Case Study, Stage 2 Data Flow Among Health Care Systems Before .docx

Case Study, Stage 2: Data Flow Among Health Care Systems
Before you begin this assignment, be sure you have read the
“UMUC Family Clinic Case Study”, the course readings
assigned to date, and feedback on your graded Stage 1
assignment.
Purpose of this Assignment
This assignment specifically addresses the following course
outcomes to enable you to:
· Analyze the flow of data and information among disparate
health information systems to support internal and external
business processes
· Examine the implications of ethical, legal, and regulatory
policy issues on health care information systems
UMUC Family Clinic Medical Practice
In your Stage 1 assignment, you created process models for the
patient visit process in the UMUC Family Clinic. For the Stage
3 assignment, you will identify an Electronic Health Records
System that will address the process problems at the Clinic.
The EHR system you identify will initially be implemented at
the UMUC Family Clinic, but will soon need to be able to
connect and communicate with external systems. As part of
analyzing the requirements for the new system, one step is to
consider how that system will enable the UMUC 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 UMUC Family Clinic and those organizations and
how that can be done effectively.
Assignment
1. Review the UMUC Family Clinic Case Study and identify

two types of external organizations (e.g., hospitals, nursing
homes, rehabilitation centers, laboratories, pharmacies, etc.)
with which the UMUC Family Clinic needs to communicate and
the purpose of the communication.
2. Make a list of at least five data elements or items of
information that would be shared with each external
organization, and explain whether that information is going out
from the UMUC Family Clinic or coming in from each of the
two external organizations. Note: More than five data elements
are required to earn full points.
3. Conduct some external research and find at least one data
interchange standard that would apply to the data that is
exchanged with each organization. Provide a brief description
of what the standard is, what it requires, and why it is
important. (There are some specific data interchange standards
that apply to health data exchange; if the same standard applies
to the data exchange with both organizations, explain how it
relates to each.)
4. Research, list and discuss three legal, regulatory, or ethical
considerations that would relate to this data exchange and
explain what needs to be done to ensure compliance with each.
You must include at least one legal/regulatory consideration and
at least one ethical consideration.
Formatting
For academic writing, the writer is expected to write in the third
person. In third person, the writer avoids the pronouns I, we,
my, our, you and your. 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.
· Your paper should be about two pages, single spaced.
· You should include at least oneexternal source. These are

sources other than those provided in the classroom. Sources
should be scholarly or professional in nature, rather than
random websites. NOTE: More than one external source is
required to earn full points.
· Add a title page, and a reference page.
· Use APA formatted citations and references for all external
sources used.
· Compare your final work to the rubric to be sure you have met
content and quality criteria.
· Submit your paper via your Assignment folder as a Word
document, or a document that can be read in Word.
Your paper will be evaluated on whether or not you correctly
incorporated the course concepts from the textbook and
readings, and have addressed all parts of the assignment, using
the rubric below.
GRADING RUBRIC:Criteria
90-100%
Far Above Standards
80-89%
Above Standards
70-79%
Meets Standards
60-69%
Below Standards
< 60%
Well Below Standards
Possible Points
Communication with External Organizations

9-10 Points
The two external organizations identified and the explanation of
the communication between them and the UMUC Family Clinic
are clearly appropriate and explained in detail using course
vocabulary; demonstrates understanding of course concepts,
analysis, and/or critical thinking.
8 Points
The two external organizations identified and the explanation of
are appropriate and well explained using course vocabulary;
demonstrates understanding of course concepts and critical
thinking.
7 Points
Two external organizations are identified and an explanation of
is provided.
6 Points
Two external organizations are not identified, or are incorrect;
and/or explanation of the communication between them and the
UMUC Family Clinic may lack demonstration of understanding
of course concepts, analysis, and/or critical thinking.
0-5 Points
Identification of external organizations and/or explanation of
communication is incomplete or inadequate.
10
Data and Data Flow
27-30 Points
More than 5 data elements are correctly identified for each of
the two external organizations; the direction of the data flow is

