Midtown Family Clinic Case Study: In 1990 Dr. Harold Thompso ✓ Solved

Midtown Family Clinic Case Study: In 1990 Dr. Harold Thompson open

Midtown Family Clinic Case Study: In 1990 Dr. Harold Thompson opened the Midtown Family Clinic, a small internal medicine practice in a growing residential area. He is the owner and manager and employs two registered nurses, Vivian Halliday and Maria Costa. One nurse handles front-desk administrative duties (phones, scheduling, prescription refills, billing, faxing) while the other assists the doctor; duties rotate daily. The clinic has three exam rooms, a single PC with stand-alone scheduling software and Internet access, and otherwise operates paper-based medical records and paperwork. Billing is outsourced to a third-party billing company accessed via the billing company's web login. Patients experience long waits (often an hour); check-in and phone scheduling are slow; patients complete full paper registration forms annually; lab results and records are paper and are often lost or difficult to share for referrals. Dr. Thompson learned about Electronic Health Records (EHR) and wants to implement an affordable certified EHR to improve efficiency, patient care, safety, and financial management while meeting legal and regulatory requirements. He has hired an independent, vendor-neutral EHR consultant and seeks a process-driven approach: analyze current patient-visit workflows, optimize processes with staff involvement, and recommend a certified EHR system that fits the optimized processes and budget constraints. Your task as the professional medical consultant is to: 1) Analyze the process that occurs during a patient visit to the practice. 2) Propose workflow improvements to increase efficiency and reduce waiting times without adding staff. 3) Identify critical functional requirements and constraints (including interoperability, billing integration, data migration, security, staff training, and cost). 4) Recommend a certified EHR solution (with rationale) suitable for Midtown Family Clinic.

Paper For Above Instructions

Executive summary

Midtown Family Clinic is a small, three-exam-room, paper-based internal medicine practice with one PC used for scheduling and outsourced billing. Long patient waits, slow phone scheduling, lost lab results, and inefficient paper workflows compromise care and revenue. This report maps the current patient-visit process, recommends workflow optimizations that avoid additional hires, specifies critical functional and technical requirements, and proposes an affordable, ONC-certified cloud ambulatory EHR tailored to small practices (ONC, 2019; AHRQ, 2017).

Current-state process: patient visit

Typical flow: patient calls to schedule or walks in → front-desk nurse checks paper schedule and patient folders → patient completes or verifies annual paper registration → triage/rooming by nurse → physician visit using paper chart → orders placed on paper (labs, imaging, prescriptions) → lab results arrive on paper and are filed → coding/billing documentation faxed to third-party biller at day’s end. Phone traffic and manual registration create bottlenecks at check-in and scheduling; single front-desk workstation and rotating duties exacerbate delays (Buntin et al., 2011).

Key process improvement recommendations (no new hires)

• Digital pre-registration and online scheduling: allow patients to verify/update demographics and insurance via a secure patient portal or secure web form prior to visit; implement online appointment booking with automated confirmations and reminders to reduce phone load (AHRQ, 2017).
• Self check-in kiosk or tablet intake: install one tablet or kiosk for tablet-based check-in that uploads demographics and reason for visit directly into the EHR; this frees the front-desk nurse for phone triage when needed (HIMSS, 2018).
• Standardized rooming templates and standing orders: create EHR-driven rooming checklists and triage templates so the assisting nurse captures vitals, medication lists, and reason for visit consistently and efficiently (DesRoches et al., 2013).
• Phased document scanning and retention policy: scan active charts into EHR over a staged period (e.g., prior 12 months first) and implement a retention/indexing protocol to reduce paper retrieval time and loss risk (AHRQ, 2017).
• Automate billing workflow: integrate EHR with the third-party billing service or adopt an EHR with built-in billing module to remove manual fax routines and speed claims submission and denial management (CMS, 2020).
• Leverage e-prescribing and lab interfaces: use e-prescribing to cut pharmacy calls and establish HL7/CLEF or CCD lab interfaces to receive results directly into patient charts (ONC, 2019).

Functional requirements and constraints

Critical functional requirements: ONC-certified ambulatory EHR with e-prescribing (eRx), patient portal, online scheduling, visit and rooming templates, structured problem/medication lists, CCD/CCDA exchange, lab and pharmacy interfaces, reporting tools for quality measures, and optional integrated billing or robust billing interface (ONC, 2019; CMS, 2020). Technical constraints: limited local IT expertise, a single PC currently used, limited capital for upfront purchase, and need for cloud-hosted SaaS to minimize local infrastructure and maintenance (HIMSS, 2018).

