Case Study Proposal: Maricopa Medical Center Case Management

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TOC o “1-3” h z u Introduction PAGEREF _Toc316575640 h 2Background Information PAGEREF _Toc316575641 h 3Electronic Medical Record (EMR) PAGEREF _Toc316575642 h 4Benefits of EMR PAGEREF _Toc316575643 h 5Improved Quality of Health Care PAGEREF _Toc316575644 h 6Security Breaches PAGEREF _Toc316575645 h 6Privacy Concerns PAGEREF _Toc316575646 h 6Staff and Storage Expenses PAGEREF _Toc316575647 h 7Connectivity/Communication PAGEREF _Toc316575648 h 7Standardizing Workflow PAGEREF _Toc316575649 h 7Standardizing Data Representation PAGEREF _Toc316575650 h 8Health Care Setting Variations PAGEREF _Toc316575651 h 8Funding PAGEREF _Toc316575652 h 9Recommendations PAGEREF _Toc316575653 h 9References PAGEREF _Toc316575654 h 11

Case Study Proposal: Maricopa Medical Center Case Management

IntroductionThe healthcare system in the U.S. is in difficulty. In spite of investing approximately $1.7 trillion per annum in healthcare, the health care industry is plagued with poor quality and inefficiency. Superior information systems ought to provide the much needed help. Most health care providers lack the requisite information systems in order to coordinate the patient’s care with the pertinent providers. The essential information systems are require in order to ensure that the health care providers share required information, monitor conformity with guidelines for prevention and disease-management, as well as evaluate and improve on performance (Corrigan, 2011).

This paper posits to provide a case study proposal for the Maricopa medical center case management. The rationale for choosing Maricopa Medical Center (MMC) in this proposal was because they are at present in their third year of a five year plan in implementing an electronic medical record (EMR). The MMC presents a perfect example in investigating how organizations are dealing with the changes in the current ear of change. Besides, the case management department is an excellent example to monitor these changes since they are working in numerous areas of the hospital. This includes clinical, financial, social services, as well as customer service. MMC, is able to present a good case in point of multiple spotlights of the business. The focus of the proposal will entail applications, leadership, system integration, regulations, technology, and overcoming barriers. Hospitals employ information systems with the anticipation that the systems would reduce costs, boost the quality of care, and improve the competence of operations and personnel productivity. They also expect that information systems would enlarge service capacity, and enhance the accuracy and timeliness of management information (Kotter, 2006).

Background InformationMaricopa Medical Center is presently converting to some different information systems. MMC uses the Midas program, which is not an EMR. The MMC has been implementing EPIC and Cerner information systems into the hospital in phases. Cerner and Epic offer technology solutions in healthcare systems with the intention to create accountable health care organizations.However, the use of the two systems jointly has been difficult, since it seems that the builders for financial and clinical have not been working together. Consequently, it has been difficult to have the two systems work in collaboration. In order to provide a solution to this predicament, this proposal suggests an immediate shit to EMR.

The case management department at MMC is aware of the role played by the changes to funding in healthcare and reimbursement. The department is mandated to focus on issues that relate to balancing government mandates, managing the insured patients, and managing the self pay/no pay patient. This proposal will look into the various areas of interest, and subsequently provide the necessary recommendations.

Electronic Medical Record (EMR)In the $787 billion American Recovery and Reinvestment Act signed by President Obama in 2009, approximately $1.2 billion included an electronic medical documentation stimulus that grants benefits for electronic medical documentation implementation. The government is working to ensure the shift to EMR integration, since it believes that this would restructure patient care and present the health sector with long-term savings. The electronic medical records stimulus provides incentives to facilitate physicians in converting to paperless medical documentation. However, several studies have proved that even in the absence of the incentives, the integration of EMR has tangible benefits (Dave & Mike, 2010).

The Electronic Medical Record (EMR) is an application setting that entails clinical data repository, controlled medical terminology, clinical assessment support, order entry, computerized provider order entry (CPOE), clinical and pharmacy documentation applications. This environment sustains the patient s electronic medical documentation across outpatient and inpatient environments. It is employed by healthcare practitioners to record, monitor, as well as manage the delivery of health care in a care delivery organization (CDO). The information in the EMR is a legal account of what transpired in regard to the patient in their visit at the CDO (Janz, 2010).

