Implementation of NueMD System in a Clinic

The clinic is proposing to use NueMD as its IT solution, which has all the necessary modules to streamline its operations. The software is easy to use and can be accessed through desktops and smartphones. The configuration of the system is straightforward, and employees can receive training on how to use it. Data migration will involve entering patient data, appointment schedules, and staff information from past records. Maintenance will be automatic, with updates provided by the vendor. Overall, NueMD offers a comprehensive solution for the clinic, automating repetitive tasks and improving efficiency.

EHR System
All Sections Covered

Table of Contents
Introduction..............................................................................................................................................2
I. Organizational Analysis and Requirements (Stage 1)..........................................................................2
A. Introduction..................................................................................................................................2
B. Strategic Use of Technology........................................................................................................3
C. Components of an Information System.......................................................................................3
D. Functional Requirements.............................................................................................................5
E. Summary......................................................................................................................................6
II. Sharing Data........................................................................................................................................6
A. Introduction.....................................................................................................................................6
B. Need to Share Data..........................................................................................................................6
B.1. External Organization #1 and purpose of communication.......................................................7
B.2. External Organization #2 and purpose of communication.......................................................7
C. Types of Data to be shared..............................................................................................................7
D. Data Interchange Standards............................................................................................................8
D.1. External Organization #1: Laboratories...................................................................................8
D.2. External Organization #2: Health Insurance Providers...........................................................9
E. Summary.......................................................................................................................................10
III. Ethical, Legal and Regulatory Policy Issues...................................................................................10
A. Introduction...................................................................................................................................10
B. Table of Ethical, Legal and Regulatory Policy Issues..................................................................10
C. Addressing the Most Difficult Issue.............................................................................................22
D. Summary.......................................................................................................................................22
IV. System Recommendation................................................................................................................22
A. Introduction...................................................................................................................................22
B. Proposed IT Solution.....................................................................................................................23
C. How the Proposed IT Solution Meets the Requirements..............................................................23
D. Improvements from Proposed IT Solution...................................................................................24
E. Implementation Considerations.....................................................................................................25
F. Summary........................................................................................................................................27
Conclusion.............................................................................................................................................27
References..............................................................................................................................................27

Introduction
The current paper is concerned with the assessment of current operational procedures of
Midtown Family Clinic and suggestion of suitable Electronic Health Record System.
Midtown Family Clinic is owned by Dr Harold Thomson. The clinic employs two female
staff and caters to the local patients of the local town. The entire procedures within the clinic
are manual. One staff assists the doctor during the patient visit, while another staff handles
the various paper work such as form fill-up, prescription refill, answering the phone.
Gradually it was identified that the manual handling of the entire processes is cumbersome.
Dr Harold decided to implement EHR within the organization. The current paper assesses the
various aspects of operational activities within the clinic and based on the study, a suitable
EHR system will be suggested. The paper is divided into four main parts. The first part
analyses the organization and the requirements. The second part focuses on the data sharing
within and outside the organization. The third part focuses on the ethical, legal, and
regulatory policy issues in relation to the implementation of the new system. The fourth part
recommends the EHR system to Dr Harold for his clinic.
I. Organizational Analysis and Requirements (Stage 1)
A. Introduction
The current section analyses the goals of the organization considering the EHR
implementation. The sub-section C discusses people, organizational processes, and
data/information in relation to the information system requirements. The sub-section D looks
into the functional requirements of the system. The sub-section E summarizes the entire
section II.

B. Strategic Use of Technology
The three strategic goals identified by the Midtown Family Clinic are given below:
1. Strategic Goal 1: Operate medical practice more efficiently
Explanation: The use of HER is likely to automate most of the repetitive processes and
reduce the effort of the staffs in digging out the historic data of the patients. This will
eliminate the manual form filling and fast track the entire process. This will eventually make
the medical practice operation efficient.
2. Strategic Goal 2: Make Financial Profit
Explanation: The EHR will help the organization handle more patients in lesser time frame.
This will help in increasing the revenue for the organization.
3. Strategic Goal 3: Upgrade and Expand the clinic
Explanation: HER systems are equally efficient in handling small group of patients or large
influx of patients. Therefore, expanding will be easier with the same EHR system.
C. Components of an Information System
The current sub-section will look into the various components related to the information
system, namely, people, organizational processes, and data or information.
C.1. People
The table given below are the people who will be using the new EHR:
Person Role Functions
Dr Harold Doctor Past record of medical
treatment of patient
View scheduled

