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Integrated Case Study Read the “Integrated Case Study” resource prior to beginning the assignment.
Integrated Case Study The purpose of this assignment is to apply user testing to the created workflow for the identified case study need.
Write a 750-1,000 word test script that answers the following questions:
- Who would be part of the user testing?
- What are the elements to test?
- What are the steps used to perform acceptance testing, integration testing of new systems, and testing of system enhancements?
- Are there any rules involved?
- What is the action/outcome expected?
- What would the action plan be if testing does not work?
Cite at least two scholarly resources in your response.
Please put in-text citations and references using APA 7
Integrated Case Study
Overview:
Throughout this course, you will use this case study to demonstrate knowledge of the following
course content:
• Clinical decision support
• Assessing user needs
• Analyzing and documenting workflow
• Designing and customizing fields, forms, and templates
• User testing
• Evaluation metrics
• Designing user documentation and training
In a series of assignments, you will use this case study to integrate user interface design
(including usability/human factor principles) into a design document, analyze and develop
workflows, evaluate users’ needs (including their involvement in user testing), develop
evaluation metrics, and design end user training materials.
The case study, which will be used throughout the course, will focus on various components of
the course topics. It focuses specifically on the unique needs of oncology patients and the health
care needs of oncology navigators and prior authorization/financial coordinators.
The Case:
Universal Health is a large not-for-profit health care system with 12 hospitals in three states and
two large oncology programs in Arizona. One of the oncology programs is affiliated with
Academic Hospital and the other with a larger national oncology health care system. Although
both oncology locations are part of Universal Health, there are significant differences in how
each of the locations operates due to a recent merger/acquisition of the Academic Hospital
oncology program (Oncology South) and the affiliation of the other oncology program
(Oncology North) with a national oncology health care system. To compound these operational
issues, Oncology North had been part of Universal Health for 8 years, so its Electronic Health
Record (EHR) was Chrystal, which was the EHR platform for Universal Health and became the
model used to convert Oncology South off its EHR to align with the rest of the organization.
Management of oncology patients is quite complex and there was significant concern from
Oncology South about the EHR conversion, as well as changes that would affect its operating
model. Previously, both oncology programs worked relatively independently with IT to create
custom solutions, but now would need to work together to create a standardized oncology
solution for Universal Health. Integrated Case Study
2
If a merger/acquisition of a large academic hospital and its oncology program was not complex
enough, adding the conversion of an EHR certainly made the situation more difficult. Also
compounding the issue, Oncology North—although it had been on the EHR Chrystal for almost
8 years—had significant issues with the current build and felt that there were several gaps related
to functionality for oncology clinicians to service its unique population. Since Universal Health
was in the process of converting the EHR at Academic Hospital and Oncology program, the
EHR vendor, Chrystal, was actively involving its alignment specialists to assist in the
conversion. One of the key first steps of the Chrystal alignment specialists was to do a gap
analysis and prioritization of EHR functionality for oncology as well as throughout Universal
Health.
The gap analysis done by Chrystal found that the oncology build for Universal Health overall did
not align to its recommendation for oncology specialties in several areas within the EHR. As a
result, a focused team (including a project manager, nursing informatics, Universal Health IT
resources, Chrystal oncology alignment specialists, and Chrystal oncology IT experts) was
created to systematically address the recommendations from the Chrystal oncology gap analysis.
Although there were recommendations globally related to Universal Health’s overall EHR build,
there were some specific recommendations related to the build of the oncology platform within
Chrystal. Some of the initial focus was related to concerns related to prior authorization/financial
gaps and the functionally/workflow of all the oncology providers/clinicians, but also the
oncology navigators who really did not have any oncology functionality within Chrystal.
Servicing an oncology population is a significant part of the patient demographics of any large
health care organization. Oncology patients have unique needs due to the frequency of their
visits and the length of their treatments and follow-up, which can last a lifetime. A cancer
diagnosis is life changing and can cause great emotional, physical, and financial stress. Oncology
navigators exist to assess and assist patients and their families during their cancer treatment and
hopefully into remission/survivorship. Unfortunately, cancer treatment can be costly, and dealing
with insurance companies for prior authorization is an unfortunate reality in the current health
care system. For health care providers, there is great financial responsibility in providing cancer
treatment, so obtaining authorization from insurance companies and ensuring that patients are
aware of their own financial responsibility are essential for both the patient and the organization.
