Mountain View Community Hospital

Introduction

This case is included to provide you an opportunity to apply the concepts and techniques you will learn in each chapter. The case can also be used to support a semester-long database project built throughout the term that results in a complete application. We have selected a hospital for this case because it is a type of organization that is at least somewhat familiar to most persons and because health-care institutions are of such importance in our society today. A segment of the case is included at the end of each chapter in this text. Each segment includes a brief description of the case as it relates to the material in the chapter followed by questions and exercises related to the material. Additional requirements, assignments, and project deliverables are provided in support of a semester project.

Case Description

Mountain View Community Hospital (MVCH) is a not-for-profit, short-term, acute care general hospital. It is a relatively small hospital, with some 150 beds. Mountain View Community Hospital strives to meet the needs of a community of about 60,000 with an annual growth rate of 10 percent, a trend that is expected to continue since the surrounding area is attracting many retirees. To serve the health-care needs of this growing community, Mountain View Community Hospital plans to expand its capacity by adding another 50 beds over the next five years, and opening a managed care retirement center with independent apartments and assisted living facilities. The basic goal is to provide high-quality, cost effective health-care services for the surrounding community in a compassionate, caring, and personalized manner.

Within the last fiscal year, the hospital performed more than one million laboratory procedures and over 110,000 radiology procedures. During that time, the hospital had 9,192 admissions and 112,230 outpatient visits, brought 1,127 babies into the world, and performed 2,314 inpatient and 1,490 outpatient surgeries. Patients who receive outpatient surgeries do not remain in the hospital overnight. With an average of 2,340 patients a month, the emergency department experienced approximately 28,200 visits throughout the year. Approximately 30 percent of the patients admitted to the hospital were first treated in the emergency room, and about 13 percent of emergency room visits resulted in hospital admission. The hospital employs 740 full-time and 439 part-time personnel, among them 264 fulltime and 176 part-time registered nurses, and 10 full-time and 6 part-time licensed practical nurses. The hospital's active medical staff includes over 250 primary physicians, specialists, and subspecialists. Volunteers are an integral part of MVCH's culture and contribute greatly to the well-being of patients and their families. Approximately 300 volunteers from different backgrounds and of all ages devote their time, energy, and talents to many areas of the hospital. They greet visitors and patients and help them find their way through the hospital, deliver mail and flowers to patient rooms, escort patients, aid staff with clerical duties, work in the gift shop, assist at community and fund-raising events, and help out in a host of other areas.

Mountain View Community Hospital provides a number of key services, including general medical and surgical care general intensive care, a cardiology department, open-heart surgery, a neurology department, pediatric medical and surgical care, obstetrics, an orthopedics department, oncology, and a 24-hour emergency department. The hospital also offers a wide range of diagnostic services. A specialty service within the neurology department is the recently opened Multiple Sclerosis (MS) Center, which provides comprehensive and expert care for patients with multiple sclerosis in order to improve their quality of life. Using an interdisciplinary team approach, the center emphasizes all aspects of MS care from diagnosis and treatment of MS symptoms and secondary complications, to individual and family counseling, rehabilitation therapy, and social services. Headed by Dr. Zequida, called Dr. ""Z"" by staff and patients, the MS Center is a member of a consortium of MS centers.

The current organizational chart for Mountain View Community Hospital is shown in MVCH Figure 1-1. Like most other general hospitals, Mountain View Community is divided into two primary organizational groups. The physicians, headed by Dr. Browne (chief of staff), are responsible for the quality of medical care provided to their patients. The group headed by Ms. Baker (CEO and president) provides the nursing, clinical, and administrative support the physicians need to serve their patients. According to Ms. Baker, the most pressing issues affecting the hospital within the last year have been financial challenges such as bad debt, personnel shortages (particularly registered nurses and imaging technicians), and malpractice insurance. Other critical issues are the quality of care, patient safety, compliance with HIPAA, and technological innovation, which is seen as a major enabler for decreasing costs and improving quality. The trend toward managed care and the need to maintain costs while maintaining/improving clinical outcomes requires the hospital to track and analyze both clinical and financial data related to patient care services.