Security, compliance, and data migration

Solutions must meet HIPAA privacy and security requirements and include encryption at rest/in transit, role-based access, audit logs, and a breach response plan. Data migration plan: index and scan active paper charts first, convert appointment and demographic data from the scheduling system, and perform a phased validation. Maintain legacy paper access during the transition. Vendor must provide Business Associate Agreement (BAA) and support for Meaningful Use/Promoting Interoperability attestation where applicable (ONC, 2019; CMS, 2020).

EHR recommendation and rationale

Recommendation: adopt an ONC-certified, cloud-based ambulatory EHR tailored to small practices that offers integrated online scheduling, patient portal with pre-registration, e-prescribing, lab interfaces, and either built-in billing or a strong API to the current billing partner. Examples include commercially proven ambulatory vendors with small-practice pricing and SaaS delivery (e.g., Athenahealth, eClinicalWorks, or other ONC-certified ambulatory systems). A cloud SaaS reduces capital expenditure, provides vendor-managed security/backups, and simplifies updates (HIMSS, 2018; Buntin et al., 2011).

Rationale: cloud ambulatory systems are typically subscription-based (OPEX model) with predictable monthly costs that align with Midtown’s limited capital. Integrated scheduling and portal functions will reduce phone volume and wait times; built-in templates and e-prescribing improve encounter efficiency; lab interfaces and CCD exchange will eliminate paper test filing and ease referrals (Adler-Milstein & Jha, 2017).

Implementation roadmap and training

1. Phase 1 (0–2 months): stakeholder meetings, workflow mapping with staff, select vendor and sign contract with clear deliverables and BAA.
2. Phase 2 (2–4 months): configure EHR with rooming templates, scheduling, patient portal, and billing interface; scan most recent 12 months of charts; set up lab and eRx interfaces.
3. Phase 3 (4–6 months): pilot with a subset of patients, teach staff “super users,” refine templates, and launch patient portal for pre-registration and appointment confirmations.
4. Phase 4 (6–12 months): full implementation, ongoing training, optimization of billing workflows, monitor KPIs (wait times, throughput, denial rate, collections).

Training: vendor-led on-site and remote sessions plus “just-in-time” tip sheets. Engage staff early to secure buy-in and identify a local “super-user” to lead day-to-day support (HIMSS, 2018).

Expected benefits and ROI

Benefits include reduced average wait times via pre-registration and online scheduling, fewer phone calls, faster claims submission and improved cash flow, decreased lost lab results and improved referral coordination, and improved quality reporting capability. ROI is typically realized through reduced administrative time, lower billing denials, increased visit throughput, and potential incentive payments for interoperability or quality programs (Buntin et al., 2011; CMS, 2020).

Conclusion

Midtown Family Clinic can substantially improve efficiency, patient experience, and financial performance without adding staff by optimizing workflows and adopting an ONC-certified, cloud ambulatory EHR that supports online scheduling, patient self-registration, e-prescribing, lab interfaces, and billing integration. A phased, staff-inclusive implementation with a strong vendor BAA and training program will minimize disruption and deliver measurable gains in throughput and quality.

References

• Office of the National Coordinator for Health Information Technology (ONC). (2019). Certification Programs for Health IT. https://www.healthit.gov
• Centers for Medicare & Medicaid Services (CMS). (2020). Promoting Interoperability Programs. https://www.cms.gov
• Agency for Healthcare Research and Quality (AHRQ). (2017). Health IT Playbook: Patient Flow and Care Coordination. https://www.ahrq.gov
• Health Information and Management Systems Society (HIMSS). (2018). EHR Implementation Guide for Ambulatory Practices. https://www.himss.org
• Buntin, M. B., Burke, M. F., Hoaglin, M. C., & Blumenthal, D. (2011). The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results. Health Affairs, 30(3), 464–471.
• Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act Drove Large Gains In Hospital Electronic Health Record Adoption. Health Affairs, 36(8), 1416–1424.
• DesRoches, C. M., et al. (2013). Electronic Health Records' Effects on Practice Efficiency and Quality in Ambulatory Settings. Journal of the American Medical Association (JAMA).
• Athenahealth. (2019). Ambulatory EHR and Practice Management for Small Practices. https://www.athenahealth.com
• eClinicalWorks. (2020). Cloud-based EHR for Ambulatory Practices. https://www.eclinicalworks.com
• McGlynn, E. A., et al. (2018). Implementing EHRs in Small Practices: Lessons Learned and Best Practices. BMC Medical Informatics and Decision Making, 18(1), 123.