appointments
Vivian Staff Schedule appointments for
the doctor
Patient Information Entry
Maria Staff Generate automated bills
Automatically manage clinic
insurances
C.2. Organizational Processes
Three processes that can be improved by the organization are listed below:
Process 1: Scheduling Appointment
The patients can schedule appointment with the doctor from the comfort of their home and
don’t have to make calls to the staff. The system will show the patients available schedule
and appointment can be made through mobile application or web portal (Tang & McDonald,
2006).
Process 2: Billing
All the bills will be generated automatically based on the medicine required and the doctor’s
fees. Staff will not have to invest manual effort.
Process 3: Easy Patient Record Management
The patient past personal information and past treatment information can be stored in a
database and can be retrieved with ease (Hsiao & Hing, 2012).
C.3. Data/Information

The table below lists down the ten types of data that will be needed by the clinic:
Data/Information Items Needed for EHR System
1. Name of the Patient
2. Age of the Patient
3. Male/Female
4. Address
5. Phone Number
6. Email Address
7. Blood Group
8. Emergency Contact Number
9. Relation with the Emergency Contact
10. Employer
D. Functional Requirements
The table below show the necessary requirements for the EHR system as per the case study:
Functional Requirements
1. Auto-schedule appointments and show available schedule
2. Print out information when needed
3. Record patient data
4. Update patient data
5. Manage bills and invoices automatically
6. Manage insurance bills automatically
7. Automatically notify doctor of next appointment
8. Show patients past record (on screen and printable)
9. Online check-in of patients

10. Online record of laboratory copy
E. Summary
The overall goals of the clinic are to improve the patient check in and increase the revenue of
to expand further. The new HER system can be used strategically for the activities that are
repetitive and requires less human intervention. The necessary data of the patients such as
name, location, age, and others can be recorded to keep track of patient improvement and
reduce the need for repetitive manual entry of the information.
II. Sharing Data
A. Introduction
In the second stage, the focus of the paper is on the sharing of the data among the two
external organizations. The two external organizations are laboratories, and the health
insurance providers. The next few sections will look into the data sharing needs with these
organizations, types of data to be shared, and the applicable data interchange standards.
B. Need to Share Data
The following sub-sections details on the two external organizations with whom the data
interchange will take place and the purpose of the communication. Data sharing in healthcare
ensures that the outcomes for the patients can be improved (Wicks et al, 2010)
B.1. External Organization #1 and purpose of communication
The first organization is the laboratory where the various tests of the patients are carried out
such as blood test, urine test, and others. Whenever a patient visits a doctor, then different
tests are conducted which can only be done at laboratories maintained by the other

organizations. Unless doctor will not see the report, it will be difficult to make the right
treatment decision. Therefore, information from these laboratories are necessary for the
doctor’s clinic.
B.2. External Organization #2 and purpose of communication
The second organization is the insurance provider. The doctor is mostly visited by patients
with health insurance. Here, the payment to the doctor is partly made by the patient and the
rest is paid by the insurance companies. Therefore, it becomes important for the doctor to
know the amount which will be paid by the patients and the amount to be paid by the
insurance companies. Therefore, for this purpose, the doctor needs to communicate with the
insurance companies, every time a patient visits the clinic.
C. Types of Data to be shared
Both the organizations have different data needs and they can share only specific type of data.
Therefore, in this section, data types have been identified which will be shared among the
clinic and the external organization.
Organization #1: Laboratories
Data Element or Item Data Goes TO/FROM Midtown Family
Clinic
1. Patient Name From
2. Patient Phone Number From
3. Number of Completed Test To
4. Full Report of completed test To
5. Tests in Progress To