Goals and Critical Success Factors

In response to the steady growth and expansion plans at Mountain View Community Hospital, a special study team including Mr. Heller, Mr. Lopez, Dr. Jefferson, and a consultant has been developing a long-term strategic plan, including an information systems plan for the hospital. Their work is not complete, but they have begun to identify many of the elements necessary to build the plan. To meet the goals of high-quality health care, cost containment, and expansion into new services, the team concluded that the hospital has four critical success factors (CSFs): quality of medical care, control of operating costs, control of capital costs, and recruitment and retention of skilled personnel. The development of improved information systems is viewed as an enabler in dealing with each of these CSFs.

The team is currently at work to generate two to four short- or long-term objectives for each CSF. So far they have developed the following four objectives related to the control of the operating costs CSF:

1. Reduce costs for purchased items

2. More efficiently schedule staff

3. Lower cost of liability insurance

4. Expand volunteer services

The study team has developed a preliminary list of business functions that describe the administrative and medical activities within the hospital. These functions consider the organizational goals and CSFs explained in the prior section. At this point, the study team has identified five major business functions that cut across all of the organizational units:

1. Patient care administration Manage the logistical and record-keeping aspects of patient care

2. Clinical services Provide laboratory testing and procedures, and patient monitoring and screening

3. Patient care services Provide patients with medical care and support services

4. Financial management Manage the financial resources and operations of the hospital

5. Administrative services Provide general management and support services not directly related to patient care.

The study team has been able to break each of these high level business functions into lists of more detailed functions (see MVCH Figure 1-2), but the team knows that these lists are not complete nor well defined at this point.

Mountain View Community Hospital has computer applications that support the following areas (among others): patient care administration, clinical services, financial management, and administrative services. Many of these applications have been purchased from outside vendors, but a few have been developed internally. Most of the computer applications are implemented using relational database and client/server technology. In the client/server environment, the client runs the database applications that request the data. The server runs the DBMS software, which fulfills the requests and handles the functions required for concurrent, shared data access to the database. Most of the databases (as well as the applications) are two tier, using the classification introduced in this chapter.

Enterprise Modeling

The study team identified a preliminary set of 11 entity types that describe the data required by the hospital in support of the various business functions: FACILITY, PHYSICIAN, PATIENT, DIAGNOSTIC UNIT, WARD, STAFF, ORDER, SERVICE/DRUG, MEDICAL/SURGICAL ITEM, SUPPLY ITEM, and VENDOR. From discussions with hospital staff, reviewing hospital documents, and studying existing information systems, the study team developed a list of business rules describing the policies of the hospital and nature of the hospital's operation that govern the relationships between these entities. Some of these rules are:

1. A FACILITY maintains one or more DIAGNOSTIC UNITS (radiology, clinical laboratory, cardiac diagnostic unit, etc.).

2. A FACILITY contains a number of WARDs (obstetrics, oncology, geriatrics, etc.). 3. Each WARD is assigned a certain number of STAFF members (nurses, secretaries, etc.); a STAFF member may be assigned to multiple WARDs.

4. A FACILITY staffs its medical team with a number of PHYSICIANs. A PHYSICIAN may be on the staff of more than one FACILITY.

5. A PHYSICIAN treats PATIENTs, and a PATIENT is treated by any number of PHYSICIANs.

6. A PHYSICIAN diagnoses PATIENTs, and a PATIENT is diagnosed by any number of PHYSICIANs.

7. A PATIENT may be assigned to a WARD (outpatients are not assigned to a WARD). The hospital cares only about the current WARD a patient is assigned to (if assigned at all).

