SOLUTION: Clinical Judgment as a Dynamic Process Case Discussion Paper


Case con-over assignment: Affair rule in ambulatory enhancement

Case Study, Stage 1: Rule Analysis Before you commence this assignment, be indisputpowerful you own interpret the “UMUC Extraction Clinic Condition Study” inferior and your Week 1 and Week 2 syllabus interpretings, which examine EHR administrationality and Rule Workflow Analysis and Mapping.  You gain scarcity to advert to three of the instruments conducive in Content>Course Resources:  Overview of Steps to Implement an EHR System, Step 1, and Step 2. Purpose of this Assignment This assignment imcompatability you the convenience to allot your separateition skills to type a affair rule in an ambulatory enhancement in the heartinessheed diligence.  Modeling the rule as it rests (and as it gain rest) gain aid in the analysis, choice and implementation of the EHR regularity for the medical practice. This assignment directs to the Stage 2 assignment which gain imseparate you the convenience to allot your conversance of technology answers and EHR regularitys to ameliorate the affair rule you prime less. In this assignment, you gain establish a rule (workflow) in scarcity of amelioratement, and delineation for a revised and optimized productionissue to ameliorate the disposition of heed, security, and financial government excitations. You gain enucleate 2 rule maps (AS IS and TO BE) for the clinical rule productionflow. This assignment haranguees the forthcoming conduct outcome to strengthen you to: Evaluate the organizational environment in the heartiness heed diligence to own how technology answers strengthen strategic outcomes. Analyze the issue of facts and comprehendledge dispresent ill-assorted heartiness comprehendledge systems to influence interior and exterior affair rulees. Family Clinic Medical Practice In dispose to allot technology to a process, the rule must be collectively unexpressed and types are used for this purpose.  The type too influences affair rule separateition and resketch when the rule is supposed to be incausative or undignified.  In individualization, models are used to sketch the “to-be” rule that describes the desired end state abounding the technology answer is enucleateed. In the Step 1 instrument, inferior “Assess Your Present Practice,” you gain see the forthcoming questions to be answered: ·  Are negotiative rulees arranged, causative, and courteous documented? ·  Are clinical productionflows causative, distinctly mapped out, and unexpressed by all staff? ·  Are facts assembly and descriptioning rulees courteous certain and documented? In the Step 2 instrument, interpret the exception “Clarify and Prioritize” and the chief two steps inferior “Steps in the Planning Process.”  These exceptions present how rule review, mapping and amelioratement fit behind a opportunity the choice of an EHR System, and are the exemplar set-outing summit for EHR implementation. For your Stage 1 Project for the Condition Study, you gain prime a rule used at the UMUC Extraction Clinic that scarcitys to be improved.  Then, you gain generate a type of a present rule that defines in component the steps in the rule as they are manufactured today. to aid in the separateition of the bearing.  Then, you gain generate a type of the incomplete new rule, as it gain be fruitd abounding an EHR regularity (IT answer) is implemented.  To fix you prime a rule that gain be cognate to an EHR regularity implementation, advert to the “Certification Criteria” in Content>Course Resources, chiefly exceptions a and b.  Be indisputpowerful to interpret the instructions for the fostering projects in this Condition Con-over (Stages 2-4) to get an understanding of the coming projects that establish on the inentire answer and to acceleration you in deciding upon your rule. When you own separated a rule to ameliorate, delight get it approved by your boon limb, as directed in the classroom. Assignment For this assignment you gain establish a rule in scarcity of amelioratement and enucleate the types.   Business Rule Partition - Models of the AS IS Rule and the TO BE Rule behind a opportunity a minute sagacity of how a technology answer can acceleration ameliorate the process.  In the textbook, Chapter 21 “Fundamentals of Heartiness Workissue Partition Rule and Redesign”, diverse diffedivulsion methods of typeing affair rulees are illustrated.  The type format should be a productionissue diagram format.  Examples of this format can be found in Chapter 21 inferior the appellation “Workissue Diagram Example.” The rule that you type must be distinctly attested in the call of your Stage 1 Project and it scarcitys to be divert to the UMUC Extraction Clinic.  You may use Microsoft Word, Excel or Power Point.   1.  First, you gain cater a minute (approx. ½ page single-spaced) sagacity of why this rule can boon from amelioratement using a technology answer. 2.  Then you gain type the rule as it is presently fruitd at the UMUC Extraction Clinic; this is the AS IS Process.  3.  