appropriate to the case study; strongly demonstrates
understanding of course concepts, analysis, and critical
thinking.
24-26 Points
At least 5 data elements are correctly identified for each of the
two external organizations; the direction of the data flow is
appropriate to the case study; demonstrates understanding of
course concepts, analysis, and critical thinking.
21-23 Points
At least 5 data elements are identified for each of the two
external organizations; direction of the flow of data is
appropriate to the case study.
18-20 Points
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.
0-17 Points
Data elements and flows are not presented or are not
appropriate to the case study, or are otherwise inadequate.
30
Data Interchange Standards
18-20 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.

16-17 Points
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.
14-15 Points
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.
12-13 Points
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.
0-11 Points
Data interchange standard is not identified, or explanation is
severely lacking.
20
Legal, Regulatory, and Ethical Considerations
18-20 Points
Three legal, regulatory, or ethical considerations that would
relate to the identified data exchanges are identified, with a
convincing explanation of what needs to be done to ensure
compliance with each; both legal/regulatory and ethical
considerations are included; demonstrates understanding of
course concepts, sophisticated analysis, and critical thinking.
16-17 Points
relate to the identified data exchanges are identified, with a
good explanation of what needs to be done to ensure compliance
with each; both legal/regulatory and ethical considerations are
included; demonstrates understanding of course concepts,

analysis, and critical thinking.
14-15 Points
relate to the identified data exchanges are identified, with an
explanation of what needs to be done to ensure compliance with
each is provided using course vocabulary and concepts; both
legal/regulatory and ethical considerations are included.
12-13 Points
Fewer than three legal, regulatory, or ethical considerations are
listed; they may not relate to the identified data exchanges;
explanations may be incomplete; and/or may not address both
legal/regulatory and ethical considerations; may be lacking in
demonstration of understanding of course concepts, analysis,
and/or critical thinking.
0-11 Points
List and explanation of legal, regulatory, or ethical
considerations may be very incomplete or missing.
20
External Research
9-10 Points
More than one source other than the course material is
incorporated and used effectively. Sources used are relevant and
timely. References are appropriately incorporated and cited
using APA style.
8 Points
At least one source other than the course material is
incorporated and used effectively. Source(s) used are relevant
and timely. References are appropriately incorporated and cited
using APA style.
7 Points
At least one source other than the course material is
incorporated correctly. Reference is cited using APA style.
6 Points
A source other than the course material may be used, but is not

properly incorporated or used; and/or is not effective or
appropriate; and/or is not relevant or timely; and/or does not
follow APA style for references and citations.
0-5 Points
No external research is incorporated or reference listed is not
cited within text.
10
Report Format
9-10 Points
Report is very well organized and is easy to read. Very few or
no errors; demonstrates correct sentence structure, grammar,
and spelling; written in third person and presented in a
professional format.
8 Points
Report reflects effective organization; may have a few errors in
sentence structure, grammar, and spelling; written in third
person and presented in a professional format.
7 Points
Report is organized and may have some errors in sentence
structure, grammar and spelling. Report is written in third
person.
6 Points
Report is not well organized, and/or contains several grammar
and/or spelling errors; and/or report is not written in third
person.
0-5 Points
Report is extremely poorly written; and/or contains many
grammar and/or spelling errors; and/or does not convey the
information.
10
TOTAL Points
Possible
100

11/27/2016 IFSM 305 – Stage 2 Page | 1
11/29/2015 IFSM 305 – Case Study 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
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
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. Martin
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. Martin has to optimize his administrative 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 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 1980.
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 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 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 and take 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. Martin, 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. But the clinic also accepts
walk-in patients.
At a recent medical conference Dr. Martin 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. Martin 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. 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 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. Martin has
contracted with an independent EHR
consultant, who is not associated with 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 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. Martin 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 UMUC 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. Martin 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 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.
STAGED ASSIGNMENTS
The case study and assignments address the Course Outcomes to

enable you to:
uate the organizational environment in the health care
industry to recognize how technology
solutions enable strategic outcomes
health information systems to support
internal and external business processes
improve the quality of care, safety,
and financial management decisions
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:
inical process and diagram the steps (Stage 1)
organizations (Stage 2)

