A better way to consider information technology

IT isn’t always beneficial

By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR

Information technology (IT) has brought many changes to the job of the hospital case manager, but does that mean that IT always is beneficial? The simple answer is no. In many ways, IT can cause higher costs and inefficiencies. At times, it is easy to be persuaded of the benefits of technology. For example, automating the coding of diagnoses and procedures is expected to improve accuracy and consistency. However, when the system actually is installed, sometimes the anticipated beneficial features actually slow the work process or require more staff support.

Before investing in IT that could fail to deliver promised benefits, case managers should thoroughly evaluate work systems and the potential impact of IT. This evaluation involves understanding work activities and then determining if IT will improve performance.

The first step in determining the value of IT in case management activities is to understand the "what and why" of case management performance as a system. For example, if you want to automate the discharge planning process, first get a thorough understanding of the "what and why" of the current discharge planning system. In simple terms, this means looking at the process from end to end. Questions to answer during this assessment:

  • What is the purpose of this process?
  • What are its core activities?
  • What is the process capability (e.g., what can be predictably achieved)?
  • Why does the process behave in this way?

When you know the "what and why" of performance in the discharge planning, you can see two things: What is possible, and what is stopping you from achieving it. Now it’s time to look for inefficiencies and the causes. Questions to answer during this assessment:

  • What needs changing to improve performance?
  • What actions can be taken with what predictable consequences?
  • How will the success of actions be measured?

If you have done a good job understanding the system, you should be able to improve performance by cutting out unnecessary steps, re-designing the process, or whatever. The consequences will be an improvement in discharge planning activities — and without any investment in IT.

Now (and only now) should you consider if IT could further enhance the process. By first understanding and improving the case manager’s activities, you can better predict what benefits IT solutions will bring to the way the process works. The result may be less investment in IT or a realization that IT truly will improve performance. Automation should be "pulled" into the work of case managers. Technology should not "push" the way the work gets done.

The features and functionality of IT should not lead the design and management of case managers’ work. All too often, people are persuaded that IT system features will benefit the work of case managers because, generally speaking, the features fit with current views about the work requirements and processes. For example, IT links to insurance companies that allow for confirmation of patient insurance benefits will lead to more timely discharge planning decisions — but that can only be true when case managers know how to effectively use this information to make post-hospital service arrangements.

The value of IT should be questioned from a thorough understanding of the "what and why" of case management performance. This investigation is something that only can be done by involving people who do the work. Then improve the efficiency of the process in achieving its desired purpose. Don’t make decisions about the use of IT before this first step is completed. The traditional approach to implementing new automation is "push" — here is the new computer system, now use it. When IT is "pulled" into case management processes, people understand the value and know exactly what to expect. Often implementation problems, resistance and so on, simply do not exist when a bottom-up approach is used.

Success at integrating IT into case management activities doesn’t come in equipment or software but rather in the empowerment of the people who do the work. One misconception regarding IT is that installing new software will reduce staffing needs when, often, additional personnel must be hired. If case managers are not provided adequate levels of support, they are unlikely to use new technologies effectively.

The promised benefits of computerization also will fall short unless a significant investment is made in showing case managers how to integrate the technology with their daily activities.

Ultimately, the human aspects of IT are far more important than the technological side. It is futile to support just one part. In other words, purchasing new technology is useless without funding staff support and training. New software products cannot simply be added on to the already full plate of activities expected of case managers. It has to become an integral part of the case manager’s experience in order to gain performance improvements. To achieve this goal, case managers are likely to need ongoing one-on-one and just-in- time instruction in using new technologies. This is not a job that can be performed by a technical troubleshooter or IT specialist. Someone with an understanding of case management activities as well as the associated computer systems should be available for ongoing staff training and support.

The IT industry is continually reinventing itself with the introduction of new and improved automated solutions. Will these products actually benefit case managers or merely add financial and productivity burdens? After more than a decade of having IT available to assist in case management functions, the benefits are becoming clear.

However, before committing to the purchase of new technology, make sure the people who do the work understand the value it will bring to case management activities. As hospitals acquire more and more computerization capabilities, the necessity for case managers to understand the role of IT becomes increasingly critical. The enthusiasm over new technology can quickly change from being an exciting possibility to an intimidating nuisance if IT is "pushed" into the case management process and the human side is not adequately supported.