Organization #2: Health Insurance Providers
Data Element or Item Data Goes TO/FROM Midtown Family
Clinic
1. Patient Name From
2. Patient Phone Number From
3. Bill to be paid From
4. Amount to be paid by Patient To
5. Amount to be paid by Insurance Provider To
6. Due date of payment transfer To
D. Data Interchange Standards
The current section will focus on the various interchange standards with the external
organizations.
D.1. External Organization #1: Laboratories
The data interchange standard refers to the rules or policies that should be followed to ensure
that the quality of the data is maintained (Mead, 2006). It also ensures that the stakeholders
such as patient, doctor, and others receive appropriate information needed for uninterrupted
treatment or other required action. The DIS requires that the different parties value the
importance of privacy, security, and availability of right data. It is important as it helps all the
parties access the data easily and responsibly.

As per the data exchange with the laboratories are concerned, given below are the standards
that have been defined:
- All the data should be in the electronic form. The organizations must record all the
data on the computer and it should be in shareable format such as .pdf, .docx, .rtf,
or .txt
- Data should be uploaded to the clinic’s database and the patients should be given a
copy of the same on their email addresses.
- Laboratories are required to verify the availability of name and phone number from
the clinic.
- Only full patient report should be uploaded to the clinic’s database to avoid confusion
and data duplication.
- Laboratories will update the system about the incomplete report submission.
D.2. External Organization #2: Health Insurance Providers
The presence of data standards will ensure that the necessary flow of information is
maintained throughout the network while ensuring the safety of the patient data (Souza et al,
2007). As per the insurance provider is concerned, it is required that the data regarding the
insurance payment are exchanged securely with the clinic. The information should be in the
human readable format and on the encrypted network to prevent data theft. The key
information transfer to take among the clinic and the insurance company is regarding the
payment due and whether the patient can avail treatment on insurance. The timely delivery of
this information is necessary for appropriate actions from the clinic in favour of the patients.
E. Summary
In the second stage, the sharing of data has been discussed. The organizations that have been
identified, with whom the data interchange will take place, are laboratories, and the health

insurance providers. The types of data that will be shared among these organizations are
listed. The patient name and the phone number are the common set of data to be transferred
from the clinic to these organizations for patient identification. Appropriate data interchange
standards have been discussed too.
III. Ethical, Legal and Regulatory Policy Issues
A. Introduction
In the current section, the ethical, legal, and regulatory policy issues have been considered for
the discussion in relation to the implementation of EHR system in the Midtown Family
Clinic. In the second sub-section, twenty ethical, legal, and regulatory policy issues have
been covered. In the third section, the most difficult issue among these twenty issues has been
picked and discussed. In the end, a summary has been provided.
B. Table of Ethical, Legal and Regulatory Policy Issues
Table of Ethical, Legal and Regulatory Policy Issues
Topic Definition of the Topic
How the topic impacts and
will be addressed in the
selection and use of an
EHR system
1 Safe Design The safe design refers to the
system that is safe for the user
to use and does not harm them
in any way.
The users will be accessing
the system through their
personal devices, it should
be safe to use and does not
disrupt other parallel
systems. This has been
addressed by understanding

the compatibility of the new
system with the existing
system and appropriate
design steps will be taken.
2 Meaningful Use
The system should be of use to
the users and must help them
resolve any challenge or
support the users in the
intended way.
The EHR should be able to
fulfill the need of the users.
The EHR to be developed
has been based entirely on
the current requirement of
the clinic and no
unnecessary modules have
been introduced.
The functions of the systems
are as per the need of all the
stakeholders. The dashboard
for the doctor, other staff
members. A dashboard for
the laboratory will be there
for data entry on various
tests.
3 Quality Improvement The implementation of the
system should be able to
improve the quality of the
process.
The EHR should be able to
fast track the process. At
present, all the processes are
manual and the newly

