If info you need is in your system, can you find it?
If info you need is in your system, can you find it?
Work with your hospital’s IT department
Today’s case management departments need access to information as quickly as possible, and that can be a challenge unless your hospital’s information technology (IT) system is tailored to fit the needs of the department and someone knows how to retrieve the information that’s needed, asserts Don Collins, owner of Clarity Report Development, a Paradise, CA, computer technology consulting firm.
"In general, the health care industry is still reeling from the computer technology that was thrust upon it 20 years ago. The systems today are supposedly better, stronger, and faster, but the typical user has been left behind because the technology and tools tend to be a little outside their realm," he says. Collins has worked with hospital case management directors for about eight years, helping them navigate the technology field.
"There is a huge gap between the objectives they want to achieve when it comes to information and what they are actually able to get out of their computer systems," he says.
Denial data usually are at the top of the list of information that case management directors want to get from their computer systems, Collins says. They need to know what claims are denied and why, which insurance companies deny the most claims, and which physicians incur the most frequent denials.
"Because of the pressure on hospitals these days, they can’t wait three months and do a retrospective study. They need information concurrently so they can quickly and aggressively pursue appeals," he says. Case managers need to be able to justify their department, and this takes data, Collins says. For instance, the case management department could document a decrease in the number of denials or an increase in the appeal rate and determine what that means in terms of dollar savings. But they’ve got to be able to gather the data first, he adds.
According to Collins, hospital case management departments typically fall into two categories: those with a large database system purchased by the hospital information services department, and smaller departments that survive with pen and paper or basic tools.
Both types face problems when it comes to getting the information they need, he says. The case management departments with high-tech equipment often have laptops the case managers can take with them or computers they can use at nursing stations. "A prevalent problem with this kind of system is that getting the kind of information a case management director needs can be a real problem," Collins says.
In many cases, the organization has purchased a generic type of software product that never meets the specific needs of a case management department. The case managers with basic tools may use just pen and paper or an off-the-shelf spreadsheet product to collect their data.
These departments would like to have a better system, but often they’re too small to justify purchasing it, he says.
"In these departments, it’s always panic time when somebody asks for data because it’s usually strewn across a number of office desktops. This means somebody has to come in and do a lot of manual manipulation to get the data in the form needed," he says. Case management directors have a keen sense of what information they want, but often they don’t know where it is and how to retrieve it, Collins says.
Part of the reason is that software companies are packing their applications with so many features and functions that very few people can figure out how to use all of them.
"Software systems are often overdesigned, and getting the information you want requires a lot of time and effort. There’s a big gap between the technology in a database and the expertise of the people who are using it," Collins says.
Even the smaller systems have some basic features and functions that can improve the case management department’s efficiency. You just have to know how to use them, he says.
In many cases, someone in the case management department has the skills and knowledge to get what you need out of your IT system, you just have to be able to find them and harness their talents, often with the help of the IT department.
"The [IT] department can give case managers basic tools and pointers for getting the information they need out of their computer systems. But case management directors have to know how to speak their language and give them an idea where the information is coming from," Collins says.
Start by figuring out what information you need for your day-to-day operation and what data you need for your reports to management. Find out if the information you need is being collected, who is collecting it, and where it is stored in the system. This often means opening your database application, scrolling through the various screens, and finding out where the information exists. "This will help clarify the type of reports you need and help them teach you how to retrieve the data," he adds.
When your hospital buys new IT equipment, the case management department should be closely involved in the decision-making process or risk not being able to get the kind of reports it needs, he adds.
"Even when case managers are involved, they may not get what they want out of the system because typical software demonstrations don’t always speak to the challenge and complexity of working with database operations," he says.
List the things you expect the system to be able to do for you. Choose the three most important and make sure the database system the hospital is considering will meet that need. Have the sales representative put together a scripted demonstration that will show you how to use the software to meet your specific needs.
"People often are so wowed by the initial software demonstration that they don’t realize that some of the things they want are left out. Usually, there is a hidden expectation that is never met," Collins says.
Don’t rely on just asking the sales representative, who may just want to say yes to your questions and make the sale. "It may be a matter of the nature of the question meaning two things to two different people. The best way to find out if it meets your needs is to insist on an actual demonstration," he recommends.
Todays case management departments need access to information as quickly as possible, and that can be a challenge unless your hospitals information technology (IT) system is tailored to fit the needs of the department and someone knows how to retrieve the information thats needed, asserts Don Collins, owner of Clarity Report Development, a Paradise, CA, computer technology consulting firm.Subscribe Now for Access
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