Health Information Technology Architecture

1.    Title

Health Information Technology Architecture

2.    Introduction

Largo Corporation has recently acquired Suburban Independent Clinic, Inc. (SIC) which serves the general outpatient medical needs of a suburb just outside of Washington, D.C.  It competes directly with CVS Minute Clinic and Urgent Care Center. The corporation appointed you as the chief information officer (CIO) of the clinic in charge of managing clinical and administrative information, technologies and systems.

The clinic is feeling the pressure in many respects – cost, quality of care, access, and efficiency. Disease and personal injuries are on the rise, requirements for efficient and effective care delivery are increasing, and healthcare costs have climbed over time.

Legislation such as the Affordable Care Act has called for the greater adoption of health information technology to improve access, delivery, efficiency and quality of health care serves and treatments while reducing costs and the occurrence of medical errors. This project explores the development and use of information technology IT since it has emerged as a powerful enabler in helping to achieve multiple goals and objectives across the entire U.S. healthcare system.

As the CIO you realize the value and importance of applying IT and have been asked to analyze the issues faced by the clinic and develop a new IT architecture for the facility.

You will benefit from this project in that it will develop your knowledge of information technology in the context of the health care field.  So welcome to the world of health information technology and let’s begin this journey step-by-step.

3.    Steps to Completion

1) Understand the Setting

The mission statement of Suburban Independent Clinic is as follows:

1.  Provide high quality medical care to the patient regardless of race, ethnicity, and gender.

2.  Optimize visit experience, communication standards and patient understanding.

3. Treat patients with respect.

4. Maintain patient confidentiality and security.

5. Provide a pleasing working environment for employees.

6. Follow established policies and procedures for clinics such as HIPAA.

Besides yourself, employees include:

  • Clinic Director
  • Attending physicians (general practitioners)
  • Nurses
  • Office manager [designated as the Health Information Management (HIM) Manager]
  • Receptionist/Interpreter

A survey was conducted involving the patients and specific employees of SIC.  Here is a representative sample of their feedback:


  • I can only make appointments by phone. SIC, you need to move to the 21st century!
  • The only way I can view my medical record is by being physically in the office.
  • Boy, it takes a really long time for the office people to find my medical records. I notice that they keep them in paper files.  Once they gave the doctor the wrong record for me because I had the same name as another patient.
  • I once saw an employee leave my medical records out in the open where anyone can view it!
  • I have to complete all forms by hand. What a pain!
  • Drug costs are skyrocketing.  We need to look if pharmaceutical companies are ripping us off!

  • My pharmacist once told me that the prescription from the doctor was difficult to read. She had to call the doctor’s office to find out what medication was being prescribed.
  • I often forget what the doctor told me after my examination especially when he gives a lot of instructions.
  • I had a drug-drug interaction that could have been prevented. I am suing SIC!

  • I have a difficult time getting to the office. No one will take me and the cost of a taxi is expensive.

  • I like the fact that the receptionist is bilingual but sometimes she is too busy and cannot interpret for me.
  • I don’t like searching for information and reading a lot of reports.  I wish there was a way to get the information I want quickly and accurately as if a doctor or nurse was talking to me.


  • I cannot read the handwritten charts from Dr. Smith because of his lousy penmanship. Some comments he includes are scribbled in the margins.
  • I like to identify trends and patterns among my patients (is there an epidemic of a particular virus?) but it is too much of a manual process to compile and compare all of the records. I also like to explore trends among all clinics in the region and in the country.
  • It takes a long time to get patient records from the filing cabinet. It is sometimes misfiled or even missing!
  • I wish I could better communicate with my patients beyond an office conversation.
  • I want to start a wellness program but printing and mailing costs makes it prohibitive.

  • I wish I could see the patient’s medical history from birth to the present particularly when the patient has changed doctors.

  • I have a difficult time managing my certifications.  They are all lying in my office drawer or hanging in frames.

  • I like spending time with patients and teaching but I hate the paperwork and administration issues I face every day!
  • We need more insight on diagnosing complex medical problems.  We have to dig into research journals and contact experts.  This takes an inordinate amount of time. Information is delivered in long written reports. There must be a better way!


  • Often medical supplies were low and had to be ordered them by phone at the last minute.
  • Sometimes there is an inadequate staffing of nurses and I have to work a double shift. It’s just not fair!
  • Occasionally we have to repeat tests because we cannot find the patient’s data.
  • I don’t have the time to take training sessions I need during regular office hours.
  • It takes a while to contact immunization registries by phone.

  • I am spend less and less time on patient care and more time with bookkeeping.

Office Manager / HIM Manager

  • The facility is running out of space due to the frequent addition of file cabinets to hold the growing patient data. It is expensive to buy these cabinets and we are losing space that we normally use for patient care.
  • Documentation is inadequate when corporate auditor want to examine records for cost and compliance reviews.
  • Once we lose medical records they were gone forever.
  • Health insurance claims are handled manually and subject to errors.  And when there is changes in the rules, we learn about it much too late and some employees are not informed of the change.
  • We have a frequent cash flow problems because we tend to send bills late. We should ask for payments on the spot!

  • Please, I don’t want to use computer technology since it will increase costs tremendously. I don’t believe those computer systems vendors – they are just out to make a buck.
  • I am overworked and underpaid! I would like to start a union of clinic office managers!

  • Archived medical records are stored in a warehouse.  If they need to be retrieved they need to faxed, scanned or mail which is a time consuming process when it could be a life or death situation.
  • We keep all of our equipment purchasing data in one server and I am worried about someone coming in and corrupting it.  In addition there are many verifications needed to ensure data is accurate.  We need to hire a lot of trusted third parties to do this. I wish life was more simple!

2)  Analyze the Issues

Your work begins now.  As a first step you are to organize these issues into logical categories and prioritize them.

In analyzing each issue, think about these questions:

  • Do I understand the meaning and nature of the issue?
  • Should we care about this issue?
  • What does literature say about this issue?
  • Who is affected by the issue? How so?
  • Which issues are most important? Least important?
  • How does this issue relate to corporate strategy and goals?

Do not jump the gun and start identifying solutions now. That step comes later.

Deliverable:  Prepare a narrative and a summary table that would capture the results of your issue analysis in this step.  The table should prioritize the issues in the context of SIC and Largo Corporation.  Minimum length = 600 words. Be sure to state your assumptions.

  1. Issue analysis table (from Step 2)

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