01/23/2014 IFSM 305 – Case Study Description Page | 1 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 i ...

1. 01/23/2014 IFSM 305 – Case Study Description Page | 1
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

2. 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

3. 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

4. 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. The new
01/23/2014 IFSM 305 – Case Study Description Page | 2

5. EHR system needs to work with the optimized processes of his
practice. Dr. Martin 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.
Martin realizes that EHR adoption will 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 expect to qualify for the financial
incentives for achieving meaningful use
1
. This extra money will help reduce the burden of the cost on a
clinic that is barely able to sustain any more costs at this time.
Dr. Martin, the owner of the UMUC Family Clinic, has just
learned that 2014 is the last year to begin
participation in the Medicare Incentive Program and that
beginning in 2015, Medicare eligible
professionals who do not successfully demonstrate meaningful
use will be subject to a payment
adjustment according to CMS. To add to his confusion even
more, he also learned that there is also a
Medicaid Incentive Program and is confused on which one to
pursue. For the Medicaid Incentive
Program the last year however is 2016. Time is running out.
He needs to act before it is too late.
Based on his fellow doctor’s recommendation, Dr. Martin has
contracted with an independent EHR

6. consultant, who is not associated to any vendor, to advise him
through this process. Throughout this
course you will be the EHR consultant.
Dr. Martin has several strategic goals in mind that he shares
with you during your first consultation with
him as his consultant. For one, he would like to see his medical
practice operate more efficiently and
make some financial profit that would allow him to 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 it is in his best interest
to actively start the process of EHR adoption and take
advantage of the incentives provided through the
meaningful use program
1
. So this has now become another strategic goal for the
practice. By
implementing an EHR system, he will be able to fulfill another

7. strategic objective, which is to raise the
level of IT-awareness among his staff. Dr. Martin also wants to
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.
Your task is to help Dr. Martin decide which of his clinical
processes can benefit from an IT solution,
which processes should be automated first, how an EHR system
could help his practice, which incentives
program to qualify for, how to achieve meaningful use by
adopting a certified EHR system and how to
meet meaningful use reporting requirements. You are not
expected to solve all of the problems identified
or address all improvements that could be made at the UMUC
Family Clinic. Note: We’re looking for a
technology solution. While installing a TV in the waiting room
may attract new patients, it is not a
technology solution.
The following is an example of how you will identify a process
and optimize it using an EHR system: Last
year, the medical practice had no effective way to check its
members in when they arrived. Sign-in
sheets were used at the front desk, and the nurse had to check
off the name on the sheet against
existing medical records in the filing cabinet. Some of the
patients were walk-ins, so the nurses had not

8. pulled their files off the shelf when they started the day. The
nurse had to leave the desktop go search
for the file on the shelf. This caused patients a long wait at the
front desk, and several had complained
to Dr. Martin about this situation. To address the business need
of quickly checking members in, the
appointment scheduling system was modified to allow the clinic
office to quickly lookup patients by last
name and date-of-birth (DOB) on the computer as they sign in.
1
From the CMS.gov website: “The Medicare and Medicaid EHR
Incentive Programs provide financial incentives
for the “meaningful use” of certified EHR technology to
improve patient care. To receive an EHR incentive
payment, providers have to show that they are “meaningfully
using” their EHRs by meeting thresholds for a number
of objectives. CMS has established the objectives for
“meaningful use” that eligible professionals, eligible hospitals,
and critical access hospitals (CAHs) must meet in order to
receive an incentive payment.” Meaningful use will be
covered in the course materials.
01/23/2014 IFSM 305 – Case Study Description Page | 3

9. 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.
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:

10. Analyze a clinical process and diagram the steps (Stage 1)
Propose an appropriate EHR technology solution (Stage 2)
Identify and explain the meaningful use reporting requirements
to qualify for the financial
incentives (Stage 3)
Identify and explain the considerations in implementing the
solution proposed in Stage 2 (Stage
4)
The staged assignments are designed to follow the relevant
chapters of the textbook in the class
schedule, and are due on the dates as assigned. Assignments for
stages 2 and 3 require external
research, outside of the textbook and other materials provided
in the classroom. The grading rubric is
included with each assignment.
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. When
you are writing a paper or developing a
presentation, prepare it as if it is going to the owner, Dr.
Martin, whom you want to impress with your
knowledge and abilities. Don't just go through the mechanics of
pulling together information -- think
about what you are doing, why you're doing it, whether it make

