Medical Quality Management: - Case Study Example

Medical Quality Management: UMUC Family Clinic The need to stay in touch with all major technological innovations along with maintaining a healthy society has always been one of the crucial subjects of concern all around globe. To be precise, health care stakeholders have been doing their best to ensure that they adopt the necessary technological practices promote delivery high quality Medicare services (Rodrigues, 2010). Among the most recent health care innovations is the use of a Electronic Health Records System (EHR) to aid in promoting efficiency, accuracy and faster provision of health care services to patients. To ensure that a certain technology is well implemented in a particular health care centre, it is crucial that a strategized approach is followed. This paper therefore focuses on the subject of adoption of an Electronic Health Records System via an account of the UMUC Family Clinic. Case Study Stage 1, Process Analysis is clearly a very crucial step in the justifying the need to implement the targeted EHR system. In fact, in the current constantly advancing technological world, the subject of adoption of an Electronic Health Records System has come out as one of those technological innovations that can hugely enhance the quality of Medicare services. In this sense, this paper has first laid major emphasis on application of analytical concepts in the ambulatory setting of a health care to aid in the selection and implementation of an Electronic Health Records System for the UMUC Family Clinic (Skolnik, 2011). In simple terms, an Electronic Health Records (EHR) System entails a well-configured set of computer software components that are integrated to provide a quality platform for processing and storage of a hospital’s data. The EHR provides a significant number of benefits to the day-to-day operations of a health care centre. These benefits include faster processing of Medicare services such as booking appointments with a doctor. The system further makes it easy to search for a patient’s data, along with better storage of hospital data. This plays a huge role in enhancing efficiency, accuracy and effectiveness in the daily operations of a Health care centre. In essence, the Electronic Health Records System is a very important technological innovation in the delivery of high quality Medicare Services (Rocker & Ziefle, 2012). In this sense, the need to implement an Electronic Health Records System for UMUC Family Clinic is driven by the fact that it will aid in delivery of better services than what is currently experienced by the patients and practitioners at large. There is a great need for immediate changes in the operations of the hospital mainly to promote the Medicare service provision (Rodrigues, 2010). As-IS Patient Front Desk Nurse Doctor Assist (Nurse 2) Doctor Medical Billing Company Among the challenging issues in the care centre is that there is a lot of overhead for the doctor and the other two practitioners. This has resulted in an ever-increasing patient waiting time as one waits to be attended to. This has further led to the need to optimize the admin and clinical operations at the centre (Compton, et. Al, 2005). As indicated in the As-IS diagram, the major processes at the centre include scheduling of appointments upon a patient’s request for services at the centre. It is important to note that currently, the hospital benefits from an appointment scheduling software, which plays a significant role in simplifying the process of arranging the times that different patients have to meet the Dr Martin. In some cases, patient can call the nurse to request for scheduling. In this scenario, when the number of calls are many, it means a patient has to make long waits before attending to. Thus, some of the patients end up being discouraged or annoyed by the quality of services at the centre (McCormick & Gugerty, 2013). Apart from the above software-based (process) operation, almost all the other processes at the UMUC Family Clinic are paper based. This includes the medical records filling at the front desk where a patient’s medical data is captured and stored in a paper format by the appointed nurse. That is, all the medical records about the centre’s patients is always recorded in a paper thus leading to a lot of time wastage. Additionally, the paper based medical records process is highly hectic and tiresome as one tries to search for a previously stored record. In general, it hinders efficiency, effectiveness and accuracy in the delivery of high quality health care services. The hospital also maintains a paper-based patient check-in process, which has proved to be a significant challenge on the goal of delivering high quality Medicare services. In this process, a nurse can be on phone while a patient is eagerly waiting to be checked in. This means, patient has to wait until the nurse is through with the current phone conversation before attending a patient’s request. Most the moms end up highly annoyed as they have to fill their information in a paper while taking care of their sick children (Scarlat, 2012). Lastly but certainly not the least, there is the process of medical billing both for the services and for the insurance cover. Here, the front office nurse has to fax the needed data to a third party medical billing company. The company then submits the data to an insurance company before billing the company. To check a particular patient’s bill a nurse at the UMUC Family clinic has to login into the medical billing company to access the details. This wastes a lot of precious time that the nurse could use in provision of better services. It also exposes most of the clinic’s business operational secrets to a third party thus acting as a threat to its competitiveness in the global health care industry. In fact, since the medical billing company has to be reimbursed, it ends up a lot of money being paid to a third yet it could internally utilized and aid in increasing the centre’s profit values (Rocker & Ziefle, 2012). It is vital to note that upon a thorough analysis of the current processes at the Medicare centre, it became clear that there is a great for implementation of an Electronic Health Records System (Skolnik, 2011). To be specific, the EHR is aimed at simplifying the billing process at the clinic. The following diagrams provide a clear description of the current medical records system used for billing of patients, along with the targeted one upon implementation of the Electronic Medical Records System. In essence, for the sake of promoting the business goal of the health care centre, the stage of this case study has focused on integration of the medical billing process with respective patient data at the health care centre. This is as indicated in the To-Be diagram below. Patient Nurse/Technician Doctor Integrated Billing Module As indicated in the To-Be diagram above, the processes involved in the targeted EHR system has been simplified and involves a lot of automatic implementation of activities. When the patient arrives at the health care centre, the check in process is done electronically. This process is much faster and saves of a lot of patient and practitioner time. If lab test is required the nurse provides an automatic notification, which upon its completion an integrated billing component captures the details. The billing component is designed with variables that aid in automatic determination of the cost of each lab process (Scarlat, 2012). All the patient information is then documented and a notification is automatically sent to the doctor, along with the details. The doctor performs examination, orders for medication, injection and all requirements, which are automatically captured by the billing component and integrated with the initial lab costs (“American College of Medical Quality”, 2010). Based on the insurance policy variables, the billing system generate a patient’s bill and automatically sends a confirmation to both the doctor and the nurse. The patient is then released from the hospital upon completion of bill payment (Saba, McCormick & Abbott, 2005). The targeted EHR system clearly provides a better platform for conduction of Medicare operations. Most importantly, the integration of a billing module in the enhanced EHR provides an efficient medical records system, which is fast enough and paves ways for significant profit making necessary for promoting the standards of health care services at the UMUC Family clinic (McCormick & Gugerty, 2013). References American College of Medical Quality. (2010). Medical quality management: Theory and practice. Sudbury, Mass: Jones and Bartlett Publishers Compton, W. D., Fanjiang, G., Grossman, J. H., Reid, P. P., Institute of Medicine (U.S.), & National Academy of Engineering. (2005). Building a better delivery system: A new engineering/health care partnership. Washington, D.C: National Academies Press. McCormick, A & Gugerty, B. (2013). Healthcare Information Technology exam guide for CompTIA Healthcare IT Technician and HIT Pro certifications. New York: McGraw-Hill. Rocker, C & Ziefle, M. (2012). E-health, assistive technologies and applications for assisted living: Challenges and solutions. Hershey PA: Medical Information Science Reference. Rodrigues, J. (2010). Health information systems: Concepts, methodologies, tools and applications. Hershey PA: Medical Information Science Reference. Saba, K, McCormick, A & Abbott, A (2005). Essentials of nursing informatics. New York: Mc-Graw Hill. Scarlat, A. (2012). Electronic health record: A systems analysis of the medications domain. Boca Raton: Taylor & Francis. Skolnik, N. S. (2011). Electronic medical records: A practical guide for primary care. New York: Humana. Read More