Description

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.