11. sense, whether the information seems
realistic, and what the results show. It’s important that you
identify relevant, timely resources that
specifically support the points or information you provide in
your assignment. You should read the
source and assimilate the information first, and then put it into
your own words and incorporate it into
the flow of your writing (with an appropriate in-text APA
citation and a list of references at the end of
your paper). Direct quotes should be used very sparingly—only
when the author’s own words uniquely
present a concept that would be lost if paraphrased by you.
One of the prerequisites for this course is that you have a
fundamental working knowledge of word
processing and presentation software. Detailed instructions for
each Staged Project, 1 through 4, are
posted in the Assignments area of the classroom. You are to
prepare each assignment in the indicated
format (i.e., table, outline, report, presentation or other
specified format) and submit it as an attachment
through your individual Assignments Folder in LEO. No credit
will be given for assignments
submitted in file formats other than those stated in the
assignment instructions.
Do not wait until the last minute to begin an activity. You
should read through all the assignments
in advance to ensure you (1) understand what is expected, and
(2) allow enough time to effectively

12. create the information being requested.
Case Study, Stage 1: Process Analysis
Before you begin this assignment, be sure you have read the
“UMUC Family Clinic Case Study” and your Week 1 and Week
2 syllabus readings, which discuss EHR functionality and
Process Workflow Analysis and Mapping. You will need to
refer to three of the HealthIT.gov documents available in
Content>Course Resources: Overview of Steps to Implement
an EHR System, Step 1, and Step 2. In addition, you should
obtain concurrence from your faculty member that you have
selected an appropriate process (see below).
Purpose of this Assignment
This assignment gives you the opportunity to apply your
analysis skills to model a business process in an ambulatory
setting in the healthcare industry. Modeling the process as it
exists (and as it will exist) will aid in the analysis, selection and
implementation of the EHR system for the medical practice.
This assignment leads to the Stage 2 assignment which will give
you the opportunity to apply your knowledge of technology
solutions and EHR systems to improve the business process you
select here. In this assignment, you will identify a process
(workflow) in need of improvement, and plan for a revised and
optimized workflow to improve the quality of care, safety, and
financial management incentives. You will develop 2 process
maps (AS IS and TO BE) for the clinical process workflow.
This assignment addresses the following course outcome 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.

13. Family Clinic Medical Practice
In order to apply technology to a process, the process must be
thoroughly understood and models are used for this purpose.
The model also supports business process analysis and redesign
when the process is deemed to be inefficient or ineffective. In
addition, models are used to design the “to-be” process that
describes the desired end state after the technology solution is
developed.
In the Step 1 document, under “Assess Your Current Practice,”
you will see the following questions to be answered:
· Are administrative processes organized, efficient, and well
documented?
· Are clinical workflows efficient, clearly mapped out, and
understood by all staff?
· Are data collection and reporting processes well established
and documented?
In the Step 2 document, read the section “Clarify and Prioritize”
and the first two steps under “Steps in the Planning Process.”
These sections demonstrate how process review, mapping and
improvement fit with the selection of an EHR System, and are
the standard starting point for EHR implementation.
For your Stage 1 Project for the Case Study, you will select a
process used at the UMUC Family Clinic that needs to be
improved. Then, you will create a model of a current process
that defines in detail the steps in the process as they are done
today. to aid in the analysis of the problem. Then, you will
create a model of the proposed new process, as it will be
performed after an EHR system (IT solution) is implemented.
To ensure you select a process that will be related to an EHR
system implementation, refer to the “Certification Criteria” in
Content>Course Resources, particularly sections a and b.
Be sure to read the instructions for the remaining projects in
this Case Study (Stages 2-4) to get an understanding of the
future projects that build on the proposed solution and to help
you in deciding upon your process.