(Stage 3)
l, ethical and
regulatory considerations for a
system (Stage 4)
The staged assignments are designed to follow the relevant
chapters of the textbook and other readings
in the course content, and are due on the dates as assigned in
the class schedule. 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
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. It is the
student's responsibility to ensure the
assignment submission can be read using the specified file
format.
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
create the information being requested.

Running head: NURSING CASE STUDY
1
NURSING CASE STUDY
2
77% is being posted. Please review comments/feedback below;
scoring details can be found on the grading rubric. Thank you.
Nursing Case Study
UMUC
April 2, 2017
The Objectives of Dr. Martin
Dr. Martin has several goals in the case study. First, he
wants his medical process to function more competently than

ever before. He also wants to earn more benefits from the
medical practice. He also thrives on improving the medical
practice by the use of the EHR system. He believes that the
system will enable him to keep better health records and correct
issuing of bills. The system will also facilitate the billing of
medical insurance companies. This will ease the operations of
the medical practice there will not be the need to employ a
billing company. As such, Dr. Martin will have saved the
amount that he could have used to pay the billing company,
thereby increasing the profits of his business.
Dr. Martin also has a strategic goal of re-investing in the clinic
to upgrade the technology in the clinic. Once he has achieved
the goal of making more profits, he intends to use these
proceeds to improve his clinic through the integration of
technology. The Electronic Health Record (EHR) system will
augment the operations and improve the incomes of the patients
in his clinic. He wishes to get more patients through this system
and as such, make more profits. He is so determined in making
the profits to reinvest in the infrastructure of his clinic.
Comment by Gabrielle L. Gretch: I’m not sure how an
EHR will improve his patients’ incomes. I don’t think this is
relevant to increasing his profits.
Another important goal is performing the basic renovation of
his clinic. The doctor claims that the waiting and the
examination area are old and need to be revamped. He also aims
at expanding his clinic to accommodate three physicians and
rent out the extra space to pharmacist and therapist so as to
increase his profits. Dr. Martin can achieve this goal by using
the profits he will make from the EHR system. Since more
patients will be frequenting his clinic, he will have a greater
opportunity to rent out some rooms for pharmacy. The patients
would, therefore, buy their medicines from the pharmacy.
Comment by Gabrielle L. Gretch: Delete this word.
Comment by Gabrielle L. Gretch: Delete this word.
Finally, the doctor wishes to increase the quality of care in his
clinic. Apart from the quality care, he seeks to improve the

safety measures in the hospital as well as the financial
management decisions. He eyes the patient care efficiencies and
saving costs as the primary drives to achieve his goals.
Comment by Gabrielle L. Gretch: This doesn’t discuss
anything on how the implementation of the EHR would help
meet this objective.
The patient visit workflow from the time he/she arrives at the
clinic until the time he/she leaves
Patient enters the clinic
pa
Patient checks in at the reception
Reserving for appointment
Pull paper chart
appt
Does pt. info need an update?
Billing company sends back the billing details
Patient out
Make flow sheet to indicate the patient is ready for diagnosis
The insurance details forwarded to billing company