implemented EHR system
will bring everything online
and the doctor and the other
staff members will be able
to reduce the paper work
and increase the time for the
patient services. This is
more likely to increase the
quality.
4 Data Accuracy The data accuracy refers to the
aspect where it is judged that
whether the data values entered
into the system is correct.
This aspect will help the
doctors and patients in easily
accessing the right
information. This can further
improve service by reducing
time in recollecting and
verifying the data. Various
conditional tags will be
placed in the system that
will allow the users to enter
specific type of data. Also,
the duplicate data will be
crossed checked and data
operator will be notified of
the same for further

verification.
5 Data Accessibility
The data accessibility refers to
the availability of the data to all
the concerned stakeholders.
This will allow everyone to
participate equally in the
service. The wide
availability of the data also
reduces the chances of errors
as all the concerned person
can check and verify the
data at their end, be it doctor
patient, or staff.
6 Data
Comprehensiveness
The data should be up to date,
and near the event or the
observation. The focus should
be on current data.
This will help in timely
decision making by the
doctors. The doctor will be
able to diagnose the issues
on time. In the clinic, all the
data will be entered in real
time, whether from the
doctor’s side, staff, or
laboratory. It will be ensured
that no paper and pen mode
is used for any relevant note
taking or data entry.
Information will be brought
and kept online. All the
individuals will be put in the

habit of online note making
in the built in dashboard.
7 Data Consistency
Data in the system should act,
behave, stored, and transact
only in the established process.
Data consistency is
necessary to increase the
reliability on the data. It
helps the stakeholders to see
and expect the data to
behave in a particular way.
In the current EHR system,
the data rules will be defined
for data manipulation in the
system and outside the
system. Also, it will be
ensured that the operations
related to the data
transaction is taking place
with accuracy and not
violating any predefined
rules.
8 Privacy System should allow disclosure
or misuse of the information. It
should only be used after the
appropriate authorization
(CDCP, 2003).
This will increase the faith
of the customers on the
system. They can readily
support the new system
through providing accurate

information.
The privacy policy will be
written and implemented in
the clinic. It will be ensured
that each individual abides
by those rules.
9 Confidentiality The data in the system should
be confidential and accessible
only to the authorized
personnel. The data should
have limited accessibility under
the predefined rules and
regulation.
This will increase the faith
of the patients on the
hospital. The customers will
share the information with
confidence with the doctor.
The doctor, staff and the
laboratory staffs, and
insurance company will not
share the information with
any third party. If there is
any need, then the consent
of the concerned patients
will be taken.
1
0
Security The system should be secure
from any external or internal
threat. Also, the system should
be protected from theft of
damage either in software or
This will ensure that the
system can provide support
to the clinic without
disruption. It will also
protect the data from being

hardware (Annas, 2003). stolen. For the current EHR,
appropriate antivirus, and
firewall will be placed. Also,
users will be trained on
ways to protect the system
from any data breach.
1
1
Individually
Identifiable Health
Information
These are the personal
information of the patients
visiting the hospital. It must be
kept confidential.
The protection of this
information is necessary as
it is directly associated with
the reputation of the clinic.
Also, it is an ethically sound
step to protect the personal
information.
In the current EHR system,
the individual information of
the patients will be stored
securely. Only the relevant
individuals will be given
access to it.
1
2
Protected Health
Information
It refers to any information
related to health status,
provisions, payment, and others
that are collected by a business.
These information needs to
protected from unsolicited
sharing. Most of these
information are directly
related to patients and

therefore the protection is
considered mandatory for
the sake of clinic’s
reputation and credibility.
The appropriate measures
will be taken to protect such
information. The
information will be shared
with the appropriate
organizations only.
1
3
HIPAA Privacy Rule This rule provides standards
that protect the medical records
of an individual.
The rule is important to
protect the clinic patients’
records. It also provides
standards that should be
followed to protect other
health records of the
patients.
In the clinic, most of the
policies will be directly
picked from this rule. It will
be ensured that the clinic
and the associated
institutions or organizations