8. A PATIENT uses MEDICAL/SURGICAL ITEMS, which are supplied by VENDORs. A VENDOR also provides SUPPLY ITEMs that are used for housekeeping and maintenance purposes.

9. A PHYSICIAN writes one or more ORDERS for a PATIENT. Each ORDER is for a given PATIENT, and a PATIENT may have many ORDERs.

10. An ORDER can be for a diagnostic test (lab tests such as lipid profile, CBC, liver function tests; diagnostic imaging such as MRIs and X-rays) or a drug.

They recognized that certain business functions, such as risk management and volunteering, were not adequately represented in the set of data entities and business rules, but they decided to deal with these and other areas later. The study team stored descriptions of these data entities and the business rules in the CASE repository for later analysis. Using the identified entities and business rules, the study team developed a preliminary enterprise data model (see MVCH Figure 1-3). Again, this conceptual model is preliminary and does not follow all the conventions used in the information systems department for drawing data models, but the purpose of this enterprise model is to give only a general overview of organizational data.

Case Questions

1.      What are some of the costs and risks of using databases that the hospital must manage carefully?

2. How could the hospital use Web-based applications?"

Charges and Hazards Demanded in Applying Databases

 1. Costs:

 Initial Setup Costs: Database involves tremendous costs, which comprises of hardware cost, software and other costs which are required for initial setup of a database system.

 Maintenance and Upgrades: They are the costs incurred in the day to day running and sustaining of the software such as update of the software and hardware, maintenance of the systems and any improvement on the systems.

 Training: A database can be an expensive investment and therefore the staff needs to be trained on how to apply as well as manage the database.

 Data Storage: Mass storage of huge volumes of data especially in a health facility with many records is very absorbing and demanding.

 Security Measures: Security measures that are to be put in place to ensure that patient data is not compromised are costly when one has to factor encryption of data, restricted access to patient data, and security check-ups.

 2. Risks:

 Data Breaches: Action by or on behalf of an unauthorized party can lead to violation of patient right to privacy, legal consequences and fines.

 System Downtime: Production mishaps cause breakdowns in hospital activities and services for patients and business management.

 Data Loss: These risks include and have the potential of the contract, erasure, or damage to capability hardware bringing about probable loss of important patient data.

 Compliance Issues: Oblivion to laws such as HIPAA attracts legal consequences as well as fines.

 Integration Challenges: One of the challenges of implementing new database systems is the time that it takes to adapt it to the current applications and this in most cases results in data dilemmas or operational problems.

 Using Web-Based Applications

 1. Enhanced Accessibility:

 Remote Access: Web applications have flexibility and responsiveness if the healthcare staff obtain the patients’ information and working from distant places.

 Real-Time Updates: Information is real time, and this can improve care co-ordination as well as the ability to make sound decisions.

 2. Improved Patient Engagement:

 Patient Portals: Health Record may allow more patient engagement through self service portals on the Internet and establish a better way of communication through web applications for Health Records, Appointment and more satisfactory feedback.

 3. Cost Efficiency:

 Reduced IT Costs: Being web-based mostly, usually they do not require a significant amount of on-site hardware and IT personnel, which could bring overall costs down.

 Scalability: Some of these applications can be scaled easily to the next level when the company grows and this is without requiring much capital investment.

 4. Integration and Collaboration:

 Interoperability: Computerized web applications can typically link up with different healthcare systems and databases, improving on the flow of information between different departments and healthcare organizations.

 Collaborative Tools: Such web-based tools may bring in elements of team work in the provision of healthcare at various center stages.

 5. Security Considerations:

 Data Encryption: Where patients ‘ details are captured, it’s important that web-based applications have high security measures including encryption.

 Access Controls: Enforcing strict access control measures also means that only the approved individuals can get to certain information.

 In general, with the help of proper cost and risk control concerning database systems and by taking the advantages of Web applications, MVCH can focus on the organization improvement, better patient care and proper function of the hospital.