Collection of insurance card
Reception of the lab outcomes from the lab specialist
The patient gets treatment form the doctor
Transfer of results to
physician
The inefficiencies of the Workflow
Scheduling- During the booking of appointments, there is
a probability of the patient can be linked to the wrong doctor
due to the issues of inaccuracy, certain physician based entries,
and the use of manual appointments. Furthermore, the process is
time-consuming, and the patient could wait for longer hours
before he/ she gets the feedback. Similarly, suppose the patient
forgets the date of appointment, the secretary would spend more
time flipping through the file records to get the appointment for
cancellation.
Similarly, since the patient will need to repeat the whole
process of rebooking, the hospital clerk will also need to repeat
the process of rescheduling. This is a waste of time and
resources and interruption of the functionality of the operations
in the clinic as the other appointments will have to be adjusted.
Likewise, it could lead to loss of valuable information since the
clerk has to maintain all the copies of the arrangements.
Comment by Gabrielle L. Gretch: Good discussion of the
inefficiencies with the current process. Some steps are missing,
others are out of order. Please review scoring rubric for
comments.
Validation of the insurance card is another major problem.
There are many different insurance companies, and the billing

company requires a protocol that is time-consuming and
complicated. First, the hospital has to send a copy of the
insurance coverage information to the billing company for
validation. After validation, the hospital has to send the
information again for the process to go through. This method is
susceptible to faults and is also time-consuming and leads to
confusion as well.
The workers of the clinic and the doctors have to spend extra
time when dealing with the billing company. Likewise, after the
examination of the patient, the billing company has to verify the
payments and update their systems then sends back the billing
inventory to the hospital. This can cause confusion between the
two organizations. Similarly, it affects the patient as he/ she has
to wait for all these processes regardless of his/her condition.
Finally, during the prescription, the pharmacist still have to go
back to the lab technicians for clarifications. This will interrupt
the physician and hence waste a lot of time for the doctor, and
the patient.
Patient visit procedure for Dr. Martin’s clinic with the
implementation of EHR system Technology
Nurse: medical history
Medical hbhhhistory
Physician
Soap notes
Patient’s Portal

Booking and Scheduling Appointment
Registration of Patient
Patient in
Lab
Technician
Billing at the
Front Office
Billing
Patient out
Pharmacist
Prescriptionorder
The Importance of the EHR Workflow in Eliminating the
Efficiencies
The workflow with the implementation of EHR will
begin with the registration of patients at the front office. This
personnel will register the patients as soon as they enter the
hospital or they make reservations over the phone or online. The
patients will be given a free portal to indicate that they are
members of the clinic and to ease work during their next visit.
The workers of the hospital will just be checking through the
portal of the patient.

The system will also allow a check-in an application
that enables the patient to develop their personal profile and
medical history. The medical history will include past illnesses
if appropriate, prior treatments and the current diseases. The
information will be helpful, and thus it will be displayed in the
patient's chart for the physician to access it and for the
consultation process. The physician will also be able to make
informed decisions linking the current diagnosis to the previous
illnesses. Similarly, the process of checking in will be much
easier as the physicians, nurses and the lab technicians will just
test the patient's chart flow in their portal to carry out their
roles. Comment by Gabrielle L. Gretch: Good discussion of
the improved process. Please review scoring rubric for missing
steps, other comments.
Finally, the EHR system will be more efficient in the
billing process as a billing company will not be necessary. The
insurance company will get the bills much easily with the
implementation of the system. The invoices and claims will be
appropriate and prompt. There will not be wastage of time for
verification from the billing company. As such, the clinic will
be able to serve more patients in less time and provide them the
best care.
References
Case study. UMUC Family Clinic.
Charles, K., Willis, W. K., & Coustasse, A. (2014). Does
Computerized Physician Order Entry Reduce Medical Errors?.
Flores, C. (2016). Upgrading EHR System for Local Clinic
(Doctoral dissertation, The College of St. Scholastica).
Meeks, D. W.,Taylor, L.,(2014). An analysis of electronic
health record-related patient safety concerns. Journal of the
American Medical Informatics Association.
Nguyen, L., Bellucci, E., & Nguyen, L. T. (2014). Electronic
health records implementation: an evaluation of information
system impact and contingency factors. International journal of

medical informatics, 83(11), 779-796.

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