Question

ABC medical group is focusing to provide quality care to all patients. Currently all patient management processes are handled manually. The management wanted to develop a health care system to achieve improved Patient Service and Patient Data Security. The patient care processes are mentioned below: When a patient needs an appointment, the front office must be contacted for required service, If the patient is approaching first time, the registration procedures need to be completed. The patient also informs that he/she is eligible for health care insurance or not. The patient details are recorded into patient file by front office. Doctors are providing their weekly schedule to front office. Appointments are created based on doctor's availability with the details from weekly schedule. For confirmed appointment, token will be issued to patient immediately. If patient is in the waiting list, he/she will be updated later. Billing department is responsible for completing billing procedures of patients. Billing department receives appointment details of patients for the required bill preparation. Doctor also sends the list of tests prescribed for each patient to billing department. Surgical department also forwards a statement to billing department with payment details of surgical procedures conducted for patient (if any). All these inputs are used for bill generation by billing department. Once the bill is generated, the details are also recorded into accounts file. If patient is eligible for health care insurance, front office staff is expected to carry out necessary tasks for getting payment from insurance agency. Front office staff retrieve the insurance details from the patient file and bill details. They then prepare an insurance claim which is forwarded to the insurance agency for the required payment.

Explain the core functions of the proposed information system (minimum 4 major functions).

Answer 1

The core functions of the proposed information system for patients care are:

a) Doctors schedule: Before the action towards the patients care, the core functions of the system is to access the availability of the doctors as per the schedule submitted by them to the front office.

b) Getting appointment: After having schedule of the doctors, the next core function of the system is to get the appointment of the doctor after getting the registration of the patient.

c) Collection of data by billing department: The next core function of the system is to get the required information towards the treatment of the patients from the doctors, the tests and the surgery conducted.

d) Billing and raising Insurance claims: After getting the information of various treatments provided to the patients, the next core function of the system is prepare the bill of the patients and if the patient is eligible for the health care insurance, then necessary claims is to be raised on insurance agency by the front office to get the payment.

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