abide by this rule.
1
4
HIPAA Security Rule
This rule has stated certain
standards that should be
followed to protect the
electronic version of the patient
records.
This rule will require that
the clinic place all the online
data under given standards
for the security. This will
help in improving the
reputation of the clinic.
The clinic will include all
the necessary standards
mentioned under this rule.
1
5
Business Associate
Contracts
This is a contract between
HIPAA covered entity and the
HIPAA business associate.
The business associates of
the clinic have to ensure that
the protected health
information is secured. The
disclosure of the information
should only be under
permissible limit.
The clinic will sign contract
with all its business
associates. An electronic
version of the contract will
be shared with all.
1
6
Authentication It is a process in which the
credentials given by the user is
This will require that the
EHR system has user

verified against data stored in
the system and then access is
given.
authentication system. The
users can only access the
system after keying in
particular codes, it can be
username password, or
thumb print.
In the current EHR system,
all the users will be provided
individual username and
password. The users will be
required to enter the id and
password every time they
access the system.
1
7
Authorization Giving access rights of
resources to particular entity or
individual only.
This will require that the
data should segregated into
less and highly critical.
Based on the importance,
the accessibility to different
users will be provided.
In the current EHR system,
the access to the data will be
based on the need of each
user. The doctor will be
given the full data access,

staff will be given only
access to certain
information, the laboratory
staffs will be given access to
name, address, and contact
of the patients along with
the data they enter into the
system.
1
8
Encryption
It is the process in which the
data is encrypted so that only
the intended users can access
the data and not someone else.
This will require that the
system uses encryption
technology. The clinic
information will be
encrypted with SSL
encryption.
1
9
Technical Safeguards It is the technology and the
policy that helps in protecting
the health records and ensures
control accesses.
This requires that the health
information of the patients is
protected. Also, it requires
that access to information
should be limited to
authorized personnel.
In the current EHR
authorized personnel will be
given access such as doctor
and staff. Also right security

measures will be there to
safeguard the information.
2
0
Healthcare Ethical
Principles
It states that the medical
practice should adhere to
autonomy, justice, beneficence,
and non-maleficence.
This aspect requires that the
entire medical team work for
the good of the patients and
do not engage in any
activities that may harm the
patients in any manner.
The current EHR will not
share any information to the
unauthorized third party as it
is unethical. Only relevant
persons will have access.
C. Addressing the Most Difficult Issue
The most difficult issue will be data comprehensiveness. The reason is that this aspect
requires keeping the data up to date and relevant in the system which can be accessed
anytime for right decision making. However, the clinic staffs, doctor, and other external
individuals are not in habit of making online update of the data in the real time. And if the
data will not be entered on time or in real time into the system, then the stored data will lose
its significance. Therefore, it has to be ensured that the data comprehensiveness is
maintained. To ensure that this happened, the clinic has to train its personnel and all the
external personnel who will be accessing the system. However mere two day training would
not be enough and therefore constant monitoring will be kept for at least a month. When the

staffs and all the members who have the access to the system become habituated, then the
monitoring will be stopped.
D. Summary
The current section was concerned with understanding the various ethical, legal, and
regulatory frameworks that is concerned with the EHR system for the clinic. Twenty relevant
aspects have been discussed and the ways to implement those in the current proposed system.
Data comprehensiveness has been found to be difficult to implement. However, it is has been
expected that right training, monitoring, and control can help in improving this aspect.
IV. System Recommendation
A. Introduction
The current section of this paper is concerned with understanding the IT solution that has
been proposed to the clinic, the way proposed solution meets the requirements of all the
stakeholders involved, and things that should be considered while implementing the
technology.
B. Proposed IT Solution
The IT solution that has been proposed to the clinic is NueMD. The full name of the software
is NueMD Medical Billing Software. It has been considered over other software as it fulfils
all the requirements as specified earlier in the paper. The price of the software is $149 per
month, per provider. The software covers various aspects such as electronic health recording,
medical billing, scheduling, and other additional elements. The software has easy to
understand user interface and with the given demo and tutorial, anyone can understand it
easily and use it smoothly. This software has received 4.5 average rating which has been
gathered from 409 users (Softwareadvice.com, 2017).