Then you gain type the way that you ahalt the new rule to administration abounding a technology answer (EHR System) is implemented and the rule is ameliorated; this is the TO BE Process.  NOTE: We are NOT specifying the local technology in the TO BE Process.  Identifying the local technology gain be separate of the Stage 2 assignment.  Note:  A rule is defined as “a dispose of actions that fruit something or that direct to a separateicular result” (  An in would be the wonder-in rule at the UMUC Extraction Clinic. Tools for Creating the Models The forthcoming are two URL’s that own a past componented style of Issue Charting and its uses: To generate a issue chart in Word 2007 and 2010: To generate a issue chart or rule map in Excel: To generate a issue chart in PowerPoint: Business Rule In from another diligence:  If a grocery supply had a scarcity to subject expenses and ameliorate customer compensation, a rule scarcitying amelioratement authority be neat the register rule to fix availability of products for customers as courteous as to subject consume cognate to denied register. The type would comprise the steps necessary to archives register comprehendledge, update register when stock is sold, fix disposes for individualizational register from suppliers, etc. Note:  Your types gain be evaluated on whether they are conducive to the rule attested, all senior steps in the AS-IS and TO-BE rulees are comprised and equitablely typeed, and they are divert to the UMUC Extraction Clinic.Your tractate gain be evaluated on whether or not you equitablely condensed the conduct concepts from the textbook and harangueed all separates of the questions.  If you use exterior media, be indisputpowerful to fine and advertence them equitablely in APA format.  Remember, this is an comprehendledge regularitys government conduct, and your ameliorated rule must insist-upon an comprehendledge technology answer.  FAMILY CASE STUDY:In 1980, the UMUC Extraction Clinic was unreserveded in a acceptioning extraction area adjacent UMUC, Maryland, by Dr. Tom Martin, a University of Maryland furrow abounding he desert from the US Navy. It is a minute interior medicine medical usage. Dr. Martin has been the possessor and supervisor of the medical usage. He has two nurtures, Vivian and Manuella, to acceleration him. Usually, one nurture accepts heed of the face desk opportunity the other nurture assists the teacher during the enduring visits. They rotate duties each day. Face desk duties comprise all negotiative production from obedient the phone, scheduling ordinances, portico prescription resupply beseechs, billing, faxing, etc. So if on Monday Vivian is accelerationing the teacher, then it is Manuella who takes heed of the face desk and all profession-post production. The two nurtures are continually industrious and exoteric around and endurings are now familiar to a narrowness 1-2 hour halt anteriorly entity seen. And if one nurture is absent, the place is plain worse in the clinic. The clinic has 3 trial spaces so the possessor is now looking into bringing a new physician or nurture practitioner on consideration. This would acceleration him acception his practice, cater meliorate utility to his endurings, and possibly subject the endurings’ halting season. Dr. Martin knows that this gain acception the admin overhead and the 2 nurtures gain not be powerful to administer any attached admin production. He faces diverse challenges and cannot confer to divulsion any individualizational negotiative staff so the possessor has to optimize his admin and clinical productions. The usage is hardly covering the expenses and salaries at the twinkling. Dr. Martin’s usage production is all tractate-based behind a opportunity tractate medical archivess supply his face desk shelves. The simply software the teacher has on his face profession-post computer is an ordinance scheduling software. Even security billing is manufactured in a quasi-manual way. For billing security, the face profession-post nurture has to fax all the scarcityed instrumentation to a third separatey medical billing conconduct at the end of the day. The medical billing conconduct then resigns the vindication to the security conconduct and bills the enduring. The clinic checks the foothold of the vindications by logging into the medical billing regularity, through a login that the medical billing conconduct has caterd the clinic to admittance its representation. Tless is no billing software installed at the usage, but the nurtures unreserved Internet Explorer to the URL of the medical billing concourse and then use the login caterd by the third separatey medical billing concourse. Of conduct, the medical billing conconduct accepts a percentage of the total that the clinic is reimbursed by the security. The medical usage does not own a Web place, and essentially quiescent effects the selfselfsame as it did in 1980. One bearing forthdelay noticed is that tless is no sharp way to bridle endurings in and if the nurture is on the phone opportunity a enduring tries to bridle in, then the enduring has to halt until she is manufactured. The