After a patient receives a cancer diagnosis, the next step is usually a referral to an oncology
specialist/program like Oncology North or Oncology South. That referral can come from a
patient calling an oncology specialist/program directly or from the diagnosing physician
contacting an oncology specialist/program. Oncology South and Oncology North both have
dedicated intake referral specialists who work directly with patients, families, and referring
physicians to get patients scheduled with an oncology specialist based on their diagnosis. Before
the patient sees the oncology specialist for the first time, many documents need to be sent to the
prior authorization team for review to ensure that the appropriate prior authorization is obtained
from the insurance company, as well as making sure that the patient will be seen by the most
appropriate oncology specialist for the specifically diagnosed cancer. These documents vary
from pathology reports, diagnostic results, and referring physician notes that can be sent to the
prior authorization specialist at different times for different patients. It is essential to have a
standard workflow and expectation of standard documentation in a certain place in the EHR, so
that everyone involved in the initial authorization and clinical care knows what steps have been
taken and what actions are pending. While these financial steps are occurring behind the scenes Integrated Case Study
3
and are important details that need to be secured before a patient’s first appointment, it is worth
noting that at this juncture patients have just received some of the worst news in their life and
they just want to get treatment as soon as possible.
Oncology navigators are nurses that specialize in assisting patients navigate their cancer journey
from diagnosis through treatment and into survivorship. After the first contact with the oncology
intake specialists, oncology navigators are the next foundational step in the patient’s journey
towards treatment and recovery. After the initial documentation is completed by the intake
specialist who provides some basic information, including name of person calling, contact
information, referral sources, provider information, and diagnosis information, such as type of
cancer. Based upon the type of cancer on the intake documentation, an oncology navigator who
specializes in that cancer type is notified of the new patient and contacts the patient to initiate a
custom navigation plan based upon assessment of needs. The oncology navigator role is an
extremely important part of the oncology team. However, oncology navigators were identified as
being significantly underdeveloped within Universal Health EHR based upon Chrystal’s gap
analysis, so there needed to be focused attention on this group within the organization.
As a result, a dedicated team needed to be formed to include individuals from nursing
informatics from Universal Health, Chrystal oncology alignment and IT specialists, Chrystal IT
staff, and oncology navigators from both Oncology North and Oncology South. This team would
be responsible documenting workflow, assessing end user needs, and submitting a final design
recommendation (including training materials) to the Universal Health IT build team. The
completion deadline for the design document is 8 weeks.
Assessing current state and understanding end user needs must be one of the first goals of this
dedicated team. Two days were dedicated for onsite observations of oncology navigators at
Oncology South and Oncology North, during which it was discovered from the observations that
even though the oncology navigators at both locations performed the same role, they had some
significant differences that needed to be overcome to be able to collaborate and create a single
oncology navigator solution. The grid below outlines some of the differences.
Operations Differences Oncology South Oncology North
Initial Contact With Patient Phone interview within 3 days Initial physician clinic visit
Patient Oversight
All oncology patients Only oncology patients that
have identified needs
Documentation
Paper form: See document: Nav
Assessment 2018
Paper form: See document:
Oncology North
Although each location has operational differences, they also have several similarities in how
they used some of the tools in the EHR, as well as their need for data and the ability to
track/trend the outcomes of their patients. One key request was to make it easier for all oncology
clinicians to be able to see their documentation within Chrystal. These foundational similarities
aligned to what Chrystal oncology specialists had implemented at other institutions, having
already created an Oncology Navigator Recommended Design Document that could be used at
Universal Health. The table below provides some similarities between Oncology North and
Oncology South. Integrated Case Study
4
Operations Similarities Oncology North and Oncology South
Position Navigator/Coordinator RN
Data Request Wanted discrete data for reports
Electronic Documentation Used same two electronic methods to chart:
1. Electronic forms shared by all types of navigators (e.g.,
ortho, pulmonary)
2. Free-text note also shared by same navigators above
Electronic Documentation Wanted it to be easier to find specific oncology navigator
documentation
Health care is all about data. In addition to using EHR for recording documentation, it is used to
extract data to evaluate outcomes. Data in the EHR can come from discrete data from
ICD10/ICD9 used by providers/coders, SNOMED, IMO codes used clinicians, but also directly
from forms and flowsheets from discrete data fields. Understanding the unique data requirements
of the oncology navigators, as well the initial prior authorization team, is foundational to creating
the appropriate discrete fields or using existing data fields like ICD10 to help sort and organize
data.