Running head: Business Case Proposal: New Century Wellness Group 1

Business Case Proposal: New Century Wellness Group

Saikiran Mallogi

Piyush Zope

IST-7020

Wilmington University

02/23/2019
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.
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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

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Founders
Timothy Jones
Dolores Garcia

Office Manager
Anita Devenport

Ordering and
Suppliers of Human Resources Appointments Patient Records Insurance Billing Accounts
Medicine Fred Brown Lisa Sang Susan Gilford Tammy Alipio Tom Capalet
Carla Herrera

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
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Strenths Weakness
Customer Loyalty Online Presence
Innovative Culture Cost Structure
Unique Products Weak Management

Opportunites Threats
Innovation Intense Competition
Emerging Markets Govt. Regulations
New Services Volatile Costs
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1.1.2 Business Needs

With an increasing number of staff and patients, New Century Wellness Group requires an in-

house 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

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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
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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 Drop-in Report

Bill
Hours
Payment
Fixed fees
Receipt data
Report data
Patient data
Insurance fees
Data Elements 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
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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,
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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.
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2.1.4 Schedule and Approach

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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
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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

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