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Case Study, Stage 4: IT, Legal, Ethical and RegulatoryConsiderations for Proposed EHR Technology
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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 rescheduled, 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: 

 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: 

 Analyze a clinical process and diagram the steps (Stage 1)

Analyze the data flow among a clinical practice and external organizations (Stage 2) 

Propose an appropriate certified EHR technology solution (Stage 3) 

Identify and explain the requirements and legal, 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.

 

Case Study, Stage 4: IT, Legal, Ethical and RegulatoryConsiderations for Proposed EHR Technology Solution

Before you begin this assignment, be sure you have read the “UMUC Family Clinic Case Study”, the Case Study Stages 1-3, your required readings and feedback on your graded work so far.

Purpose of this Assignment

This assignment gives you the opportunity to apply the concepts of this course to address the capabilities and requirements for the certified EHR technology solution you have proposed for the UMUCFamily Clinic.  This assignment addresses the following course outcomes to enable you to:

  • Evaluate the organizational environment in the health care industry to recognize how technology solutions enable strategic outcomes.
  • 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.

IT, Legal, Ethical and Regulatory Considerations for Proposed EHR Technology Solution 

Following your recommendation of a certified EHR system for the UMUC Family Clinic in your Stage 3 project, the owner of the UMUC Family Clinic wants to be sure he has considered everything before authorizing funding for the project.  In evaluating an IT proposal, there are several areas that need to be considered. The owner, Dr. Martin, has asked you to prepare atableaddressing the important aspects/considerations of the project. These considerations are listed in the table provided with this assignment.Considerations include such areas as IT operational, architectural, project, legal and ethical considerations.

Depending on the specific EHR technology solution you proposed, some of the considerations would be more important than others, and some will be implemented as part of the system while others will require processes and procedures to be developed. 

The responses that you enter into the table for each consideration must be aligned to the one specific EHR solution you proposed and must be appropriate to theUMUC Family Clinic.

  •  

Using the EHR technology solution you proposed in Stage 3, you should briefly explain it and then copy the table below and complete the remaining two columns.For each area of consideration, you should provide a brief description, a minimum of two sentences, and a brief explanation, a minimum of two sentences, to explain how that consideration will be accommodated in your solution. DO NOT copy the definitions from the textbook or other sources but put into your own words to demonstrate your understanding of the concept as you provide your descriptions.  Descriptions and explanations must provide enough information to convey your understanding of the consideration.  Use the Grading Rubric to be sure you have covered everything.  Submit your paper with both parts 1 and 2 below via your Assignment Folder as a Microsoft Word document, or a document that can be read using Microsoft Word.

 

Part 1: Briefly explain your proposed EHR technology solution.  Identify what the solution is, what it is expected to do for the UMUC Family Clinic, and what major hardware, software and communications components will be used, summarizing the information you provided for Stage 3.  You must provide enough information here so that it is clear that your explanations in the table that follow apply to your proposed solution.

 

Part 2:Table of Considerations.  The Areas for consideration are defined in the section “Course Resources” which follows the table of considerations below.  An example for one entry is also provided below (you cannot use the area identified in the example for your assignment).  Click on the upper left corner of the table to copy it into your paper.  Then, provide a description (like a definition, but in your own words) for each consideration and an explanation of how it will be accommodated in your proposed EHR solution; the area may be addressed by a specific capability provided with the system, by a policy/process/procedure to be developed at the UMUC Family Clinic, or by a combination of the two.  Explain how the consideration will specifically be accommodated.  NOTE:  For full credit for all descriptions and explanations, the (minimum of) two sentences must fully explain and justify your reasoning.  Roll your mouse over the top left corner of the table to select it and copy it into your assignment paper.

 

There should also be a well-written introduction to this table to tie it to Part 1 of the assignment; do not just insert a table with no explanation.

 

Table of Considerations

 

 

Area

 

Description of the Area

(minimum 2 sentences for each, a definition in your own words)

How you will address it(minimum 2 sentences for each, linked to specific EHR technology solution proposed and to the UMUC Family Clinic)

1

Authentication

 

 

2

Access Control

 

 

3

Security Policies

 

 

4

Usability

 

 

5

Reliability

 

 

6

Availability

 

 

7

Confidentiality

 

 

8

Integrity

 

 

9

System and Data Backup

 

 

10

Encryption

 

 

11

Transmission Security

 

 

12

Audit Control

 

 

13

Safety/Safe Design

 

 

14

Quality Improvement

 

 

15

Project Resources (Human, Financial)

 

 

16

Ethical Practices

 

 

17

Business Associate Contracts

 

 

18

HIPAA Privacy Rule

 

 

19

HIPAA Security Rule

 

 

20

Research and add a consideration from your knowledge of the course

 

 

 

 

For consideration #20, it is up to you to add a consideration that you feel is important, and that was not covered in the 19 considerations listed in the table.  It is expected that you may do some external research, if you can’t find an additional consideration through your course readings. This is part of the assignment and is not additional credit.

Course Resources and Example

The table below provides the sources for the definitions and explanations of the areas of consideration.  You may use other resources as well, but be sure they apply to health care information technology implementations.

