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Tracking outcomes essential in today’s climate
If your hospital isn’t using case management software that is integrated with the rest of the hospital’s information systems, you may be behind the curve, asserts Vicky Mahn-DiNicola, RN, MS, vice president of ACS Healthcare Solutions, a Tucson, AZ-based health care technology firm.
She calls case management "the glue that holds it all together" but adds, "people often question what case managers do because it’s an interdisciplinary profession with what is often a nebulous role."
That’s why it’s important to be able to come up with data that demonstrate how case managers contribute to the outcomes of their populations, Mahn-DiNicola says.
"Case managers’ jobs depend on their ability to tell those qualitative and quantitative stories to stakeholders. They have to be accountable for justifying their positions in terms of quality of care and financial efficiency," she explains.
In her dealings with hospital case management departments, Mahn-DiNicola has found that about 40% of case managers are savvy users of case management software and applications.
The rest are using paper-based systems or stand-alone homegrown systems that don’t interface with their hospital’s health information systems.
"It’s amazing how many departments are using homegrown tools they’ve created with off-the-shelf software. Unless these systems talk to other systems in the hospital and do so in real time, case managers may be spending unnecessary time searching for information or entering data into their systems. Case management departments that are run on information islands are not likely to be as productive or as valuable to their organizations," she adds.
For instance, if a diabetic patient is admitted to the hospital and case management is going to follow him or her, the case manager likely would have to enter the patient’s demographic information into the case management system and consult a totally different information system to view medical history, laboratory data, or insurance information.
"This is just one illustration of how systems that are not integrated create nonvalue-added work," Mahn-DiNicola says.
In a system where the case management department’s software is integrated with the hospital’s legacy system, the administrative discharge transfer (ADT) and the discharge abstract system (DAB), the systems are interfaced so that much of the information case managers need to manage their patients already is available to them without duplication or redundancy.
"As care management systems become more sophisticated, they are beginning to interface with other parts of the medical record such as pharmacy data, laboratory data, imaging, and order entry. Not all case management systems are doing this yet, but case management departments that want to stay in the game are at least exploring these possibilities," she adds.
Case managers should be involved in the selection process of a vendor for any information system they will use, Mahn-DiNicola advises.
That means doing a lot of groundwork to prepare yourself for the selection process. To determine what you need to get from a new computer system, you must understand how patients and information move through your hospital’s systems and what data already are being tracked, she says.
For instance, if your quality improvement department has software, learn all you can about the information it is collecting so this information can be leveraged to identify high-risk clients or evaluate case management outcomes.
"If possible, case managers should spend at least a full day shadowing a nurse who reviews records for purposes of quality improvement. It is the best way I know to build a mutual understanding and appreciation for the contribution of another’s roles," Mahn-DiNicola says.
Case managers should create opportunities to shadow inpatients and same-day surgery patients through the admission process so they can experience firsthand the information flow through the patient’s eyes.
"It’s amazing how many times patients are asked the same question between the time they walk into the admissions department and the time they are admitted to the nursing unit. Experiencing this firsthand will help case managers be better advocates for patients when they choose their information systems," she adds.
Here are some other suggestions that can prepare case managers to be savvy information system users and help choose a system that will meet their needs:
"Once case managers have a bird’s eye view of how patients and information move across the continuum of care in their hospital system, they are better positioned to identify what information needs they still have. This is important because you can’t expect to get budget dollars for a case management system if you’re not clear on how the various information systems will work together without duplication or redundancy," Mahn-DiNicola explains.
For instance, do you want a list of everybody who came through the emergency department (ED) last night or all patient who have been in the intensive care unit (ICU) for five days?
"There are countless different combinations of things that case managers want the case management system to do for them," Mahn-DiNicola points out.
As you start to come up with what you want in your system, keep your department’s future plans in mind so you won’t outgrow your system as soon as you implement it. If your hospital-based case management program has a vision to expand beyond the hospital walls, take this into consideration when you choose a software system. Make sure what you purchase now will meet your needs in a few years.
Mahn-DiNicola suggests developing a project team with representatives from each point of care in the continuum.
Typically, the information system department will take the lead on this type of project. The team should include representatives from quality management, utilization management, the medical staff, finance department, social work, and case management.
Once the software team gets together, the educational process begins. The information technology people must teach the members of the case management team basic principals of information management. Case managers should be able to articulate their workflow processes and other information needs so the team can support them in selecting the right product.
Everybody needs to be knowledgeable about the hospital’s information management policies and procedures and the Health Insurance Portability and Accountability Act.
The first step in identifying software vendors is to create a request for information, a document that explains broadly to a variety of vendors what the organization is seeking. It should include information on the hospital’s mission, number of beds, and how the software will be used.
The purpose of a request for information is not to choose a vendor but to weed out vendors who can’t meet your needs.
"At this stage of the game, you should not expect a quote or detailed product specification, although you might receive a list of clients from organizations similar to your own," she says.
Typically, hospitals send out a dozen or more requests for information and narrow the selection down to a few vendors who are invited to submit more detailed proposals.
After you have identified a short list of vendors, the next step is to create a formal request for proposal (RFP) document, typically a collaborative effort between the information systems department and the stakeholders.
The RFP is a very detailed document that identifies specific case management processes and other details about how the system will be used. Include information about your hospital’s technology infrastructure.
For instance, if your system has eight hospitals all connected by a wide-area network, you’d have different needs than those of a 32-hospital system in a nationwide chain with no connectivity.
The RFP should include a case management scenario to be used in demonstrating how the system works and an evaluation tool that you will use to evaluate all vendors.
To create the demonstration scenario, Mahn-DiNicola suggests thinking of the most challenging case management scenario you handle so you can see the full potential of the vendor’s system and identify any problems you will encounter.
For instance, a patient comes into the ED after an accident and is admitted to the ICU. How can the case manager find out quickly that the patient was in the health care system several months previously being treated for diabetes?
How does the case manager who has been coordinating the diabetes care find out that the patient has been readmitted for the trauma?
"The case managers should weave the story so you involve all the things they have to deal with during the day," Mahn-DiNicola says.
If your case managers handle insurance authorization, utilization review, or discharge planning, build that into the scenario.
Ask how the case manager would find an agency that matches a payer’s approved list of services or get a summary of a patient’s benefits.
Ask for a demonstration of how reports, letters, or tickler files are generated.
Work with the vendors to design the system.
"Vendors work collaboratively with a lot of different case management models and a lot of different ways of managing care," she says.
Make sure that the system you choose can be customized to meet your particular needs.
The case management director and staff should be involved in establishing what the software should do, such as what kind of reports will be generated and what kind of data you will put in and get out.
"You should think about what the end product will be like," Mahn-DiNicola says.
The software will be different depending on your case management models. Some are organized by nursing unit, others by product line or service line.
"Every hospital has its own little twist on how they do things. It’s critical for case management software to be flexible in the marketplace because one hospital case management department might have different goals from another," she says.
Mahn-DiNicola recommends that designated staff be assigned to maintain and support the system once it’s in place. The information systems staff will be heavily involved while the system is being installed, but then they tend to back off and leave the system management in the hands of case managers, she says.
Budget funds to train the staff who will be responsible for stewarding the system.
"When you have case managers who are information-savvy, you have empowered your department with the tools needed to make a big impact on care in your organization. Having one or two case managers who can run reports, explore trends in performance data, and synthesize clinical information is really the new frontier for case managers. It’s an exciting role for nurse case managers to explore," she says.