UMUC Family Clinic Case Study
In 1980, the UMUC Family Clinic was opened in a growing family area near UMUC, Maryland, by Dr. Tom
Martin, a University of Maryland graduate after he retired from the US Navy. It is a small internal
medicine medical practice. Dr. Martin has been the owner and manager of the medical practice. He has
two nurses, Vivian and Manuella, to help him. Usually, one day nurse takes care of the front desk while
the other nurse assists the doctor during the patient visits. They rotate duties each day. Front desk
duties include all administrative work from answering the phone, scheduling appointments, taking
prescription refill requests, billing, faxing, etc. So if on Monday Vivian is helping the doctor, then it is
Manuella who takes care of the front desk and all office work. The two nurses are constantly busy and
running around and patients are now accustomed to a minimum 1-2 hour wait before being seen. And if
one nurse is absent, the situation is even worse in the clinic. The clinic has 3 examination rooms so the
owner is now looking into bringing a new physician or nurse practitioner on board. This would help him
grow his practice, provide better service to his patients, and maybe reduce the patients’ waiting time. Dr.
Martin knows that this will increase the admin overhead and the 2 nurses will not be able to manage any
additional admin work. He faces several challenges and cannot afford to hire any additional staff for
admin so the owner has to optimize his admin and clinical operations. The practice is barely covering the
expenses and salaries at the moment.
Dr. Martin’s practice operation is all paper-based with paper medical records filling his front desk shelves.
The only software the doctor has on his front office computer is an appointment scheduling software.
Even billing insurance companies is done in a quasi-manual way. For billing insurance, the front office
nurse has to fax all the needed documentation to a third party medical billing company at the end of the
day. The medical billing company then submits the claim to the insurance company and bills the patient.
The clinic checks the status of the claims by logging into the medical billing system, through a login that
the medical billing company has provided the clinic to access its account. There is no billing software
installed at the practice, but the nurses open Internet Explorer to the URL of the medical billing company
and then use the login provided by the third party medical billing company. Of course, the medical billing
company takes a percentage of the amount that the clinic is reimbursed by the insurance. The medical
practice does not have a Web site, and essentially still operates the same as it did in 1980.
One problem that you notice immediately is that there is no quick way to check patients in and if the
nurse is on the phone while a patient tries to check in, then the patient has to wait until she is done. The
doctor could be also waiting for the patient to be checked in, wasting valuable doctor time. Also many
patients experience long waits on the phone when they are trying to schedule an appointment, while the
nurse is checking in patients or responding to another patient’s request in the office. Every year, the
clinic requires its patients to fill their information and insurance information anew, rather than have them
just verify what they have on file. This annoys some of the moms when they have to fill all this
paperwork and take care of their sick young child in the lobby. All of the medical records, lab results and
financial and payroll accounts are kept on paper, so there is not a quick way to look up a patient’s history
or current prescriptions if the doctor gets a call while he is away from the office. At the beginning of
each day, the nurses pull the files for all patients who have appointments scheduled for that day. But the
clinic also accepts walk-in patients.
At a recent medical conference Dr. Martin learned of the government’s financial incentives for Electronic
Health Records (EHR) and meaningful use adoption. After attending several demonstrations by the
different vendors, ClinicalWorks, AthenaHealth, etc., he realized how inefficiently his practice is running
and realized all the opportunities that EHR systems can bring. The owner recognizes all the benefits of
moving to electronic medical records but feels very overwhelmed on how to start, or what to do. He is
also concerned about disruption to his practice which may negatively affect his patients’ care experience.
Moreover, neither the doctor nor the nurses have any knowledge or experience when it comes to
information technology. Upon the recommendation of a fellow doctor, Dr. Martin has decided to hire an
independent EMR Consultant, to help him select the best EHR for his practice. His friend also advised him
that he should not just buy any package from a vendor but have the EHR consultant analyze the
workflow processes at the practice first, then optimize them, and then look at the EHR systems.