Lesson 1: Understand the Universal Health oncology case and current-state stakeholders

Lesson objective

This lesson summarizes the Universal Health oncology context, the two oncology programs, the merger and EHR environment, the reason for the oncology gap analysis, and the main stakeholder groups involved in intake, navigation, prior authorization, informatics, and IT, based on HCI-670_Case_Study.

Universal Health oncology context

According to HCI-670_Case_Study, Universal Health is a large not-for-profit health care system with 12 hospitals across three states. Within this system are two large oncology programs in Arizona. The case study focuses on the oncology setting because oncology care includes complex clinical, operational, financial, and documentation needs, especially for oncology navigators and prior authorization or financial coordinators.

The two oncology programs

HCI-670_Case_Study identifies the two programs as Oncology South and Oncology North.

• Oncology South is affiliated with Academic Hospital.
• Oncology North is affiliated with a larger national oncology health care system.

Although both programs are part of Universal Health, they do not operate in the same way. The case explains that important operational differences exist between the two locations.

Merger and EHR environment

In HCI-670_Case_Study, the differences between the two oncology programs are tied to organizational change and EHR history. Oncology South had recently become part of Universal Health through a merger or acquisition involving the Academic Hospital oncology program. Oncology North, by contrast, had already been part of Universal Health for 8 years.

This history created a difficult EHR environment:

• Oncology North had long used the Chrystal EHR.
• Academic Hospital and its oncology program were in the process of converting to Chrystal.
• Oncology North still reported significant issues with the existing Chrystal build.
• Those issues included functionality gaps for oncology clinicians and their unique workflows.

As a result, Universal Health was not only managing differences between two oncology programs, but also dealing with EHR conversion and dissatisfaction with the current oncology build at an existing site.

Why the oncology gap analysis was needed

HCI-670_Case_Study states that Chrystal alignment specialists became actively involved during the EHR conversion. One of their first major steps was to perform a gap analysis and prioritization of EHR functionality for oncology and for Universal Health more broadly.

The gap analysis was needed for several reasons:

• The oncology build at Universal Health did not align with Chrystal’s recommendations for oncology specialties.
• There were functionality and workflow concerns affecting oncology providers and clinicians.
• There were important prior authorization and financial workflow gaps.
• Oncology navigators had very limited oncology-specific functionality in the EHR.

The findings showed that oncology workflows and documentation tools were not adequately supporting the people who used them. Because of this, Universal Health created a focused team to address the oncology-related recommendations from the gap analysis.

Current-state oncology workflow context

The case in HCI-670_Case_Study describes a typical early oncology workflow beginning after a patient receives a cancer diagnosis. The patient is then referred to an oncology specialist or program, either by calling directly or through the diagnosing physician.

Both Oncology South and Oncology North use dedicated intake referral specialists who work with patients, families, and referring physicians to schedule patients with the right oncology specialist based on diagnosis. Before the first oncology visit, documents such as pathology reports, diagnostic results, and physician notes must be sent to the prior authorization team. This supports two goals:

• obtaining the proper insurance authorization, and
• ensuring the patient is matched with the most appropriate oncology specialist.

The case emphasizes the need for a standard workflow and standard documentation location in the EHR so all participants can tell what has already been completed and what remains pending.

Main stakeholder groups

Based on HCI-670_Case_Study, several stakeholder groups are central to the current state and to the redesign effort.

1. Intake referral specialists

These staff members are involved early in the patient journey. They collect basic intake information such as:

• name of the caller,
• contact information,
• referral source,
• provider information, and
• diagnosis details, including cancer type.

Their work initiates the oncology workflow and supports scheduling and downstream coordination.

2. Oncology navigators

After intake, the cancer type on the intake documentation is used to notify an oncology navigator who specializes in that cancer type. The navigator then contacts the patient and begins a customized navigation plan based on assessed needs. HCI-670_Case_Study describes the navigator role as extremely important to the oncology team.

However, oncology navigators were also identified as a major gap area in the EHR. Their functionality in Chrystal was significantly underdeveloped, making them a key stakeholder group in the redesign effort.

The case also notes similarities across navigators at Oncology North and Oncology South:

• both used the Navigator/Coordinator RN role,
• both wanted discrete data for reporting,
• both used shared electronic forms and free-text notes, and
• both wanted oncology navigator documentation to be easier for clinicians to find.

3. Prior authorization and financial staff

HCI-670_Case_Study highlights prior authorization as an essential part of oncology operations. Cancer treatment carries major financial responsibility for both the patient and the organization. Prior authorization staff review incoming clinical documents, work with insurance requirements, and help ensure that the patient’s financial responsibilities are addressed appropriately.

Because documents may arrive at different times, this group depends on clear workflow steps and consistent EHR documentation to know what information has been received and what actions are still needed.

4. Nursing informatics

Nursing informatics staff are part of the focused team created in response to the gap analysis. Their role, as described in HCI-670_Case_Study, includes helping document workflow, assess end-user needs, and support development of final design recommendations. They help connect clinical practice needs with system design.

5. IT and EHR specialists

Several IT-related stakeholder groups are involved:

• Universal Health IT resources,
• Universal Health IT build team,
• Chrystal oncology alignment specialists,
• Chrystal oncology IT experts, and
• Chrystal IT staff.

These groups support the gap analysis, workflow review, prioritization, system design, and eventual build or configuration changes in the EHR.

6. Project management and oncology clinicians

The focused team also includes a project manager, and the case references the workflow and functionality needs of oncology providers and clinicians more broadly. These users are stakeholders because they rely on clear oncology documentation, visible navigator notes, and workflows that support care delivery.

Why these stakeholders matter

HCI-670_Case_Study shows that the oncology workflow crosses multiple teams. Intake staff begin the process, prior authorization staff manage insurance-related steps, navigators assess and coordinate patient needs, clinicians deliver care, informatics staff analyze requirements, and IT teams translate those needs into EHR design. If any group lacks the right tools or visibility, patient care coordination and operational efficiency can suffer.

Key takeaway

In summary, HCI-670_Case_Study presents Universal Health as a health system with two Arizona oncology programs operating under different affiliations and histories. A recent merger, ongoing EHR conversion, and dissatisfaction with the existing oncology build created the need for a formal oncology gap analysis. That analysis revealed misalignment with recommended oncology functionality, especially in prior authorization workflows and oncology navigation. The main stakeholder groups in the current state include intake referral specialists, oncology navigators, prior authorization and financial staff, nursing informatics, Universal Health IT, Chrystal alignment and IT specialists, project management, and oncology clinicians.