Case Study: James Healthcare Centre (JHC) James Healthcare Centre (JHC) offers a holistic approach to health care with an emphasis on preventive medicine and traditional medical care. JHC has grown and now includes ten GP, six nurse practitioners, eight physical therapists, three registered nutritionists, nine nurses, and eleven support staff people. The JHC currently has a patient base of 12,000 patients from 450 different employers, many of which provide insurance coverage for employee wellness and health maintenance. Currently, JHC accepts insurance plans from 35 licensed health insurance providers. JHC is also considering opening another location with modern medical facilities. Doctor James (owner) recently decided that the practice needs a modern information system to support its business and health information management needs. The new system would replace a mix of paper-based and legacy systems. Dr James asked you to design an information system that could support the JHCâ€™s current operations and future growth. In your first meeting, Dr. James provided an overview of the centreâ€™s business processes and staff members. He told you that Emily Cox, who has been with JHC since its inception, is the office manager. She supervises the support staff of seven people. Jack Carpenter handles human resources and employee benefits. Amanda Brown reports directly to Jack and works with payroll, tax reporting, and profit distribution among the associates. Angela Harrison is responsible for the maintenance of patient medical records. Jayden Greig handles accounts receivables and Riley Jeff is the insurance billing specialist. Lee Sue is responsible for managing appointments. Her duties include reminder calls to patients and preparing daily appointment lists. Carl Hunter is concerned primarily with ordering and organizing office and medical supplies. You will explore the possibility of a business support system for the scheduling, billing, accounting, and payroll functions of the practice as well as a system to support the clinical applications of Electronic Medical Records (EMR), Computerized Provider Order Entry (CPOE), and a Clinical Decision Support System (CDSS). After studying this information, you start to prepare for your next meeting with Dr. James. At your next meeting, Dr. James explains what the practice partners have in mind in more detail. They are looking for a medical practice software solution that allows each office worker to conduct their job more efficiently. He explains to you what systems they are looking for from the perspective of a patient who comes into the office. Lee Sue schedules a patientâ€™s appointment and the patient comes into the office for the first time. On this appointment, an EMR is started for the patient that includes the patientâ€™s demographic information, medical history, and insurance information. A patient may be coming in to see any one of the healthcare providers, including a physician, nurse practitioner, physical therapists, or the nutritionist. These providers would enter any orders or prescriptions into the EMR with the CPOE system. The Providers who use the EMR and CPOE system are supported by the CDSS. Patients often schedule a follow-up appointment before leaving the practice office. After a patientâ€™s visit, Angela Harrison, who maintains the patient medical records, reviews the records to ensure they are complete. Carl Hunter orders any supplies needed to replace items used by the patient. Riley Jeff begins billing the patientâ€™s insurance provider forservices that were rendered to the patient. Jayden Greig follows up on the billing to ensure the practice is getting paid for all claims. Dr. James also tells you that the system should also include modules to support Jack Carpenter and Amanda Brown in HR and payroll. You explain to Dr. James that you would like to conduct a preliminary investigation that will give you the information you need to make recommendations about what system they should pursue. Dr. James agrees to your investigation and you set a follow-up appointment in one month. JHC asked you to perform a preliminary investigation for a new business support system. You had several meetings with Dr. James to discuss office records and accounting systems. Emily Cox, JHCâ€™s office manager, participated in those meetings. You also completed a project management plan for JHC. Now, you are ready to develop a system requirements model. In the preliminary investigation report, you recommended a detailed analysis of four key areas: patient scheduling, billing and accounts receivable, human resources, and payroll. Because these areas are highly interactive, you suggested that an integrated system would provide the greatest benefits. Dr. James and the partners agreed, but they also expressed interest in a medical practice support system and asked whether the business support system could be expanded. After research and analysis, you concluded that medical practice support should be a separate system to be considered in JHCâ€™s long-term strategic plans. Because future integration would be very important, the business support system design should be compatible with a future medical practice support system. You began the systems analysis phase by conducting interviews, reviewing existing reports, and observing office operations. New JHCâ€™s information system must interface with 35 health insurance providers. The new system represents an opportunity for significant cost saving for JHC, and more convenience for patients, who will be able to go online to update medical information, schedule appointments, and request medical records. During your fact-finding, you learned that the JHC requires various reports, as follows: â€¢ Daily appointment list for each provider. The list shows all scheduled appointment times, patient names, and services to be performed, including the procedure code and description. â€¢ Daily report call list, which shows the patients who are to be reminded of their next dayâ€™s appointments. The call list includes the patient name, telephone number, appointment time, and provider name. â€¢ Weekly provider report that lists each of the providers and the weekly charges generated, plus a month-to-date (MTD) and a year-to-date (YTD) summary as well as profit distribution data for the partners. â€¢ Monthly patient statement, which includes the statement date, head of household name and address, previous monthâ€™s balance, total household charges MTD, total payments MTD, and the current balance. The bottom section of the statement shows activity for the month in date order. For each service performed, a line shows the patientâ€™s name, the service date, the procedure code and description, and the charge. The statement also shows the date and amount of all payments and insurance claims. When an insurance payment is received, the source and amountare noted on the form. If the claim is denied or only partially paid, a code is used to explain the reason. A running balance appears at the far right of each activity line. â€¢ Weekly Insurance Company Report. â€¢ Monthly Claim Status Summary. In addition to these reports, the office staff would like automated e-mail and text messaging capability for sending reminders to patients when it is time to schedule an appointment. Data also needs to be maintained on employers who participate in employee wellness programs. This information can be used for marketing purposes throughout the year. Finally, the new system needs to track employee schedules, attendance, vacation time, and paid time off. Now you are ready to organize the facts and prepare a system requirements document that represents a logical model of the proposed system. Based on your information (logical model, etc) to JHCâ€™s partners, they decided to move forward with inhouse development of a new business support system. They liked the idea of a vertical software package, but they want to be able to customize the user interface because JHCâ€™s business
functions are more varied. However, it is very important that the new system allow future integration with vertical packages such as electronic health records, computerized provider order entry, and a clinical decision support system. Using the information, you gained in the systems planning and analysis phases of the SDLC, you sit down to begin designing the user interface of the JHCâ€™s business support system. JHC partners accepted your interface, output, input, and data designs and your recommendation to install a server and desktop computer clients on a local area network. At this point, you review your notes and plan the architecture for the JHC system. Each of the GP, nurse practitioners, therapists, nutritionist and support staff has their own workstations. The nurses work from one of four nurse stations that should have at least four computers at each station. Each nurse station will have a high-volume network laser printer and a scanner attached to one workstation. The checkin/checkout area will have an impact printer for multipart forms and a network laser printer. The network will include an online backup service, Internet access via a cable connection with a local cable company. The partners want you to ensure the physical network is scalable, and able to handle the electronic medical record phase after the business support system is implemented. The electronic medical record phase will require a computer or thin client to be installed in each exam room and procedure room. They will also use portable computers and tablets to access patient information as the providers move from room to room around the clinic. The hardware requirements are only part of the final installation plan which you must develop. You should start by reviewing the domain model class diagrams and eventpartitioned system models that you prepared in the systems analysis phase. Then, review the system architecture checklist. With this information, you should be able to prepare a system design specification. You completed the systems design for the business support system at JHC. The network will include 2 servers, 45 workstations, and ten network printers. The partners at the clinic haveapproved the design specification, and your company provided you development team to assist you with the programming and testing of the new system. You now are ready to finish the software development and begin installation, testing, and evaluation of the new system.