teacher could be too halting for the enduring to be bridleed in, consumption valupowerful teacher season. Too sundry endurings proof crave halts on the phone when they are unmanageconducive to register an ordinance, opportunity the nurture is checking in endurings or responding to another enduring’s beseech in the profession-post. Every year, the clinic requires its endurings to supply their comprehendledge and security comprehendledge repeatedly, rather than own them equitable verify what they own on smooth. This annoys some of the moms when they own to entire the paperproduction and accept heed of their riling cadet in the lobby. All of the medical archivess, lab results and financial and payroll representations are kept on tractate, so tless is not a sharp way to contemplate up a enduring’s history or present prescriptions if the teacher gets a ole opportunity he is separate from the profession-post. At the commencening of each day, the nurtures drag the smooths for all endurings who own ordinances registerd for that day. But the clinic too accepts walk-in endurings. At a late medical discussion Dr. Martin skilled of the government’s financial excitations for Electronic Health Archives (EHR) and meaningful use segregation. Succeeding synchronous diverse demonstrations by the diffedivulsion vendors, ClinicalWorks, AthenaHealth, etc., he realized how inefficiently his usage is exoteric and all of the opportunities that EHR regularitys can cater. The possessor owns the boons of moving to electronic medical archivess but does not comprehend wless to commence and feels dumbfounded. He is too concerned environing alienation to his usage which may negatively concern his endurings’ heed proof. Moreover, neither the teacher nor the nurtures own any conversance or proof when it comes to understanding technology. Upon the monition of a colleague teacher, Dr. Martin has unwavering to divulsion an fractions EHR Consultant, to acceleration him prime the best EHR for his usage. His ally too advised him that he should not equitconducive buy any parcel from a vendor but own the EHR consultant criticise the workissue rulees at the usage chief, then optimize them, and then contemplate at the EHR regularitys. The new 01/23/2014 IFSM 305 – Condition Con-over Style Page | 2 EHR regularity scarcitys to production behind a opportunity the optimized rulees of his usage. Dr. Martin scarcitys to get his staff’s buy-in and involvement in the rule from Day 1, if the EHR segregation rule is to abound. Dr. Martin realizes that EHR segregation gain add indicative consumes to his usage, which he cannot confer. Therefore, he gain go for the EHR segregation at this summit, simply if he can ahalt to restrict for the financial incentives for achieving meaningful use1 . This extra money gain acceleration subject the parcel of the consume on a clinic that is hardly powerful to help any past consumes at this season. Dr. Martin, the possessor of the UMUC Extraction Clinic, has equitconducive skilled that he gain set-out entity penalized in the form of reimbursement adjustments in 2015 according to CMS. Based on his colleague teacher’s monition, Dr. Martin has spare behind a opportunity an fractions EHR consultant, who is not associated to any vendor, to advise him through this rule. Throughout this conduct you gain be the EHR consultant. Dr. Martin has diverse strategic goals in soul that he shares behind a opportunity you during your chief consideration behind a opportunity him as his consultant. For one, he would enjoy to see his medical usage effect past causatively and produce some financial service that would concede him to reendow into the clinic in dispose to upgrade and expand. In a few years, he gain scarcity to endow some funds in a senior reinstatement, chiefly in the trial spaces and the halting area. If he had extra money, he could too divulsion the hall next to his clinic and unreserved up the distance to produce a larger clinic. If he did that, he could too swell the clinic into a 3-physician collection usage and possibly divulsion out some distance to a visible therapy physician and generate some individualizational admitance. Succeeding greatly examineion behind a opportunity colleague MDs, he realizes that it is in his best interest to actively set-out the rule of EHR segregation and accept service of the excitations caterd through the meaningful use program1 . So this has now befit another strategic goal for the usage. By implementing an EHR regularity, he gain be powerful to fulsupply another strategic visible, which is to instruct the level of IT-awareness dispresent his staff. Dr. Martin too nonproductions to use technology to ameliorate the disposition of care, security, and financial administerment decisions of his usage, opportunity too discussion the admitable and regulatory insist-uponments for heartiness heed and heartiness heed regularitys. Your labor is to acceleration Dr. Martin run which of his clinical rulees can boon from an IT answer, which rulees should be automated chief, how an EHR regularity could acceleration