Business Case Proposal Highlighted points PDF

Preview

Summary

Assignment notes...

Description

Running head: Business Case Proposal: New Century Wellness Group

Business Case Proposal: New Century Wellness Group

Saikiran Mallogi Piyush Zope IST-7020 Wilmington University 02/23/2019

1

Business Case Proposal: New Century Wellness Group

2

Business Case Proposal: New Century Wellness Group Executive Summary With advancement in technology, most of the organizations have made significant strides towards automation and computerization. More and more organizations continue to rely heavily on computer systems and networks to run their day to day operations ranging from supply chain management to inventory management to human resources and payroll. Technology has transformed and improved operations to the extent that it has become one of the critical components. New Century Wellness Group is a specialized medical provider that offers a holistic approach to healthcare. It mainly focuses on traditional and preventative medical care. Being a well-established clinic, New Century Wellness Group has approximately 8,000 patients who come from more than 325 different employers. These are employers who provide healthcare benefits to their employees. Currently, New Century Wellness Group is accepting health insurance coverage from twenty-five (25) different insurance carriers. Due to its tremendous success, the clinic is now considering expanding to new locations. Given that the health care field mainly thrive in technology, it is vital for New Century Wellness Group to adopt modern technologies. With a Healthcare Information Management System, the clinic would better serve its rising number of patients by delivering services on time and keeping its billing and filing system up to date.

Business Case Proposal: New Century Wellness Group

3

1.1 Strategic Environment 1.1.1 Organizational Overview Mission Ten (10) years ago, Timothy Jones and Dolores Garcia, both of whom are medical specialists, decided to combine their medical practices and came up with New Century Wellness Group. Their mission was to establish a clinic that would offer fitness, preventative, and traditional medical care. This mission lives till this day. Strategic vision, goals, and service objectives Current activities and services Some of the medical services provided by New Century Wellness Group include preventative, fitness, and traditional medical care. This involves some activities including:      

Appointments Filing of patients’ information Preventative care screenings Blood pressure reading Monitoring of patients undergoing treatment Billing

Key Stakeholders and Clients The key stakeholders include Timothy Jones and Dolores Garcia. This is the owners of the New Century Wellness Group. Other stakeholders include four (4) primary care physicians, four (4) physical therapists, one (1) nurse, one (1) registered nutritionist, and seven (7) supporting staff. The clients are the patients (8,000 patients), 325 employers, and twenty-five (25) insurance companies. Organizational structure and talk about stakeholder anlysis

Business Case Proposal: New Century Wellness Group

4

Founders Timothy Jones Dolores Garcia

Office Manager Anita Devenport

Ordering and Suppliers of Medicine Carla Herrera

Human Resources Fred Brown

Appointments Lisa Sang

Patient Records Susan Gilford

Insurance Billing Tammy Alipio

Accounts Tom Capalet

Payrol and Taxing Corinne Summers

Existing capacity New Century Wellness Group is a healthcare provider operated by Timothy Jones and Dolores Gracias. The two are medical practitioners who have been in the medical field for over ten (10) years. In addition to Timothy Jones and Dolores Gracias, the clinic has physicians, nutritionist, physical therapists, nurse practitioner, and support staff. As we talk, the clinic is serving 8000 patients from 325 employers. It is also accepting 25 insurance companies. Due to its expansion, the clinic intends to open a new location. 4 Primary Care Physicians 4 Physical Therapists 1 Nurse 1 Registered Nutritionist

Business Case Proposal: New Century Wellness Group

Strenths Customer Loyalty Innovative Culture Unique Products

Opportunites Innovation Emerging Markets New Services

5

Weakness Online Presence Cost Structure Weak Management

Threats Intense Competition Govt. Regulations Volatile Costs

Business Case Proposal: New Century Wellness Group

6

1.1.2 Business Needs With an increasing number of staff and patients, New Century Wellness Group requires an inhouse system that will ensure that the medical providers and the staff work efficiently. The system must come alongside medical practice software solution that all the medical providers and the staff to streamline billing, accounting, payroll, and scheduling. The system must also be able to electronic medical records by automating appointments, order entry, and decision support systems. 1.1.3 Drivers for Change New Century Wellness Group wants to expand its clinic to accommodate more doctors and patients. At the same time, the clinic hopes to continue expanding its range of medical services in order to be in a position of helping more people. Strengths: Weakness: Opportunities: Threat: 1.1.4. Business Outcomes     

Generation of electronic medical records. The automated decision support system Computerized provider order entry system Automation of appointments Streamlined accounting, scheduling, payroll, and accounting

1.2. Strategic Fit

Business Case Proposal: New Century Wellness Group

7

With the implementation of the Healthcare Information Management System, New Century Wellness Group will ultimately streamline its accounting, payroll, scheduling, and accounting processes. Also, the clinic will support electronic medical records in place of paper-based medical records. Electronic medical records will be automatically initiated once Lisa Sung schedules an appointment with a patient. The records will include patients’ details including name, address, medical history, demographics, and insurance information. This information will assist in creating a daily list of appointments. A computerized provider order entry will make it possible for the staff to account for all transactions as and when they happen. Every medical order and prescription will be entered to ensure that proper and quality medical care is administered. 1.3 Detailed Description of the Business Needs 1.3.1 Problem/Opportunity Statement New Century Wellness Group is currently using a combination of paper-based and fragmented computer systems to manage and track its patients’ records. This is a well-organized workflow that has been working smoothly. However, with the tremendous increase in the number of patients (8,000 patients) and the establishment of new locations, the existing staff are stressed up and overworked. Due to the growing volume of work, the staff has been forced to devote more than six (6) hours of overtime per week. Each day, there are three file errors. Each error takes twenty (20) minutes to correct. If New Century Wellness Group continues operating this way, it will be more vulnerable to human errors which will adversely affect the provision of quality healthcare to patients. The clinic requires a well-established Healthcare Information Management System to be effectively operate its current clinical operations and future growth. 1.3.2 Constraints

