Midtown Family Clinic checks the information using Internet Explorer in the absence of the company software making the entire process very time consuming and laborious.
· Having a software based billing system would make the entire process faster and easie
[2] The Laboratories:
· The laboratory test results that are files in a paper based manner and becomes problematic for Dr. Thompson while refe
ing a patient to a specialist.
· The medical records are difficult to find at the time of re-entry.
Types of Data to be Shared
· The process of billing to insurance companies undertaken at present is in a quasi-manual manner with paper-based and individual follow ups. The process is inefficient and time consuming. The reports of the laboratories are also stored manually. The use of EHR system shall automate, digitize, and make it more efficient to undertake this process.
· The Types of Data Shared between the two external organizations are listed below:
Organization #1 The Third Party Insurance Billing Company
Data Element or Item
Data Goes TO/FROM Midtown Family Clinic
1. Patient Name
Data Goes FROM Midtown Family Clinic
2. Patient Unique ID
Data Goes FROM Midtown Family Clinic
3. Patient Date of Birth
Data Goes FROM Midtown Family Clinic
4. Billing Information
Data Goes TO and FROM Midtown Family Clinic
5. Patient Insurance Numbe
Data Goes FROM Midtown Family Clinic
6. Claims Data
Data Goes TO Midtown Family Clinic
7. Administrative Data e.g Log-in Key
Data Goes TO Midtown Family Clinic
Organization #2 The Laboratories
Data Element or Item
Data Goes TO/FROM Midtown Family Clinic
Prescription Records
Data Goes FROM Midtown Family Clinic
Patient Diagnosis History
Data Goes FROM Midtown Family Clinic
Scan / MRT Records
Data Goes TO Midtown Family Clinic
Pathological Test Reports
Data Goes TO Midtown Family Clinic
Data Interchange Standards
Interchange Standard selected for each are illustrated below:
External Organization #1 The Insurance Billing Company
· Data Interchange Standard and description: The Data Interchange Standard used is The Health Insurance Portability and Accountability Act as it acts as the national standard protocol for insurance transactions (Beik, 2017).
· What the Data Interchange Standard requires in order to be able to use it in an information system: Using the integrated coded system the requirements will be only to put in the code to the insurance company and register the claim virtually. The EHR system with the integrated billing system software will be able to do this
· Why the Data Interchange Standard is important: This is a standard protocol for submitting and claiming insurance reports electronically. This allows the Midtown Family clinic to follow a universal standard protocol helping it to ca
y out the operations seamlessly with the various Healthcare Providers.
· How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system: The role of the clinic would be to collect the patient’s data and to assign proper codes to bill all the necessary procedures. Nurses will be equipped with the EHR software. They will be able to assign specific codes, search and retrieve the code-based information, add information till the completion of the billing system. This information will be sent to the Insurance Company and they will verify the payment protocols if and when applicable. The Company will then provide the claim reports stating whether to grant, reject or partially provide the insurance to the clinic (The process of medical billing, 2018).
External Organization #2 The laboratories
· Data Interchange Standard and description: Data Interchange Standard used is the Logical Observation Identifiers Names and Codes (LOINC). Using LOINC it will be easy to standardize the question for a test or a measurement or any or request that is largely performed in laboratories (Stram et al; What LOINC is, 2019).
· What the Data Interchange Standard requires in order to be able to use it in an information system: The only requirement is the EHR system that has been chosen included LOINC as its standard.
· Why the Data Interchange Standard is important: The importance of LOINC is that it is an “international standard for identifying health measurements, observations, and documents” (Stram et al; What LOINC is, 2019).
· How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system: When Dr. Thompson refers patients for the different laboratory tests, the request will be accompanied by the LOINC code for the test that is to be made by the Lab. Upon receiving the request the code will then be identified by the lab and proper testing will be performed. Results of the tests will be uploaded automatically and securely into a shared portal, reducing the time taken to file it manually.
Summary
In summary, this section presented a detailed analysis of the data collection and communication methods that go in and out of the Midtown Family Clinic for choose the appropriate EHR system. The data and the functional requirements of the proposed EHR system can be based on the above standards and the objectives will be met.
Ethical, Legal and Regulatory Policy Issues
Introduction
Table of Ethical, Legal and Regulatory Policy Issues
Addressing the Most Difficult Issue
Summary
System Recommendation
Introduction
Proposed IT solution
How the Proposed IT Solution Meets the Requirements
Improvements from Proposed IT Solution
Implementation Considerations
Summary
Conclusion
References
Beik, J. I. (2017). Health Insurance Today-E-Book: A Practical Approach. Elsevier Health Sciences.
Stram, M., Gigliotti, T., Hartman, D., Pitkus, A., Huff, S. M., Riben, M., ... & Pantanowitz, L XXXXXXXXXXLogical Observation Identifiers Names and Codes for Laboratorians. Archives of pathology & laboratory medicine.
3/5/2018 IFSM 305 – Case Study Page | 1
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