Family First Medical Center
Dr. Robert Slate is the owner and President of Family First Medical Centers Pty Ltd, a small chain of medical centers located in various suburbs in Victoria’s North West. He is finding that the paperwork and administration costs are getting a bit unwieldy, and is hoping your company can make his business run more efficiently. Some extracts from our initial interview with him are included below:
"I originally founded the company as a single center located in Melton and now it has expanded to its current size of four centers in five years. I grew up working in my father’s business, a retail pharmacy, and developed an interest in the healthcare field at an early age. I majored in Medicine in college and, after graduation, worked in a variety of medical settings. I returned to school to earn my MBA degree, as I wanted to establish my own medical business. Five years ago, I opened my first medical center, which is this one, in Horizon Hills. I believed there was a need in the suburb for the type of services offered at Family First. The centers are for people who need occasional medical care but are without a regular family physician. The centers fill a middle ground between traditional family physician practices and hospital emergency rooms. We provide standard general medical services such as check-ups, minor operations, we suture lacerations, treat minor injuries. Each center is managed by one administrative employee. In addition, each center employees a number of personnel. In addition to the care provided to the patients by the contract physicians and employee nurses, Family First also provides pharmaceutical services. Each center operates a pharmacy in the same building as the clinic facilities."
"At the top of the organization structure is the owner (myself) and there are four center managers, one for each of the centers. The center manager here is Tom, and he oversees all the administrative and business side of this center. The receptionist, Stephanie, helps him. Then for each of the centers we have a pharmacy manager who manages all to do with the pharmacy; we have contract physicians and nursing staff. We also employ pharmacists who help dispense medication in the pharmacy."
"I expect that the system will assist in managing the paperwork. We employ about 5 to 7 people in each center, in addition to contracting about 8 to 12 doctors. On average we treat about 35 patients each day. In addition we also fill most of their prescriptions at the on-site pharmacies we operate. Given all the data and information we have to keep and manage as a result of all this, the paperwork just takes up too much administrative time and our files are beginning to overflow. I have just reassessed the way in which we do business. The amount of information that must be acquired and processed has been steadily growing, partly due to management needs to track business trends and expenses, and partly due to increasing reporting requirements to the government and to the insurance companies. It has become very difficult to keep up with these information demands using the old manual systems that have been in place since I founded the company. The time to automate has come.'
Some extracts from an interview with Tom (the center manager at Horizon Hills) are as follows:
"In a normal week, I arrive at 8:00am on Monday morning to open up the center, and I attend to any paperwork needed, check and answer the mail, work on any requests that Dr. Slate would have in terms of revenue reports, etc. Usually Stephanie arrives about 8:30am and prepares the reception area – gets out the schedule and appointments book, checks to see which of the doctors are rostered for the day, and checks the appointment list. She calls up each of the patients to remind them of their appointment for that day, and to confirm that they are coming in. She then takes out of the filing cabinet all the patient records for the appointments on that day and places them in document trays designated for each doctor. If the patient is a new patient, Stephanie prepares a folder and inserts a blank Patient information card in the folder."
"The centers are open from 9:00am, to 6:00pm Monday through Friday, and are closed on weekends and holidays. When a patient arrives, Stephanie confirms the name, date of appointment, and the doctor’s name. If the patient is a new patient, Stephanie then hands him/her a blank Patient Information Card to fill out. The patient then returns the card to Stephanie. As with all patients, Stephanie then takes the Patient Information Card, and puts it on a clipboard and hangs it on a specially designated hook for the doctor."
"When the doctor is ready, he/she just takes her clipboard with the Patient card, calls out the patient’s name and then they go to their assigned consultation room. During the patient’s consultation, the doctor fills in the consultation details, which include: the patient’s complaints, the doctor’s diagnosis, and the prescribed treatment. If the doctor prescribes any medication, this is written down on a numbered prescription form (each consultation room has a supply of these). Meanwhile, in Reception, Stephanie prepares the next patient’s card for the doctor on another clipboard. After the consultation, the doctor gives the prescription to the patient and hands back the clipboard and Patient Card to Stephanie. From the card, Stephanie informs the patient of the amount that they will be charged, collects the payment, and issues a receipt from our cash register. The patient is then responsible for making a claim with their health insurance provider."