C. How the Proposed IT Solution Meets the Requirements
The table below shows how the proposed solution meets the requirements identified in the
stage I:
Req.
No
Functional Requirement (from
Functional Requirements table in
Section I)
Explanation of How the Proposed
System Meets the Requirements)
1 Auto-schedule appointments and show
available schedule
System has auto-scheduler that helps
manage all the schedules on its own.
2 Print out information when needed The software connects with printer and
can give print command with the help of
printer software in the computer.
3 Record patient data The electronic health record module will
allow easy management of patient data
4 Update patient data Patient data can be edited and deleted as
per the requirements
5 Manage bills and invoices
automatically
These are automatically calculated after
entering the initial values. It provides
seamless management of all billing
activities.
6 Manage insurance bills automatically The staff members can enter insurance
data into the system as per each patients.
System has special insurance module to
take care of this aspect.
7 Automatically notify doctor of next
appointment
It sends notification on phone or email
depending on the preference.
8 Show patients past record (on screen All the past record can be accessed with

and printable) just one click.
9 Online check-in of patients The patients can manage their profile and
book appointments as required.
10 Online record of laboratory copy The system has special laboratory report
module and this is the key reason for the
selection of this software over others in
the lot.
D. Improvements from Proposed IT Solution
The proposed IT solution will help the clinic to manage more patients in shorter time possible
and it will be able to increase its revenue. Also, the clinic staffs and the doctor will have more
time in hand to think over other aspects of the clinic and improve care taking facility for the
patients.
The new system will drastically improve the processes for the clinic. As expected in the
beginning, the NueMD will help streamline all the time consuming routine activities such as
appointment scheduling, appointment tracking, billing, record keeping, and others. This will
allow the doctors to effectively manage the laboratory and other data at one place and reduce
the dependency on paper based processes.
E. Implementation Considerations
The software is cloud based and can be used by the clinic over the secure internet connection.
The software also has mobile application which gives seamless on the go access to all the
necessary information.
Implementation Considerations
1. Vendor Agreement

The Midtown Family Clinic has to buy the subscription for the system. A yearly payment on
the system will be enough to get the access. At present the cost of the system is $149 per
month, per provider.
2. Hardware and telecommunications
The hardware requirement of the software is very basic. The general configuration of
computer will be enough to operate this software alongside other system applications. The
mobile version of this system works like other common mobile application and there will be
no issue in running this app on any smartphones capable of running external applications
from Google Play Store or Apple Store. In the computer, wireless or LAN internet connection
can run the system and the mobile application can run with the help of mobile internet data.
3. Configuration
The options to tweak the system as per the specific need is limited. However, the system is
appropriate for the need for clinic and does not require removal or addition of any particular
module. The configuration of this system is very easy. The clinic will get online support from
the company and all the required setup can be done by following the simple instructions.
There are some extra modules in the system which can be ignored.
4. Testing
The system testing can be done by any member of the clinic. Suppose the hospital need to test
the patient record. Then, it can enter the record of few dummy data of the patients and check
it if all working as per expectation.
5. Employee Preparation

For the leadership the clinic can ensure that someone take the lead and manage everything.
The clinic can provide appropriate training. Monetary or non-monetary incentive can also be
provided to motivate any individual to assume leadership position. For the change
management, the doctor has to create a environment where the need for the change is felt.
The staffs should be brought on board to contribute to the system implementation. And then
the system can be implemented. The training can be provided to all the individuals who will
be using the system. A few hours of training can be held for first two or three days. The
training should complete with minor tests to assess the knowledge gained by the attendees.
6. Data migration
The patient personal data, insurance data, laboratory data, all the appointment schedules, and
staff and doctor data need to be entered to get started. This will be entered by one of the staff
with the help of past records saved in pen-paper mode.
7. Maintenance
The updates and corrections will be provided by the system provider. It will be automatic and
clinic does not need to worry about this.
F. Summary
The clinic has been proposed NueMD as the IT solution. The IT solution has all the modules
that are required by the clinic. The software operation requires brief training. All the
maintenances are online from the vendor sides. The software is easy to use and can be
accessed through desktop and smartphones.
Conclusion
The clinic needs a software system that can help it fast track the entire operational, time
consuming, and repetitive process. The clinic is facing challenge in properly tracking the