Running head: NURSING CASE STUDY 1


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Nursing Case Study


April 2, 2017

The Objectives of Dr. Martin

Dr. Martin has several goals in the case study. First, he wants his medical process to function more competently than ever before. He also wants to earn more benefits from the medical practice. He also thrives on improving the medical practice by the use of the EHR system. He believes that the system will enable him to keep better health records and correct issuing of bills. The system will also facilitate the billing of medical insurance companies. This will ease the operations of the medical practice there will not be the need to employ a billing company. As such, Dr. Martin will have saved the amount that he could have used to pay the billing company, thereby increasing the profits of his business.

Dr. Martin also has a strategic goal of re-investing in the clinic to upgrade the technology in the clinic. Once he has achieved the goal of making more profits, he intends to use these proceeds to improve his clinic through the integration of technology. The Electronic Health Record (EHR) system will augment the operations and improve the incomes of the patients in his clinic. He wishes to get more patients through this system and as such, make more profits. He is so determined in making the profits to reinvest in the infrastructure of his clinic. Comment by Gabrielle L. Gretch: I’m not sure how an EHR will improve his patients’ incomes. I don’t think this is relevant to increasing his profits.

Another important goal is performing the basic renovation of his clinic. The doctor claims that the waiting and the examination area are old and need to be revamped. He also aims at expanding his clinic to accommodate three physicians and rent out the extra space to pharmacist and therapist so as to increase his profits. Dr. Martin can achieve this goal by using the profits he will make from the EHR system. Since more patients will be frequenting his clinic, he will have a greater opportunity to rent out some rooms for pharmacy. The patients would, therefore, buy their medicines from the pharmacy. Comment by Gabrielle L. Gretch: Delete this word. Comment by Gabrielle L. Gretch: Delete this word.

Finally, the doctor wishes to increase the quality of care in his clinic. Apart from the quality care, he seeks to improve the safety measures in the hospital as well as the financial management decisions. He eyes the patient care efficiencies and saving costs as the primary drives to achieve his goals. Comment by Gabrielle L. Gretch: This doesn’t discuss anything on how the implementation of the EHR would help meet this objective.

The patient visit workflow from the time he/she arrives at the clinic until the time he/she leaves

Patient enters the clinic


Patient checks in at the reception

Reserving for appointment

Pull paper chart


Does pt. info need an update?

Billing company sends back the billing details

Patient out

Make flow sheet to indicate the patient is ready for diagnosis

The insurance details forwarded to billing company

Collection of insurance card

Reception of the lab outcomes from the lab specialist

The patient gets treatment form the doctor

Transfer of results to


The inefficiencies of the Workflow

Scheduling- During the booking of appointments, there is a probability of the patient can be linked to the wrong doctor due to the issues of inaccuracy, certain physician based entries, and the use of manual appointments. Furthermore, the process is time-consuming, and the patient could wait for longer hours before he/ she gets the feedback. Similarly, suppose the patient forgets the date of appointment, the secretary would spend more time flipping through the file records to get the appointment for cancellation.

Similarly, since the patient will need to repeat the whole process of rebooking, the hospital clerk will also need to repeat the process of rescheduling. This is a waste of time and resources and interruption of the functionality of the operations in the clinic as the other appointments will have to be adjusted. Likewise, it could lead to loss of valuable information since the clerk has to maintain all the copies of the arrangements. Comment by Gabrielle L. Gretch: Good discussion of the inefficiencies with the current process. Some steps are missing, others are out of order. Please review scoring rubric for comments.

Validation of the insurance card is another major problem. There are many different insurance companies, and the billing company requires a protocol that is time-consuming and complicated. First, the hospital has to send a copy of the insurance coverage information to the billing company for validation. After validation, the hospital has to send the information again for the process to go through. This method is susceptible to faults and is also time-consuming and leads to confusion as well.

The workers of the clinic and the doctors have to spend extra time when dealing with the billing company. Likewise, after the examination of the patient, the billing company has to verify the payments and update their systems then sends back the billing inventory to the hospital. This can cause confusion between the two organizations. Similarly, it affects the patient as he/ she has to wait for all these processes regardless of his/her condition.

Finally, during the prescription, the pharmacist still have to go back to the lab technicians for clarifications. This will interrupt the physician and hence waste a lot of time for the doctor, and the patient.

Patient visit procedure for Dr. Martin’s clinic with the implementation of EHR system Technology

Nurse: medical history

Medical hbhhhistory


Soap notes

Patient’s Portal

Booking and Scheduling Appointment

Registration of Patient

Patient in



Billing at the

Front Office


Patient out


Prescription order

The Importance of the EHR Workflow in Eliminating the Efficiencies

The workflow with the implementation of EHR will begin with the registration of patients at the front office. This personnel will register the patients as soon as they enter the hospital or they make reservations over the phone or online. The patients will be given a free portal to indicate that they are members of the clinic and to ease work during their next visit. The workers of the hospital will just be checking through the portal of the patient.

The system will also allow a check-in an application that enables the patient to develop their personal profile and medical history. The medical history will include past illnesses if appropriate, prior treatments and the current diseases. The information will be helpful, and thus it will be displayed in the patient’s chart for the physician to access it and for the consultation process. The physician will also be able to make informed decisions linking the current diagnosis to the previous illnesses. Similarly, the process of checking in will be much easier as the physicians, nurses and the lab technicians will just test the patient’s chart flow in their portal to carry out their roles. Comment by Gabrielle L. Gretch: Good discussion of the improved process. Please review scoring rubric for missing steps, other comments.

Finally, the EHR system will be more efficient in the billing process as a billing company will not be necessary. The insurance company will get the bills much easily with the implementation of the system. The invoices and claims will be appropriate and prompt. There will not be wastage of time for verification from the billing company. As such, the clinic will be able to serve more patients in less time and provide them the best care.


Case study. UMUC Family Clinic.

Charles, K., Willis, W. K., & Coustasse, A. (2014). Does Computerized Physician Order Entry Reduce Medical Errors?.

Flores, C. (2016). Upgrading EHR System for Local Clinic (Doctoral dissertation, The College of St. Scholastica).

Meeks, D. W.,Taylor, L.,(2014). An analysis of electronic health record-related patient safety concerns. Journal of the American Medical Informatics Association.

Nguyen, L., Bellucci, E., & Nguyen, L. T. (2014). Electronic health records implementation: an evaluation of information system impact and contingency factors. International journal of medical informatics, 83(11), 779-796.