A.Introduction

midtown-family-clinic-case-study.jpg Midtown Family Clinic over the years has seen a decrease in efficiency and service provision as the clinic continues to grow which as led to poor overall performance hence the need to implement a management system that in addition to improving organization within the clinic aims at automatizing most of the processes. Making the systems automatic is aimed at integrating different parts of the clinic while eliminating the ones that are not necessary within the system of operation. The most critical parts as per the clinic’s setting include the front desk operations and billing that are carried out by the nurses and an external organization that benefits from the billing process. Having a well-integrated and modern system is bound to save costs in the billing process and also time used at the front desk time hence allotting the nurses input into more hands-on activities that reduces the time taken to record data as well as treat the patients.

B. Need to Share Data

The Midtown Family Clinic in the aim of ensuring that the information flows smoothly has the objective of integrating other organizations so as to make the system run smoothly. At the particular time, the two main problems come in data organization, data retrieval and the billing process. The organizations that will be implemented to make the system run smoother include the integration of the health insurance providers which is a service provided by an external organization and hospitals. The organization in charge of health insurance providers service offers a one place for payment processing by following up the payment from insurers which eliminates the need of an accountant at this particular time when the clinic does not have enough funds to hire one. The second organizations to be integrated into the system include hospitals hence during the online application process by the patient will include the hospitals attended prior to vising the clinic so as to enable the EHR system to contact the institution and get the relevant patient files from past treatment processes.

C. Types of Data to be Shared

The clinic aims at implementing an efficient Electronic Health Record (EHR) system that allows for the integration of all the systems together so as to increase efficiency through enabling better planning. The EHR will integrate the clinic records with the external records from the health insurance providers and the other hospitals to enable better patient information record keeping that will shorten the time taken to retrieve information from the database. The system will be cloud hosted allowing information retrieval via a number of approaches that are better placed to serve all the parties involved. The system will have an application for the patient side and another for the administrators and clinic users. This will ensure information retrieval and access by the health insurance providers management organization whereas the hospitals will provide patient files that will be attached to the patient profile and later on added to the system by the clinic personnel.
Based on the planned EHR, there will be the provision of an online website and applications that will allow the implementation of push notification for the clinic operatives and also the patients. The data in the EHR to and from the external organizations will be organized and included in the system as shown below.

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1. Patient Identity From Midtown Family Clinic
Organization #1 Health Insurance Providers Management Organization
Data Element or Item Data Goes TO/FROM Midtown Family Clinic
2. Communication info and bill From Midtown Family Clinic
3. Indemnification/Billing Info To Midtown Family Clinic
4. Indemnification/Billing Approval To Midtown Family Clinic
5. Indemnification/Billing Files To Midtown Family Clinic
Organization #2 Hospitals
Data Element or Item Data Goes TO/FROM Midtown Family Clinic
1. Patient Identity From Midtown Family Clinic
2. Health Antiquity To Midtown Family Clinic
3. Radiology Pictures To Midtown Family Clinic
4. Laboratory and Assessment outcomes To Midtown Family Clinic
5. Aversions To Midtown Family Clinic

From the table above, the first part is based on the billing requirements and details are forwarded to the health insurance providers management organization while the other requirements will be used by the external organization and refer to the insurance companies. Through the information provided, the organization is able to follow up on the payment from the insurance companies and then the feedback is input into the system by the organization for in place of the clinic. The information that is input in the system by the organization that is contracted to work on billing includes that indemnification/billing info that allows the system to mark the payment from the insurance to have been approved or rejected. If the payment is processed then the billing organization presents the approval of payment and the payment files to confirm the payment else the rejected payment is marked on the patients account that then reflects on the patients end and allows for further follow up on the payment.

The hospitals on the other hand will have the patient details sent to them which include the names, registration number and other details that may be helpful for patient identification in the hospital systems. In return, the information that will be sent to the clinic from the hospitals through the EHR include the patient health antiquity, radiology pictures, laboratory and assessment outcomes and aversions that will be in file form that will allow for patient file updates without having to input the details manually at the front desk which is one of the processes that take a lot of time to process before the patient is passed on to the doctor.

Data exchange is a very sensitive aspect in operations hence the need of well detailed requirements and standards that ensure there in maintenance of integrity between organizations. For the Midtown Family clinic, there are standards that are required when sharing data with other healthcare organizations and others needed for the data exchange with the contracted health insurance providers management organization.

1. Health Insurance Providers Management Organization

a. Data Interchange Standard and description
These are the protocols, specifications, terminologies, and methods for the collection, exchange, retrieval and storage of data and information relating to healthcare applications i.e. medications and medical records. The introduction of technology has aided in disease management and patient outcomes. It has made the job of physicians, hospital administrators, nurses and the medical staff easier. This has ensured better outcomes in terms of quality in a shortened duration of time, it also provides safe patient care.
b. What the Data Interchange Standard requires
The standard allows the implementation of the interphase that is standardized and accustomed to an effective and easier use of the system as per the requirements of the standardized system that effects the user digression as an important part of the whole data use process.
c. Why the Data Interchange Standard is important
d. How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system
In this case, the data interchange covers the part of the organization that is supplied with the insurance claim data and is supposed to use the data solely for insurance claims and not for any other purposes. The data is the property of the clinic which means that is should not be used for any other purposed or given to other parties.

2. Hospitals

a. Data Interchange Standard and description
The privacy act of 1974 is a very good reference point for the data sharing process that has been modified to guide the hospitals on data sharing and the purpose of the data sharing process. It involves sensitive data sharing management hence defining that which should remain private and for being used by medical practitioners only.
b. What the Data Interchange Standard requires
The privacy of data remittance between medical institutions is as per the approval by the patient and in this case the approval requires integration of the patient approval part that will allow sourcing of information from hospitals.
c. Why the Data Interchange Standard is important
The interchange process is vital as it presents an easy reference point between medical personnel on past treatment procedures. Although there is the data collection process, it limits the exposure of patient data to other parties hence allowing only the medical institutions to share the date. This offers treatments details that show the patient profile hence helping the practitioner to proceed with treatment at the privacy of the patient which is a right that is highly valued by health practitioners.
d. How the Data Interchange Standard applies to the data elements listed and the Midtown Family Clinic EHR system
The standards allow the sharing of data with the clinic hence the medical processes that cannot be issued by the clinic can be sourced elsewhere. As a clinic, there are many medical tests that have to be sourced from advanced and specialized institutions hence the need for the standards to manage how the data is shared and stored to allow the digression of the patient data.
E.Summary
The EHR system is of great importance for the clinic and since there are third party organizations that are a part of the data management process, there is the need to understand the standards required in data sharing. The standards enable the articulate use of data in a manner that allows the privacy of the patient is maintained and there is a better management of the way the external organizations can use the data. The EHR is a multiorganizational system that should be well managed so as to ensure that there is proper channeling and use of data.

Reference

  Kalra, D. (2006). Electronic health record standards. Yearbook of medical informatics, 15(01), 136-144.
Westra, B. L., Delaney, C. W., Konicek, D., & Keenan, G. (2008). Nursing standards to support the electronic health record. Nursing outlook, 56(5), 258-266.
Feero, W. G., Bigley, M. B., & Brinner, K. M. (2008). New standards and enhanced utility for family health history information in the electronic health record: an update from the American Health Information Community's Family Health History Multi-Stakeholder Workgroup. Journal of the American Medical Informatics Association, 15(6), 723-728.
Sinha, P. K., Sunder, G., Bendale, P., Mantri, M., & Dande, A. (2012). Electronic health record: standards, coding systems, frameworks, and infrastructures. John Wiley & Sons.

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