 

 

 

Course Resources for Table of Considerations

 

Area

Source of Definitions/Explanations

 (located in Course Content)

1

Authentication

Week 4: Chapter 9, e-textbook 

2

Access Control

 Week 4: Chapter 9, e-textbook 

3

Security Policies

 Week 4: Chapter 9, e-textbook 

4

Usability

 Week 5:  System Quality Attributes

5

Reliability

 Week 5:  System Quality Attributes 

6

Availability

Week 4: Chapter 9, e-textbook 

7

Confidentiality

 Week 4: Chapter 9, e-textbook 

8

Integrity

 Week 4: Chapter 9, e-textbook 

9

System and Data Backup

 Week 4: Chapter 9, e-textbook 

10

Encryption

 Week 4: Chapter 9, e-textbook 

11

Transmission Security

 Week 4: "System Security Procedures and Standards," lecture b 

12

Audit Control

 Week 4: "System Security Procedures and Standards," lecture b 

13

Safety/Safe Design

 Week 2:  "Principles of Quality and Safety for HIT," lecture b 

14

Quality Improvement

 Week 2:  "Introduction to Quality Improvement and HIT," lecture b 

15

Project Resources (Human, Financial)

 Week 7: Solution Building Module:  Project Management 

 

16

Ethical Practices

 Week 4: "Ethics and Professionalism," lecture d 

 

17

Business Associate Contracts

Week 4: "Privacy, Confidentiality & Security," lecture c 

 

18

HIPAA Privacy Rule

Week 4: "System Security Procedures and Standards," lecture a 

 

19

HIPAA Security Rule

Week 4: "System Security Procedures and Standards," lecture a

20

Research and add a consideration from your knowledge of the course

 

 

 

 

 

 

 

Example from another industry:For example, for a fitness center that is adopting a new technology solution involving a kiosk for customers to use to pay for their membership at the gym, then for the Area of Accessibility, the following might be entered.  Note the thorough explanation. You CAN NOT use this area for your “Additional Consideration” area in the assignment.

 

Area

Description of Area

Explanation

Accessibility

 

Accessibility is the degree to which a product, device, service, or environment is available to as many people as possible. This includes accessibility to people with various impairments such as: cognitive, visual, hearing and /or dexterity issues.

Since the customers will use the kiosk to pay their membership fees, it must be accessible to everyone, including those with some disabilities.  The system provides audio instructions and other tools for people with disabilities.  As part of the implementation, these capabilities will be tested and front desk personnel will be trained to assist customers if needed.

The "right" and "wrong" answers have to do with whether or not you correctly defined each consideration as it relates to your proposed EHR technology solution and have provided a well-supported explanation for how it will be accommodated.  Your responses will be evaluated on whether they are applicable to the solution, appropriately defined, adequately explained, and are appropriate to the UMUC Family Clinic.  Use the Rubric below to be sure you have covered all aspects.

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

 

 

 

 

 

 

Explanation of Proposed Solution

9-10 Points

 

Explanation uses course vocabulary and concepts to clearly identify what the IT solution is, what it is expected to do for the organization in the case study, and what the major components are; and it sets the stage well for the table.  A well-written introduction to the Table of Considerations is provided. 

8 Points

 

Explanation uses course vocabulary and concepts to clearly identify what the IT solution is, what it is to do for the Clinic and what the major components are; and it appropriately sets the stage for the table.  A good introduction to the Table of Considerations is provided.

7 Points

 

Explanation describes the IT solution, what it is, what it is to do, and what major components are needed; an introduction to the Table of Considerations is provided.

6 Points

 

Explanation of solution does not clearly explain what it is expected to do for the Clinic, does not provide the major components needed, or is not adequate to set stage for the table; and/or introduction to Table of Considerations is missing.

0-5 Points

 

No explanation provided, or very poor explanation of proposed solution provided; and/or little effort demonstrated

10

 

Descriptions

36-40 Points

 

Descriptions are at least two good sentences and all demonstrate a strong understanding of course concepts, analysis and critical thinking.

32-35 Points

 

Descriptions are at least two good sentences and most demonstrate an understanding of course concepts, analysis and critical thinking.

28-31 Points

 

Descriptions are at least two sentences and demonstrate a basic understanding of course concepts or analysis. 

24-27 Points

 

Some descriptions are less than two sentences, and/or may be somewhat incomplete or inaccurate.

0-23 Points

 

Few, if any descriptions are provided, or many descriptions are incomplete or inaccurate.

40

 

 

 

 

 

 

 

Explanation of how consideration will be accommodated

36-40 Points

 

Explanations are at least two good sentences each and use course vocabulary to demonstrate a strong understanding of course concepts, analysis, and critical thinking; and are clearly focused on the case study and the proposed EHR solution.  Additional consideration (#20) is highly appropriate to the case study and the EHR solution.

32-35 Points

 

Explanations are at least two good sentences each and use course vocabulary to demonstrate an understanding of course concepts, analysis, and critical thinking; and are focused on the case study and the proposed EHR solution.  Additional consideration (#20) is appropriate to the case study and the EHR solution.

28-31 Points

 

Explanations are at least two sentences that explain how the consideration will be accommo-dated and are relevant to the case study and proposed EHR solution.  Additional consideration (#20) is appropriate to the case study and the EHR solution.

24-27 Points

 

Some explanations are less than two sentences, and/or do not provide adequate explanations; may be lacking in the use of course vocabulary; or are not focused on the case study and/or the proposed EHR solution.Additional consideration (#20) may not be appropriate to the case study and the EHR solution.

0-23 Points

 

Few, if any explanations are provided, and/or are not complete; or little effort demonstrated.

40

 

 

 

 

 

 

Report Format

9-10 Points

 

Information is professionally presented; and uses course vocabulary, correct sentence structure, grammar, and spelling.

8 Points

 

Information is presented well; uses correct sentence structure, and has few grammar, and spelling errors.

7 Points

 

Information is presented with some grammar and/or spelling errors.  

6 Points

 

Information is not professionally presented, and/or contains several grammar and/or spelling errors.

 

0-5 Points

 

Information is extremely poorly written; has many grammar and/or spelling errors; and/or does not convey the information adequately.

10

 

 

 

 

 

TOTAL Points Possible

100

 

 

 

Available solutions