"Any patient can call in by phone to book an appointment. Usually what Stephanie does is take the name, phone number, date and time of appointment, and, if the patient has a preference, the name of the doctor. If there is no preference, Stephanie assigns any doctor available at that time slot. She also asks if the patient has a patient record with us. She records this information in the appointment book. Appointments are typically scheduled for each doctor in half-hour blocks. Although most appointments require no more than half this amount of time, this scheduling allows for the occasional lengthy appointment, as well as allowing paperwork to be taken care of between patients."
"For walk-in patients we can fit them in, if a doctor is available, and if they are willing to wait. If so, then we follow the same procedure with them – check if they have a record, fill in a Patient Card, etc."
"Our doctors are called 'contract physicians' meaning we do not really hire them as employees but we have a contract to have them practice on the premises for a particular rate, given a particular schedule. Dr. Slate usually is the one who negotiates the contract. Each doctor then tells us: how long they will be contracted for (1 year, 18 months, etc), and they fill in a schedule form that tells us what days and times of the week they are available for appointments. They fill this in once before they start and then when changes occur (which in most cases is not often), they just fill in another form. Dr. Slate then works out a roster of doctors for each center so that each center has about 3 to 5 doctors on duty at any given time during the week. A doctor can practice at more than one center."
"A patient can be attended to in more than one center, and this creates a problem. Because of our paper-based system, the main file for the patient is kept at the center where they were first seen. If a patient goes to another center, another file will be created for them. So we have more than one set of files for a given patient. Then if the patient requests for a receipt of all their medical consultations with our centers, they would have to ask each center individually for a receipt. We have received a number of complaints regarding this, and what we have done is have the receptionists do the calling around to each center for these receipts on behalf of the patients. This takes up quite an amount of time for them. Also because the patient has multiple files, it can compromise them medically – because a doctor does not see all of the patient’s notes, they do not have a complete history, and thus this can compromise their medical care because of incomplete information. We are hoping the system can help prevent these problems."
"When we aren’t busy attending to appointments, we gather information for various reports that Dr Slate asks for, and those that are required by the government for taxation purposes, etc. I’m mainly responsible for keeping track of revenues, both on the medical and pharmaceutical side, and I approve inventory purchases. Stephanie takes care of ordering office supplies, while Jennifer takes care of ordering pharmaceutical supplies. I don’t expect the system to approve purchases or order office supplies, but I would think that Jennifer and all the other pharmacy managers would like the system to help them determine or keep track of the pharmaceutical supplies that need to be ordered."
"We’d also like the system to keep track of things such as personal details, job title, employee category. When we hire an employee, they fall in one of three distinct employee categories: administrative staff (e.g., managers, clerks, receptionists), nurses, and pharmacists. After the usual recruitment process (advertising, short-listing, interviews, selection), we have the new employees fill in the standard Personal Information Sheet, which we keep in our files. Because our nursing and pharmacy staff all require licenses to practice, we would like to make sure that their licenses are up to date. Once in a while Stephanie tries to find time to check all the files and remind the nurses and pharmacists of their renewal dates, but sometimes she forgets."
Some extracts from an interview with Jennifer (the pharmacy manager at Horizon Hills) are as follows:
"Each patient’s prescription history is recorded using patient prescription profile cards. These are A4 cards, kept in a counter-top file box, arranged alphabetically. These must be updated each time a prescription is filled or any other information about the patient changes, so we know how often the patient has received certain medications and what other drugs are being prescribed for the patient, to allow us to check for potential drug interactions. If the prescription is for a controlled substance, additional paperwork must be done. The prescription order must be marked with a red “C” letter stamp and the dispensing information (RX number, drug name, strength, and quantity dispensed) must be entered into a controlled substances daily log form so that pharmacy inspectors from the DPR and DEA are able to determine what, and how many, controlled substance prescriptions are filled on a daily basis."