Business Case Proposal: New Century Wellness Group

8

Some of the constraints include:    

Paper-based process Fragmented computer system Few medical staff 8,000 patients and 325 employers

1.4 Scope 1.4.1 Boundaries State what is included in investment: The list below shows a list of data flows and data elements that must be included in the new Healthcare Information Management system: Data Flows

Data Elements

Drop-in Report Bill Hours Payment Fixed fees Receipt data Report data Patient data Insurance fees Patient name Patient address Patient phone number Household Patient demographics Patient registration number Date of appointment Appointment number Insurance company number

excluded from investment: Nevertheless, the new system should not include payment details of the patient's such as credit and debit card number. The inclusion of insurance company number must get approval from both

Business Case Proposal: New Century Wellness Group

9

the patient and the insurer (employer). In the case a patient request for privacy of his/her ailment, the system should not include details on the ailment. 1.4.2 Stakeholder Analysis The primary stakeholders include Timothy Jones and Dolores Garcia. The two are the owners of the New Century Wellness Group. Other stakeholders include primary care physicians, physical therapists, a nurse, a nutritionist, and supporting staff. The person responsible for managing patients’ appointments and initiating patients’ files is Lisa Sung. Susan Gifford is responsible for maintaining physical patients’ records. On the other hand, Carla Herrera is responsible for placing supply orders after patients’ visits. Tammy Alipio is the person who initiates the billing process. He is an insurance billing specialist. Tom Capaletti ensures that all claims are followed for purposes of payment. He is responsible for accounts receivables. Fred Brown is the person in charge the human resources (HR) and employment benefits. Corinne Summers is responsible for profit distribution, tax reporting, and working with payroll. She reports to Fred Brown. 2.0. Managing the Investment 2.1 Governance and Oversight The new system will be operated and managed by the receptionist, nurses, doctors, and the billing department. The receptionist (Lisa Sung) will receive training on appointment scheduling, view appointment calendar, check-in/outpatient, updating patients’ data, viewing paystubs, work schedule, and emails. On the other hand, nurses will be trained on appointment scheduling, updating patients’ data, viewing appointment calendar, and updating patient medical history. Doctors will be trained on appointment scheduling, updating patients’ data, viewing appointment calendar, updating patient medical history, prescribing medication, and sending scripts to the pharmacy. Last but not least, billing department will be trained on viewing appointment calendar,

Business Case Proposal: New Century Wellness Group

10

handling claims, managing patient personal data, sending claims to insurance, viewing insurance claims responses, managing billing & insurance information, and submitting final bill to patients 2.1.1 Project Management Strategy 2.1.2 Implementation Plan – show in flow chart: system inputs – (system process) system outputs System Inputs:  Patients’ details including name, email address, phone number, date of birth, marital status, insurance information, etc.  Medical history including screening results, lab results, past surgeries, etc.  Appointment information.  Insurer (employee) information including name, title, contact information, work schedule, and pay. System Outputs:    

Insurance/billing claims Supply orders Employee benefits and paycheck Medical tests, prescriptions, and referrals.

System Processes 

Every patient’s medical procedures are adequately coded for accurate billing, as well as,



follow up procedures. Patient’s medication information and medication are crosses referenced in order to



overlap care and adverse drug interactions. In the case there is confusion between the new medical orders and past patient history, the system must immediately alert the medical provider through a pop-up message on the



screen. Daily appointments and patient appointments entered into the schedule are automatically generated.

Business Case Proposal: New Century Wellness Group 2.1.4 Schedule and Approach

11

Business Case Proposal: New Century Wellness Group 2.1.5 Estimated Costs

2.1.6 Project Review Strategy  

Make sure that every medical procedure is assigned to the respective billing code. Double checks to ensure that medications and prescriptions prescribed by the medical providers do not conflict with other prescriptions and medications. If that happens, the

12

Business Case Proposal: New Century Wellness Group

13

system must generate a pop-up message to allow for an override in the case the medical providers feel it is the best option. 2.2 Risk Management Strategy Every medical practitioner and a staff member would be required to have unique login credentials. The login credentials will be used at varying layers of access. For instance, staff members will not have the same level of access to patients’ information and record as medical providers. Only the medical providers will have login credentials to patients’ medical records. Therefore, access and capabilities will be limited to tasks and responsibilities. 2.2.1 Risk Summary The New Healthcare Information Management System might be prone to unauthorized access especially if the computing system is not instituted with login credentials. If unauthorized users access the system, they might share confidential information about the patients. Also, they might steal patients’ payment and insurance information. If the unauthorized users are naïve, they might alter, delete, or modify medical records. In the case of fires, floods, and other natural calamities, medical records might be lost. 2.2.2 Risk Management Approach 

All systems will have login credentials. The login credentials will be shared based on



tasks and responsibilities. Medical records on transit will be encrypted to make sure that hackers do not have



access. Cloud computing would be used to backup all medical records and data in the cloud.

2.4 Performance Measurement Strategy 2.4.1 Key Performance Indicators 

The new Healthcare Information Management System must be operational 24/7

Business Case Proposal: New Century Wellness Group 

The system must generate medical and insurance information accurately and quickly.

14...