The EMR milieu is a sophisticated and complex environment. The foundation of the EMR is the clinical data repository (CDR). This is a synchronized transaction processing catalog of patient clinical data for practitioners. Controlled medical vocabulary (CMV) is vital since it guarantees that practitioners who utilize the EMR access precise and analogous information. The CMV standardizes information from a definitional and relational hierarchy that facilitates related EMR components to operate optimally. Devoid of a functional CMV, clinical decision support system (CDSS) as well as workflow components in the EMR would not perform as projected by the clinicians in the milieu. Applications of EMR setting are clinical documentation for every practitioner/clinician, computerized provider order entry (CPOE) for every clinician/practitioner, as well as pharmacy management (Janz, 2010).

There are several EMR applications foundation, necessary to develop patient safety and eliminate or reduce medical errors. These include, the CPOE, CDR, electronic medication administration record (eMAR), and pharmacy management system functionality. These applications are built and designed on similar architecture as EMR components. However, the EMR system has been implemented slowly due to lack of homogeny. Security concerns have also been a hindrance in several healthcare facilities (Dave & Mike, 2010).

Benefits of EMREMR systems are meant to monitor the patient’s entire health and medical account in an electronic and computerized format. This enormous quantity of data in this format enables healthcare professionals in retrieving and navigating crucial data. This makes the whole healthcare system increasingly efficient and secure for the patients. The principal advantages of EMR, according to several professionals in the medical field, are that the data cannot be damaged by natural disasters or fire. This has occurred on numerous occasions in the past (Corrigan, 2011).

Improved Quality of Health CareElectronic health documentation helps a doctor in instantly accessing the patients’ full medical history. This lessens diagnostic duration and reduces the probability of misdiagnosis as well as medical errors. The CPOE feature assists in increasing the safety of the patient. The system registers specific information for doctors, in prescribing medication. This greatly minimizes errors associated with medication. The CPOE approximates that there are 200,000 medication errors annually. This costs health care facilities approximately $1billion as a result of adverse affects as well as serious reactions (Janz, 2010).

Security BreachesElectronic medical documentation may be susceptible to security breaches, but in general the data is quite secure. Medical records transferred online are exchanged in the safest possible manner. When considering the enormous benefits of electronic medical records, it becomes apparent that the benefits far overshadow the security risks.

Privacy ConcernsAlthough many people are skeptical about having their private medical records over the internet, very few people have access to these records. With the expansion of the international medical environment, more persons travel to other nations for specialized surgeries or treatments. Surgeons and doctors from across the globe can instantly access a patient’s entire medical history. This radically reduces errors and saves time.

Staff and Storage ExpensesAnother benefit of EMR integration is that reduces costs for the physicians.  Avoidable staff expenses as well as, storage costs are eradicated by the EMR. This is because it consumes less space and is easily accessible than the paper versions. Furthermore, the costs of medical documentation chart materials are substituted by reasonably priced maintenance expenses, which assist in paying for investment in the long-run. Successful users of EMR decreased medical records, transcriptionist, billing, data entry, as well as receptionist costs (Dave & Mike, 2010).

Connectivity/CommunicationThree foremost areas of the implementation ought to be entirely understood so as to maximize the likelihood of its success. These three areas include variations in health care settings, standardization, and strategies for training. The implementation process of a health care automation and information system starts with modeling the health care facility in software. The level to of adaptation of the information and automation system to the health care facility if successful would designate an upper limit on the level to which the adoption would be successful. A well-designed and mature system would allow MMC to control how the software works instead of the software dictating its functions to MMC. The system would permit for a large variation in how diverse components of MMC operate. There are two types of standardization that merit consideration. These include data representation and workflow.

Standardizing WorkflowStandardization of workflow basically means, considering two or more comparable components of MMC and having them execute some work function correspondingly. Consequently, people in comparable roles in the dissimilar components parts of MMC execute similar tasks in identical sequence by means of identical tools as well as interact with the users in other comparable roles in a similar manner. Epic’s experience proposes that standardization of workflow ought to play a small role for the duration of the initial implementation. As a general rule, however, standardization, particularly in the perspective of best-practice, is best tackled in subsequent optimization initiatives rather than for the duration of the initial rollout (Janz, 2010).