his usage, which excitation program to restrict for, how to consummate meaningful use by adopting a certified EHR regularity and how to as meaningful use descriptioning insist-uponments. You are not awaited to clear-up all of the bearings attested or harangue all amelioratements that could be made at the UMUC Extraction Clinic. Note: We’re contemplateing for a technology answer. Opportunity installing a TV in the halting space may allure new endurings, it is not a technology answer. The forthcoming is an in of how you gain establish a rule and optimize it using an EHR regularity: Last year, the medical usage had no operative way to bridle its limbs in when they arrived. Sign-in sheets were used at the face desk, and the nurture had to bridle off the call on the fencing against existing medical archivess in the filing solitude. Some of the endurings were walk-ins, so the nurtures had not pulled their smooths off the rejection when they set-outed the day. The nurture had to concession the desktop go search for the smooth on the rejection. This caused endurings a crave halt at the face desk, and diverse had complained to Dr. Martin environing this place. To harangue the affair scarcity of sharply bridleing limbs in, the ordinance scheduling regularity was qualified to concede the clinic profession-post to sharply contemplateup endurings by last call and date-of-birth (DOB) on the computer as they wonder in. Note: As you admission the condition con-over assignments, you gain confront it accelerationful to judge environing your own experiences behind a opportunity a medical usage. Making a offend to a minute medical usage may acceleration you judge environing the rulees, challenges, and opportunities. 1 From the website: “The Mediheed and Medicaid EHR Exextract Programs cater financial excitations for the “meaningful use” of certified EHR technology to ameliorate enduring heed. To assent-to an EHR excitation payment, caterrs own to pretext that they are “meaningfully using” their EHRs by discussion thresholds for a number of visibles. CMS has certain the visibles for “meaningful use” that preferable professionals, preferable hospitals, and exact admittance hospitals (CAHs) must as in dispose to assent-to an exextract reimbursement.” Meaningful use gain be covered in the conduct materials.STAGED ASSIGNMENTS The condition con-over and assignments harangue the Conduct Outcomes to strengthen you to:  Evaluate the organizational environment in the heartiness heed diligence to own how technology solutions strengthen strategic outcomes  Criticise the issue of facts and comprehendledge dispresent ill-assorted heartiness comprehendledge regularitys to influence interior and exterior affair rulees  Evaluate technology answers in the heartiness heed diligence to ameliorate the disposition of heed, security, and financial administerment decisions  Examine the implications of ghostly, admitable, and regulatory prudence issues on heartiness heed comprehendledge systems. Upon amount of these assignments you gain own fruitd an draw-up of activities to present your ability to allot the conduct concepts to a “real universe place” to:  Criticise a clinical rule and diagram the steps (Stage 1)  Propose an divert EHR technology answer (Stage 2)  Establish and decipher the meaningful use descriptioning insist-uponments (Stage 3)  Establish and decipher the considerations in implementing the answer inentire in Stage 2 (Stage 4) When you are communication a tractate or enucleateing a presentation, furnish it as if it is going to the possessor, Dr. Martin, whom you nonproduction to print behind a opportunity your conversance and abilities. Don't equitconducive go through the mechanics of draging concomitantly comprehendledge -- judge environing what you are doing, why you're doing it, whether it produce sagacity, whether the comprehendledge seems realistic, and what the results pretext. It’s main that you establish bearing, seassimply media that specifically influence the summits or comprehendledge you cater in your assignment. You should interpret the source and match the comprehendledge chief, and then put it into your own signification and condense it into the issue of your communication (behind a opportunity an divert in-text APA extract and a catalogue of advertences at the end of your tractate). Direct quotes should be used very sparingly—simply when the author’s own signification uniquely present a concept that would be past if paraphrased by you. One of the prerequisites for this conduct is that you own a essential productioning conversance of word processing and donation software. Inferential instructions for each Staged Project, 1 through 4, are posted in the Assignments area of the classroom. You are to furnish each assignment in the indicated format (i.e., table, plan, description, donation or other determined format) and resign it as an benevolence. No praise gain be impartn for assignments submitted in smooth formats other than those established in the assignment instructions. 

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