Question

New Century Wellness Group offers a holistic approach to health care with an emphasis on preventive medicine as well as traditional medical care. In your role as an IT consultant, you will help New Century develop and plan the implementation of a new information system.

Phase 5

Background

You began the systems analysis phase by conducting interviews, reviewing existing reports, and observing office operations.

The New Century medical team performs services and medical procedures, which are coded according to the American Medical Association’s Current Procedure Terminology (CPT). CPT codes consist of five numeric digits and a two-digit suffix, and most insurance payers require the codes to be included with billing information.

The new system must be able to handle the new ICD-10 procedure coding system, which has been required by the Centers for Medicare & Medicaid Services (CMS) beginning October 1, 2014. ICD-10 codes consist of seven alphanumeric characters, which can be electronically transmitted and received. New Century’s information system must interface with 25 California health insurance providers. The new system represents an opportunity for significant cost saving for New Century, and more convenience for patients, who will be able to go online to update medical information, schedule appointments, and request medical records (Future System Interface).

During your fact-finding, in addition to meeting Compliance requirements (NC3), you learned that the clinic requires various reports, as follows:

• Daily appointment list for each provider. The list shows all scheduled appointment times, patient names, and services to be performed, including the procedure code and description.

• Daily report call list, which shows the patients who are to be reminded of their next day’s appointments. The call list includes the patient name, telephone number, appointment time, and provider name.

• Weekly provider report that lists each of the providers and the weekly charges generated, plus a month-to-date (MTD) and a year-to-date (YTD) summary as well as profit distribution data for the partners.

• Monthly patient statement, which includes the statement date, head of household name and address, previous month’s balance, total household charges MTD, total payments MTD, and the current balance. The bottom section of the statement shows activity for the month in date order. For each service performed, a line shows the patient’s name, the service date, the procedure code and description, and the charge. The statement also shows the date and amount of all payments and insurance claims. When an insurance payment is received, the source and amount are noted on the form. If the claim is denied or only partially paid, a code is used to explain the reason. A running balance appears at the far right of each activity line (they are willing to accept a vertical package’s suggestions for these and any additional report recommendations will be considered as well).

• Weekly Insurance Company Report.

• Monthly Claim Status Summary.

In addition to these reports, the office staff would like automated e-mail and text messaging capability for sending reminders to patients when it is time to schedule an appointment.

Data also needs to be maintained on employers who participate in employee wellness training. This information can be used for marketing purposes throughout the year with a CRM Packaged System which you will select from those available as well.

Also, the new system needs to track employee schedules, attendance, vacation time, and paid time off as part of the Payroll application module that is currently used as a service for that requirement.

Finally, the New Wellness Training System must allow for both wellness, exercise, and nutrition training classes in multiple locations as New Century wants to be able to offer classes off-site at local businesses, schools, and other suitable locations.

Now you are ready to organize the facts and prepare a system requirements document that represents a logical model of the proposed systems. Your tools will include DFDs, a data dictionary, and process descriptions.

Tasks

Q1: Prepare a data dictionary entry and process description for one of the Wellness Training System’s functional primitives.

Answer 1

Data Dictionary

The data flow diagram is used to represent the functional flow of the system. The structured English, decision tree or another documentation technique can be used for preparing the documentation for the data elements. Though New Century system is very simple, there is no need of making a logical solution complex, a new principle can be created using decision table or decision tree. Illustrating an example for New Century, this may make a decision for sending a particular memento to the patients of a particular age group. Many mock-up papers have been arranged for more than a few functional activities shown in DFD. A complete listing of the functional activities consisting of input and output data flows, have been arranged.