Standardizing Data RepresentationEven though workflow standardization provides a small purpose for the duration of the initial implementation of successful automation system in health care, the standardization of data representation ought to occupy a great segment of the system modeling period. Data representation establishes how data that is compiled throughout patient care, registration, or related utilization of the system is accumulated and retrievable later. It also determines how it may be evaluated with related data, and the simplicity with which this can be done.

Standardized vocabulary is a prerequisite for complicated clinical studies, billing, population management and several other transformational actions that may be practiced after the initial implementation and launch (Gorman, 2009).

Health Care Setting VariationsDifferent health care settings apparently have dissimilar data collection and workflow requirements. A properly integrated system at MMC would account for the variation by employing similar pieces joined together in dissimilar manner rather than as dissimilar pieces altogether, as would be the case in an interfaced, non-integrated system solution.

Linearity of the workflows should also be considered. A properly integrated enterprise information and automation system would minimize training time. This would be through utilizing similar navigation as well as data compilation tools across the multiplicity of health care settings. It would also facilitate viewing as well as interaction with data, in spite of its source, in an analogous fashion, therefore, enhancing patient care as well as the user experience (Janz, 2010).

FundingThe present approach towards provider reimbursement is founded on a fee-for-service system. This system encourages patient over-treatment and has no incentive for health care providers in efficiently harmonizing a patient’s health care. Besides, it offers little to encourage quality care improvement. Devoid of reform, this structure would persist to perpetuate the increase of healthcare expenditure without essentially improving the health of the population. However, establishment of a system that would reward health care providers for delivering quality health care in an efficient way has the prospective to restrict the healthcare costs, at the same time as also generating improved health results (Fisher, 2009).

Numerous factors such as the expense of care, divergence in patient populations as well as,the seriousness of illness ought to be taken into consideration when developing a payment system. It is essential to consider the risk assumed by health care providers and patients dependent on system of reimbursement. The degree of risk that may be assumed by the health care provider may serve as the foundation for promoting more resourceful provision of health care (Wilensky, 2010).

RecommendationsThere are numerous functions related with patient health documentation. Not only is the documentation utilized to record patient care, but the documentation is also utilized for legal and financial information, research as well as quality improvement functions. Since all this information should be shared between numerous professionals who comprise the healthcare team, and there continues to be difficulties with the paper health documentation, it has become more obvious that developing automated health documentation is imperative.

At the MMC, connectivity and communication issues are evident. The case managers, have an obligation to pull every department involved in patient care together. They should also assist each person make the most appropriate decision on behalf of the patient. This means that, all departments ought to be connected and in constant communication. In order to provide a solution to this predicament, this proposal suggests a full and immediate implementation of EPIC in order to facilitate the technology front in regard to connectivity.

It is fundamental to consider that, the initial execution of health care automation and information systems creates part of the basis for the health care transformation. It should not be seen as transformation in itself. The appropriate emphasis of the initial implementation ought to be on the things that would facilitate the maximum benefits in the long-term. These should include realizing widespread utilization of the system in as many care environments, specialties, as well as departments as practicable. This should be done to standardize data representations and long-range interaction as well as communication plans with the pertinent user community. In the event that,a these three objectives are achieved, MMC would be well positioned to exploit the sophisticated techniques and tools that would change the manner in which health care is generally delivered.

Bearing the factors mentioned in this proposal, Medicopa Medical Center should consider developing a system that would:

Reward health care practitioners for health results and improvements in quality of health care.

Adequately compensate practitioners for care management and coordination services.

Is transparent to the facility as well as to the payers.

Is sustainable.

Regulate for risk on the basis of incidence of ill health in a specified population.

Builds on experiences of comparable restructuring at the local, state, as well as national level.

ReferencesCorrigan, J. (2011). Building a Safer Health System. Washington, DC: National Academy Press.

Dave, G. & Mike D. (2010). Electronic Patient Records: Healthcare Informatics. Chicago: McGraw-Hill.

Fisher, E. (2009). Paying for Performance: Risks & Recommendations. New England Journal of Medicine. 29 (1), 25-32.

Gorman, K. (2009). Information Needs of Physicians. Journal of the American Society for Information Science, 43(3), 729-736.

Janz, N. (2010). Health Belief Model: Health Education & Health Behavior. San Francisco: Jossey-Bass.

Kotter, H. (2006). Performance & Corporate Culture. N.Y: Free Press.

Wilensky, M. (2010). Comprehensive Payment for Comprehensive Care. Journal of General Internal Medicine. 21 (3), 10 – 15.