BUSI TOMS 5302

Course Name Here

Scenario Analysis: CMA
 CMA.1
Background information: maintained in a separate database. The
patient’s medical chart was part paper based
Community Medical Associates (CMA) is a and part electronic. The paper medical file
large health care system with 2 hospitals, 25 could be stored at the hospital, centers, or
satellite health centers, and 56 outpatient clinics. Nurses handwrote their notes on each
clinics. CMA had 1.5 million outpatient visits patient, but their notes were seldom input into
and 60,000 inpatient admissions the previous the patient’s medical records or chart.
year. Just a few years ago, CMA’s health
“We must access one database for lab
care delivery system was having significant
results, then log off and access another
problems with quality of care. Long patient
system for radiology, then log off and access
waiting times, uncoordinated clinical and
the CMA pharmacy system to gain an
patient information, and medical errors
integrated view of the patient’s health. If I
plagued the system. Doctors, nurses, lab
can’t find the patient’s records within five
technicians, managers, and medical students
minutes or so, I have to abandon my search
in training were very aggravated with the
and tell the patient to wait or make another
labyrinth of forms, databases, and
appointment,” said one doctor. The doctor
communication links. Accounting and billing
continued, “You have to abandon the patient
were in a situation of constant confusion and
because you have to move on to patients you
constantly correcting medical bills and
truly can diagnose and help. If you don’t
insurance payments. The complexity of the
abandon the patient, you might make clinical
CMA information and communication system
decisions about the patient’s health without
overwhelmed its people.
having a complete set of information. Not
Prior to redesigning its systems, having all the medical information fast has a
physicians were faced with a complex array direct impact on quality of care and patient
of appointments and schedules in order to satisfaction.”
see patients in the hospital, centers, and
Today, CMA uses an integrated operating
clinics. For example, an elderly patient with
system that consolidates over 50 CMA
shoulder pain would get an X-ray at the clinic
databases into one. Healthcare providers in
but have to set up an appointment for a CAT
the CMA system now have access to these
scan in the hospital. Furthermore, the
records through 7,000 computer terminals.
patient’s blood was sent to an off-site lab, and
Using many levels of security and some
physician notes were transcribed from tape
restricted databases, all patient information is
recorders. Radiology would read and
accessible in less than two minutes. For
interpret the X-rays and body scans in a
example, sensitive categories of patient
consultant report. Past and present
records such as psychiatric and AIDS
medication records were kept in the hospital
problems were kept in super-restricted
and off-site pharmacies. Physicians would
databases. It cost CMA $4.46 to retrieve and
write paper prescriptions for each patient.
transport a single patient’s paper-based
Billing and patient insurance information was
medical chart to the proper location, whereas

1Adapted from: David A. Collier, and James R. Evans (2020): Operations and Supply Chain Management;
2nd edition; Cengage; 686 pages
the more complete and quickly updated
electronic medical record costs $1.32 to
electronically retrieve and transport once. A
patient’s medical records are retrieved on
average 1.4 times for outpatient services and
4.8 times for inpatient admissions. In
addition, CMA has spent more money on
database security, although it has not been
able to place a dollar value on this. Electronic
security audit trails show who logs on, when,
how long he or she views a specific file, and
what information has been viewed.
The same doctor who made the previous
comments two years ago now said, “The
speed of the system is what I like. I can now
make informed clinical decisions for my
patients. Where it used to take several days
and sometimes weeks to transcribe my
patient medical notes, it now takes no more
than 48 hours to see them pop up on the CMA
system. Often my notes are up on the system
the same day. I’d say we use about one-half
the paper we used with the old system. I also
find myself editing and correcting
transcription errors in the database—so it is
more accurate now.”
The next phase in the development of
CMA’s integrated system is to connect it to
suppliers, outside labs and pharmacies,
other hospitals, and to doctors’ home
computer.

Assignment:

Write a memo (use the template file that is made available) to the TOMS 5302 instructor
that provides answers to the following questions:
1. Explain how CMA used the four principles of lean operating systems to improve performance.
2. Does this CMA improvement initiative have any effect on sustainability? If so, how? If not, why?