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CASE New Century wellness Group New Century Wellness Group offers a holistic approach to health care with an emphasis on pre-preventive medicine as well as traditional medical care. In your role as an IT consultant, you will help New Century develop a new information system. Background Ten years ago, internal medicine specialists Timothy Jones and Dolores Garcia decided to combine their individual practices in Brea, California, to form New Century Wellness Group. They wanted to create a clinic that would concentrate on preventive medicine and fitness, as well as traditional medical care. New Century has competition from other health care providers, but no other clinic offers the same range of services. New Century's practice has grown and now includes four primary care physicians, one nurse practitioner, four physical therapists, one registered nutritionist, eight nurses, and eight support staff people. The clinic currently has a patient base of 8,000 patients from 325 different employers, many of which provide insurance coverage for employee wellness and health maintenance. Currently, New Century accepts insurance plans from 25 licensed health insurance providers. New Century is also considering opening another location near a new medical center. Doctor Jones and Doctor Garcia 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. Jones asked you to design an information system that could support the clinic's current operations and future growth. In your first meeting, Dr. Jones provided an overview of the clinic's business processes and staff members. He told you that Anita Davenport, who has been with New Century since its inception, is the office manager. She supervises the support staff of seven people. Fred Brown handles human resources and employee benefits. Corinne Summers reports directly to Fred and works with payroll, tax reporting, and profit distribution among the associates. Susan Gifford is responsible for the maintenance of patient medical records. Tom Capaletti handles accounts receivables, and Tammy Alipio is the insurance billing specialist. Lisa Sung is responsible for managing appointments. Her duties include reminder calls to patients and preparing daily appointment lists. Carla Herrera is concerned primarily with ordering and organizing office and medical supplies. After studying this information, you start to prepare for your next meeting with Dr. Jones. New Century Wellness Group is interested in a new information system to support its business and health information management needs. The new system would replace a mix of paper-based and fragmented computer systems. Dr. Jones had previously asked you to work with him as a systems analyst and help the group develop an information system that will support current operations and future growth. 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). At your next meeting, Dr. Jones will explain 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. Lisa Sung schedules a patient'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 patient'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 therapist, or 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 patient's visit, Susan Gifford, who maintains the patient medical records, reviews the records to ensure they are complete. Carla Herrera orders any supplies needed to replace items used by the patient. Tammy Alipio begins billing the patient's insurance provider for services that were rendered to the patient. Tom Capaletti follows up on the billing to ensure the practice is getting paid for all claims. Dr. Jones also tells you that the system should also include modules to support Fred Brown and Corinne Summers in HR and payroll. You explain to Dr. Jones 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. Jones agrees to your investigation, and you set a follow-up appointment in one month. PLANNING After you conducted a preliminary investigation into New Century's request for a business support system and a medical practice support system, in your presentation to the partners, you explained that although they will communicate and share data, the two systems should be treated as separate IT projects. After discussing your recommendations, Dr. Jones and the partners decided to move forward with the business support system project and want you to describe the next steps. New Century asked you to perform a preliminary investigation for a new business support system. You had several meetings with Dr. Jones to discuss office records and accounting systems. Anita Davenport, New Century's office manager, participated in those meetings. You also completed a project management plan for New Century. 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. Jones 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 New Century'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. In your meetings with Dr. Jones and Anita, you stressed that IT projects are much more successful when users have a sense of ownership, and the best way to create that "buy-in" is to get them involved in the development process. In your view, joint application development would be an ideal method to develop the new system, and everyone agrees. Your next task is to form a JAD team and conduct the requirements modeling process. Requirements Finding You began the systems analysis phase by conducting interviews, reviewing existing reports, and observing office operations. (Your instructor may provide you with a sample set of interview summaries.) The New Century medical team performs services and medical procedures, which are coded according to the American Medical Association's Current Procedure Terminology (CPT). CPT codes consist of five numeric digits and a two-digit suffix, and most insurance payers require the codes to be included with billing information. The new system must be able to handle the new ICD-10 procedure coding system, which will be required by the Centers for Medicare \& Medicaid Services (CMS) beginning October 1, 2014. ICD-10 codes consist of seven alphanumeric characters, which can be electronically transmitted and received. New Century's information system must interface with 25 California health insurance providers. The new system represents an opportunity for significant cost savings for New Century 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 clinic requires various reports, as follows: 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. Daily report call list, which shows the patients who are to be reminded of their next day's appointments. The call list includes the patient's name, telephone number, appointment time, and provider name. - Weekly provider report that lists each of the providers and the weekly charges generated, plus a monthto-date (MTD) and a year-to-date (YTD) summary as well as profit distribution data for the partners. - Monthly patient statement, which includes the statement date, head of household name and address, previous month'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 patient'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 amount are 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. - Weekly Insurance Company Report. - 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. Based on your presentation to New Century's partners, they decided to move forward with the in-house 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 New Century's business functions are more varied. However, it is very important that the new system allows future integration with vertical packages such as electronic health records, computerized provider order entry, and a clinical decision support system. cosTs Based on your earlier recommendations, New Century decided to continue the systems development process for a new information system. Now, at the end of the systems analysis phase, you are ready to prepare a system requirements document and give a presentation to the New Century associates. Many of the proposed system's advantages were described during the fact-finding process. Those include smoother operation, better efficiency, and more user-friendly procedures for patients and New Century staff. You also must examine tangible costs and benefits to determine the economic feasibility of several alternatives. If New Century decides to go ahead with the development process, the main options are to develop the system in-house or purchase a vertical package and configure it to meet New Century's needs. You have studied those choices and put together some preliminary figures. You know that New Century's current workload requires six hours of office staff overtime per week at a base rate of $15 per hour. In addition, based on current projections, New Century will need to add another full-time clerical position in about six months. Neither the overtime nor the additional job will be needed if New Century implements the new system. The current manual system also causes an average of three errors per day, and each error takes about 20 minutes to correct. The new system should eliminate those errors. You estimate that by working full-time, you could complete the project in about 12 weeks. Your consulting rate, which New Century agreed to, is $35 per hour. If you design the new system as a database application, you can expect to spend about $2,500 for a networked commercial package. After the system is operational and the staff is trained, New Century should be able to handle routine maintenance tasks without your assistance. As an alternative to in-house development, a vertical software package is available for about $12,000. The vendor offers a lease-purchase package of $4,000 down, followed by two annual installments of $4,000 each. If New Century buys the package, it will take you about four weeks to install, configure, and test it, working full-time. The vendor provides free support during the first year of operation, but then New Century must sign a technical support agreement at an annual cost of $600. Although the package contains many of the features that New Century wants, most of the reports are predesigned, and it would be difficult to modify their layouts. No matter which approach is selected, New Century probably will need you to provide about 10 hours of initial training and support each week for the first three months of operation. After the new system is operational, it will need routine maintenance, file backups, and updating. These tasks will require about four hours per week and can be performed by a clinic staff member. In both cases, the necessary hardware and network installation will cost about $12,500. In your view, the useful life of the system will be about five years, including the year in which the system becomes operational. New Century Wellness Group has four primary care physicians, one nurse practitioner (NP), four physical therapists, one registered nutritionist, eight nurses, and eight support staff. Each of the physicians, NP, therapists, nutritionist, and support staff has their own workstations. The nurses work from one of three nurse stations that should have at least three computers at each station. Each nurse station will have a high-volume network laser printer and a scanner attached to one workstation. The check-in/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. PROBLEMS, OPPORTUNITIES, OBJECTIVES AND CONSTRAINTS MATRIX