Selecting a health IT system can be overwhelming due to the number of systems available, as well as the plethora of new features and functions to consider. However, case management leadership, who may be tasked with making the decision, and case management staff, who may be asked to participate in the selection committee, can prepare for this challenge by staying informed of the latest health care trends and technologies that impact medical management functionality.
While it is difficult to keep up with the expanding number of software applications available in the care management field, case managers need to understand the technology solutions that are available and how they can improve clinical workflows and documentation, administrative processes, and patient outcomes.
The following are typical solutions used in care management programs:
Care management software: Used to support patients through the continuum of care. These applications usually contain the following features: patient and provider information, communication and workflow management tools, clinical documentation, assessments, care plans, and other clinical content.
Electronic health record (EHR) systems: Typically used by the provider system at the point of care. These systems are found in physician offices, hospitals, and other settings. They contain information related to each individual, including patient histories, lab and x-ray results, medications, treatment plans, and other key medical information.
Utilization management (UM) applications: Decision-support tools that contain evidence-based guidelines used by payers, UM staff, medical directors, and others to review the "medical necessity" of requested admissions, continued services, and procedures. Many case management systems have this functionality fully integrated.
Patient engagement applications: Focused on helping patients become more actively involved in their health care experience by communicating with patients, scheduling appointments, providing alerts and results, and keeping patients updated on their overall health status. These efforts result in better health outcomes.
Health information content systems: Provide validated and referenced health information that can be provided to patients or used by the clinical staff to improve their knowledge about conditions and treatment protocols. There is so much information available today that it is safer and more convenient to use this type of validated information, rather than rely on everyone trying to find information on numerous Internet sites.
Data analytic and warehouse IT solutions: Support the tracking of patient and population trends through predictive modeling and data analytic reporting capabilities. Case managers do not usually work in these systems, but are provided data from them to work more effectively with their patients. The systems also include outcomes reporting to evaluate the effectiveness of the care management programs.
Before a selection committee begins to develop an RFP or contact vendors for demonstrations, they should develop a list of "must haves" for each functional area. Below is an example of essential operational capabilities that may be on a list of "must haves". Keep in mind that this process can be used when looking for any type of software.
The system must provide:
- Efficiency: Saves time for case managers, thereby making them more efficient.
- Usability: Is user-friendly and intuitive, so there is less training needed.
- Functionality: Provides effective, innovation features and functions that support key activities associated with care coordination.
- Adaptable workflows: Can be easily adapted to fit the organization’s needed workflows and make them even more efficient, rather than you having to alter the workflows to fit the system.
- Ability to modify: Can be easily configured by the organization without having to rely on the vendor to make the changes.
- Flexibility: Can be accessed from any location using any device, including mobile laptops, and tablets.
- Interoperability, integration, and interfaces: Integrates with other IT systems with relative ease.
- Reporting and dashboard capability: Able to report on all data fields in the system, as well as provide real-time data analysis and feedback loops that create actionable information.
- Privacy and security: Meets and/or exceeds federal and state privacy and security requirements.
- Ability to update: Updates are provided free of charge and can be applied without disrupting the day-to-day work.
- Scalability: Able to expand based on your growing and changing business needs.
- Affordability: Licensing fees are affordable today and also in future years. The vendor is willing to change the terms of the contract to make it more affordable.
- Effectiveness: Helps case managers realize better clinical and financial outcomes.
- Clinical content: Includes free clinical content, such as assessments, care plans, letters, and educational material.
- Automation: Includes ability for client-specific business rules to be applied in order to automate workflows and processes, resulting in quicker documentation, consistency of practice, increased speed and productivity, improved efficiency, and a better return-on-investment.
Obviously this list does not cover every requirement like an RFP would, but it does identify the necessary elements from an operational perspective. The list can also be used to create detailed technical and operational requirements for an RFP, as well as a checklist that can be used to evaluate the system during vendor demonstrations. After gathering all the detailed information from the RFP and seeing all the "bells and whistles" presented in the demonstrations, it is often "hard to see the forest for the trees." That is why this type of checklist is important - it helps you make sure you don’t lose sight of the key operational functions you determined were necessary to make your program successful.
The potential synergies between case managers and health IT solutions are tremendous. The inter-connectedness between the practice of case management and the technology platforms that support case managers will continue to grow and become even more important. Because of the time, effort, and cost to change systems, case managers and their IT colleagues must remain vigilant to ensure they are purchasing and implementing the right software at the right time with the right functions at the right cost. This is not an easy goal to accomplish and it is further complicated by the ever-changing IT landscape.
As more and more applications are developed, some clients begin to look for simpler "off the shelf" applications that can be hosted and quickly implemented with little customization. This may work well for smaller, standard programs that do not need as many customized workflows or automation. However, larger organizations typically need automation and the ability to change workflows to meet their unique needs in order to meet their efficiency, productivity, clinical outcomes and financial goals.
What should the average case manager do to get ready for the IT challenge? You can start by reading available articles and research so you are familiar with what is available. Also be sure to provide your leadership with input about your IT systems, including: what works or doesn’t work, changes that would help improve workflows and efficiency, processes that would improve the clinical outcomes for your patients, and so on. (Make sure that you present these suggestions in a positive way, rather than complaining about what your current system doesn’t do.) Although IT systems can drive us crazy, we couldn’t do our jobs without them. (I can’t even imagine going back to a totally paper-based system, can you?)
Next month’s article will discuss How to Find the "Right" Application and Vendor, including tips on preparing an RFI/RFP, preparing for and evaluating a vendor’s demonstration, and choosing the "right" application and vendor for your organization.
To contact Pat Stricker, email her at firstname.lastname@example.org, or call her at (530) 886-1700, ext. 215.