14. When you have chosen a process to improve, please get it
approved by your faculty member, as directed in the classroom.
Assignment
For this assignment you will identify a process in need of
improvement and develop the models.
Business Process Analysis - Models of the AS IS Process and
the TO BE Process with a brief explanation of how a technology
solution can help improve the process.
In the textbook, Chapter 21 “Fundamentals of Health Workflow
Analysis Process and Redesign”, several different methods of
modeling business processes are illustrated. You may use any
of the models shown, to analyze the process you identified for
improvement, breaking it down into sequential steps and
modeling it. You may use Microsoft Word, Excel or Power
Point.
The model format should be a workflow diagram format.
Examples of this format can be found in Chapter 21 under the
heading “Workflow Diagram Example” The process that you
model must be clearly identified in the title of your Stage 1
Project and it needs to be appropriate to the UMUC Family
Clinic.
1. First, you will provide a brief (approx. ½ page single-spaced)
explanation of why this process can benefit from improvement
using a technology solution.
2. Then you will model the process as it is currently performed
at the UMUC Family Clinic; this is the AS IS Process.
3. Then you will model the way that you expect the new process
to function after a technology solution (EHR System) is
implemented and the process is improved; this is the TO BE
Process. NOTE: We are NOT specifying the specific
technology in the TO BE Process. Identifying the specific
technology will be part of the Stage 2 assignment.
Note: A process is defined as “a series of actions that produce
something or that lead to a particular result”
(http://www.merriam-webster.com/dictionary/process). An
example would be the sign-in process at the UMUC Family

15. Clinic.
Tools for Creating the Models
The following are two URL’s that have a more detailed
description of Flow Charting and its uses:
http://www.hci.com.au/hcisite2/toolkit/flowchar.htm
http://asq.org/learn-about-quality/process-analysis-
tools/overview/flowchart.html
To create a flow chart in Word 2007 and 2010:
http://www.youtube.com/watch?v=RkN0dekcsmw
To create a flow chart or process map in Excel:
http://www.youtube.com/watch?v=9_R73RVfHl0
To create a flow chart in PowerPoint:
http://www.youtube.com/watch?v=s8erOL-3Bho
Business Process Example from another industry: If a grocery
store had a need to reduce expenses and improve customer
satisfaction, a process needing improvement might be improving
the inventory process to ensure availability of products for
customers as well as to reduce cost related to spoiled inventory.
The model would include the steps necessary to record
inventory information, update inventory when merchandise is
sold, place orders for additional inventory from suppliers, etc.
Submit your Stage 1 paper via your Assignment Folder Stage 1
as an attached document (or documents) with your last name
included in the filename(s) (LASTNAME_Stage1).
Note: Your models will be evaluated on whether they are
applicable to the process identified, all major steps in the AS-IS
and TO-BE processes are included and correctly modeled, and
they are appropriate to the UMUC Family Clinic.
Your paper will be evaluated on whether or not you correctly
incorporated the course concepts from the textbook and
addressed all parts of the questions. If you use external
resources, be sure to cite and reference them correctly in APA
format. Remember, this is an information systems management
course, and your improved process must require an information
technology solution. Use the Rubric below to be sure you have
covered all aspects.

16. GRADING RUBRIC:
Attribute
Full Points
Partial Points
No points
Possible Points
Points Earned
Business Process/
Workflow Explanation
Business process/workflow is identified and explained in terms
of how a technology solution could improve it; explanation
demonstrates understanding of course concepts, sophisticated
analysis and critical thinking.
Business process/workflow is adequately explained, or may be
lacking in terms of how a technology solution could improve it;
and/or may be lacking in demonstration of understanding of
course concepts, analysis, and/or critical thinking.
Business process/
workflow is not identified or explained.
10
Model Completeness
The models present all of the major steps in the process. Both
the AS IS and the TO BE processes are included. The
appropriate workflow diagram and shapes are used.
The models present most of the major steps in the processes
and/or only the AS IS or the TO BE process is modeled.
No models are included.
30
(15 for each model)
Organization of Steps
Steps in the processes are organized in a logical flow and

17. demonstrate sophisticated analysis and critical thinking.
Steps may not be organized in a logical flow or may be lacking
in demonstration of analysis, and/or critical thinking.
Process steps are not organized at all.
30
(15 for each model)
Model Presentation
Models are professionally presented; use a logical structure.
Models are adequate, or may not be professionally presented.
Models are extremely poorly presented and do not convey the
information.
20
(10 for each model)
Report Format
Report is professionally presented using sophisticated writing
and is effectively organized; uses correct sentence structure,
grammar, and spelling; references are appropriately
incorporated and cited using APA style.
Report is adequate or may not be well organized and
professionally presented; and/or contains grammar and/or
spelling errors; and/or does not follow APA style for references
and citations.
Report is extremely poorly written and does not convey the
information.
10
TOTAL Points
100

18. 100 points =10% of final course grade
Points Recorded
(total points x .10)
09/21/2014 IFSM 305 – Stage 1 Page | 1