"Only prescriptions written by Family First physicians for Family First patients are filled at these pharmacies. The reason for this is that it allows us to maintain a relatively restricted inventory of medications, as we can tailor the stock to the drugs of choice of our physicians. But, patients can fill their prescriptions at pharmacies not affiliated with Family First if they prefer. We do carry some medications that do not legally require a prescription to purchase, such as Panadol, but company policy requires that all medications dispensed from a Family First pharmacy to a patient must have a prescription order by one of the Family First physicians."
"The typical procedure for the filling of a prescription is as follows:
1) Verify the patient’s name and address written on the prescription order when presented by the patient
2) Retrieve the patient’s prescription profile card or prepare a new card if patient is new.
3) Type the prescription bottle label
4) Get the product from the shelf.
5) Put the appropriate amount in the patient’s bottle.
6) Use a numbering stamp machine to assign a sequential prescription number which must be posted on the patient profile card, the prescription order form, and the label on the prescription bottle
7) Price the prescription
8) Record the prescription information and price on the patient profile, the daily transaction log (a listing of data on all prescriptions filled that day), the prescription receipt, and the prescription order form.
9) Re-file the patient profile card alphabetically
10) File the prescription order form numerically
11) Present the prescription to the patient and collect payment for it
12) Hand the patient the prescription receipt."
"A company policy forbids refills of Family First prescriptions. If a patient has a chronic condition requiring ongoing treatment, we believe that they should establish a traditional relationship with a regular physician, rather than using the Family First model of health care. So, a given prescription can only be filled once. If a Family First physician wants to provide more of the same medication to the same patient, perhaps on a subsequent visit, they must write another prescription."
"At the moment we can only estimate how much of each medication we have on hand, but it would minimize errors and loss if we had a more accurate way of keeping track of inventory. It would be ideal if the system could keep records of what we have in stock, exactly what and how much medication is delivered, and exactly what and how much is sold every day. This way we would have an accurate picture of inventory levels, and that helps up with re-ordering. Three times a week, we do a visual check of the stock on hand. If we are running out of stock for a particular drug, we write out what we need to order in our re-order book. At the end the day on Mondays, Wednesdays, and Fridays, I phone a wholesaler and put in an order for those medications."
"We have the minimum stock level written on the card identifying the item. We estimate minimum stock levels based on customers’ needs and seasonal variations. So if the quantity of an item falls below its minimum stock level, then we know it is time to re-order. We have one preferred drug wholesaler/vendor, Johnson Drug Company, but two other vendors are used when Johnson either doesn’t carry an item or is out of stock."
"When an order arrives, the date of arrival is recorded in our delivery book. The number of packages of each drug received is also recorded in that book. Sometimes, the number of packages received may or may not be the same as the quantity ordered. There are no back-orders. So, there is only one shipment per order. Any shorted items must be obtained with another order, possibly with another vendor if the drug is needed quickly. The actual package cost of each drug received is likewise recorded. The total order cost, which is the sum of all individual item totals on the order, is also recorded. There is no shipping charge or sales tax."
From Dr. Slate, the list of functions that the system must provide is as follows:
- Maintain personnel information on all doctors and employees affiliated with Family First
- Track physician work assignments at the individual centers and print a weekly schedule for each doctor
- Track patient appointments and print daily appointment schedules for use by each of the centers
- Track total revenues generated by medical care appointment, by time period
- Track total revenues generated by pharmacy sales, by time period
- Track total expenditures for items purchased from wholesale vendors by time period
- Provide online, and be able to print, all the information currently provided by the patient profile cards
- Provide customers, upon request, with itemized yearly lists of medical care (appointment) expenses and also prescription purchases for income tax reporting purposes
- Automatically generate prescription numbers and prices, and record all information associated with the filling of prescription orders
- Generate prescription labels and patient receipts for the medications dispensed
- Generate detailed customer receipts (appointment or prescription) for insurance claims when applicable
- Generate a daily dispensed drug log and a separate log of dispensed controlled substances, which must be kept to meet DPR and DEA requirements
- Generate drug re-order reports for items that have fallen below their minimum stock amounts
- Help prevent pharmacist and nurse licenses from expiring without being noticed
- Track drug movement by category and by time period to improve inventory control
- Provide total itemized inventory in stock by quantity and total valuation for inventory tax purposes