The technology revolution can be a boon to case managers by saving time and making their jobs easier — but there are pitfalls to relying too much on electronic tools.
• New technology is changing the way case managers work by making it possible to research resources, communicate throughout the continuum, and even predict outcomes — but there’s still no substitute for the human touch.
• Continue to focus on the patient and family members instead of the technology and rely on your experience, skills, and predictive modeling when you develop a treatment plan.
• Keep work-related information and photos out of social media and make sure that any emailing or texting that involves patients’ information is encrypted.
The saying used to be that case managers were only as powerful as their little black book of resources. But, through technology, today’s case managers have access to resources that go far beyond the pages of a book.
“It’s a new world out there with a lot of exciting changes, and so many things that case managers can accomplish electronically in a fraction of the time it used to take,” says Cheri Bankston, RN, MSN, senior director of clinical advisory services for naviHealth, a Cardinal Health company.
Technology has made a lot of changes in the way case managers work. When used properly, it frees up case managers to spend more time at the bedside, Bankston points out.
“The whole future is electronic,” says Toni Cesta, RN, PhD, FAAN, partner and consultant in North Bellmore, NY-based Case Management Concepts. “It is making life so much easier for case managers, particularly when patients move through the continuum,” she adds.
As hospitals merge and create large healthcare systems, case management software becomes even more essential and useful, Cesta says. “If all of the entities have case management software, they can communicate easily and get the entire picture of the patient across the continuum,” she says. For instance, if the software interfaces, case managers can see what tests and procedures the patient received at other levels of care and ensure that they aren’t duplicated.
“Case managers can see what happens from the emergency department through the hospital stay and into the medical home, and how all the pieces become connected in a patient-centered medical home,” she says.
“There is so much technology that can support us in so many ways,” Bankston says. She urges case managers to become knowledgeable about everything that is available and decide what might be helpful to them.
Technology helps case managers coordinate with colleagues inside and outside the hospital, across multiple continuums of care much more easily than in the past, says Yomi Ajao, vice president of consulting for COPE Health Solutions.
For instance, when it’s time for patients to transition to another care setting, case managers can connect with post-acute services and send them the information they need electronically with the push of a few keys, rather than spending time faxing or calling, he adds.
“In the past, care managers tried to review every patient every day, but some of them may not have needed the attention and others had greater needs. Now, we can use algorithms to stratify patients by condition, by comorbidities, social determinants of health, and other factors so care managers can focus their energy and resources on patients who need it,” Ajao says.
“We’re not at a point where technology will replace humans, but it does allow us to be more precise in our connections with patients and on how we focus our energy,” Ajao says.
When case managers relied on written lists of resources and contact information, it was difficult for them to share it with their colleagues, Bankston points out. “Now, case managers can pool all their knowledge in a database where everyone in the department can access it for better patient outcomes,” she says.
When it’s time to transition patients, it’s much easier to find the resources they need and to connect them to post-acute services without sending out requests in an unsecured fashion, she says.
A laptop or tablet can be invaluable when you’re educating a patient on a disease process or discussing a procedure, Bankston says. “Showing patients a short video is far more effective than just describing something,” she says.
Case managers report that they find technology useful in communicating with patients after discharge and helping them avoid unnecessary readmissions.
UAB Medicine has successfully used automated interactive telephone calls to patients after discharge to replace follow-up calls from case managers, says JoAnn Clough, RN, MAON, ACM, transitional care coordinator, care transitions for the University of Alabama at Birmingham (UAB) Medicine. The calls are condition-specific and include a series of questions along with education about the disease.
“Patients often have a hard time understanding their discharge instructions while they are in the hospital because they are thinking about going home. Now that hospitals are at risk for patient care as long as 90 days after discharge, we had to find a way to interact with patients in their own home. The phone calls save a lot of time for case managers and have produced good outcomes,” she says. (For details on the UAB Medicine initiative, see story in this issue.)
There are a lot of electronic tools that case managers can use early in the stay to help them make decisions and develop the discharge plan, Bankston says. The tools can predict the first level of care and functional gains in different settings. They can determine the readmissions risk for patients and what they need at discharge, she says.
“Some of the newer tools use technology and predictive algorithms based on large data analytics and compare individual patients to those with similar diagnoses and functional levels in a large database to determine the length of stay, therapy needs, caregiver burden, and where the patient will function the best. Now case managers can have data when they talk to patients and families and help them make a decision,” she adds.
Technology continues to get better and better, says John Banja, PhD, professor in the department of rehabilitation medicine and medical ethics at Emory University’s Center for Ethics in Atlanta.
The increase in technology in the healthcare field isn’t going to eliminate the need for case managers, but it is likely to change the job descriptions, Banja says.
“Technology can lower costs by making treatment more efficient and help clinicians make medical decisions more effectively and quickly. One of the great promises of technology is saving time for clinicians by sifting through data and identifying trends,” he says.
“Case managers often coordinate care for patients with significant medical history and a clinical page that is hundreds of pages long. They could save a lot of time if they could use a program that would sift through the data and identify previous admissions and trends,” Banja adds.
As it is perfected, artificial intelligence will help case managers by making a more robust kind of clinical record possible, Banja predicts. “With a good artificial intelligence system, case managers should be able to access patient history, identify the most likely discharge date, find out what the health plan allows, and download all the pertinent information they need in a few seconds instead of the hours it takes today,” he says.
Cesta cautions case management leadership to carefully scrutinize any electronic medical record (EMR) software their hospital is considering and resist shifting case management functions to the new system unless it will do everything the case management software does.
“Large EMR companies are offering case management as part of their medical record software — but, in most cases, it doesn’t provide what case managers need,” Cesta says. “Pharmacy has its own specialty software, medical records has specialty software, and case management needs specialty software in order to function efficiently and effectively,” she adds.
Vendors often tell the hospital decision-makers that the hospital can save money by getting rid of the specialty case management software, Cesta reports. “But EMR systems have a clinical focus and it isn’t geared to the case management process,” she says.
Case management departments need software that has a discharge planning component, a utilization review component that doesn’t go into the medical record, a daily workflow component, denials and appeals documentation, an avoidable delay section, a way to document readmissions, a component that sends requests to nursing homes, and a way to build report cards, among other features, Cesta says.
Vendors may say that case management modules are in the works, but don’t fall for that, Cesta advises. “I’ve heard over and over that features I request will be available in six months — but a year or more later, it still hasn’t happened,” she says.
When choosing new software, factor case manager workload into the time it takes to use new software, Ajao suggests.
“Case management leadership should make sure the way the software is designed doesn’t add more burden to the work of case managers and nurses. Templates and tools can make the life of case managers easier, but as we deploy them we have to make sure they are helping and not adding more work,” he says.
As the technology revolution continues, it will continue to produce sophisticated artificial intelligence technology that will change the world of healthcare, Banja says.
“The optimistic perspective is that, in the future, artificial intelligence technology may free up nurses, doctors, and case managers from searching through files and writing notes, which comprises 20% to 40% of their time,” Banja says.
The pessimistic viewpoint is that technology is going to eliminate the human touch and people are going to find themselves mostly talking to machines that have voice recognition capabilities, Banja says.