Train case managers in information technology
IT skills necessary to access data
If your case management department is consolidating with related departments like utilization review, discharge planning, and social work, you're already aware of just how steep the learning curve can be. New responsibilities require more comprehensive knowledge and the tools to apply that knowledge effectively. And while many departments have provided clinical case managers with the training they need to understand financial issues, few so far have taken the necessary step of providing training in information management.
That's a shame, says Darice Grzybowski, MA, RRA, director of health information management at Hinsdale (IL) Hospital, where information specialists have trained case managers in the use of complex information systems since 1996.
"Many case managers really do lack an understanding of charge vs. cost, vs. what is discharge data," Grzybowski says. "We find that many times it's very difficult for them to make the transition from what's happening in the acute care world to what a discharge data set is supposed to reflect."
For example, with regard to discharge disposition, a case manager may place follow-up telephone calls to find out whether a patient is in rehabilitation or receiving home care visits, and then keep track by writing statistics in a manual log. "And they say, well, 75% of our patients have follow-up care. Then we run our database off what goes onto the UB92, and we'll say, no, 40% of them had that based on the discharge order," Grzybowski says. "They're following up another way, so they have additional data. But you can't reflect that on your bill. You can only reflect what's documented. And they have a hard time coming to grips with the fact that if it's not documented, it wasn't done and it's not in the data set."
When Hinsdale decided to provide its case managers with information management training, the hospital's case management efforts were splintered among three different departments: utilization review, social work, and case management itself. Because the departments were separate, no uniform process existed to orient new hires. In 1996, Grzybowski volunteered to provide such orientation. "They were coming to our department anyway to orient in other things," she says, "like how to access records and how to obtain information. So we thought, we'll have a special orientation just for these folks, who tend to use data more in their jobs as they analyze practice patterns."
Grzybowski saw early that such training was necessary. "They really didn't know what they were doing," she says. "I mean, we saw individuals collecting a lot manually, we saw them duplicating effort, we saw mistakes being made in the usage of data, and we said, `They need education.'"
She helped coordinate a joint effort between health information management, finance, and nursing to construct the curriculum of the training program, which includes an initial orientation, a follow-up meeting, and a series of less formal sessions as needed.
The initial orientation session, which lasts about an hour and a half, focuses on information contained in a packet compiled by members of the multidisciplinary team that created the program. "It basically covers all of the different databases that are in the hospital, then talks to them about data mining, data collection, and data usage," Grzybowski says. "It gives them a good resource for understanding the importance of bits of data and information in their practice."
Grzybowski confesses being surprised to find that even case managers with strong clinical backgrounds often have little understanding of the complexities of clinical data. That's why the initial session starts with "the very basics," she says. "I find that even those with masters' degrees in nursing really don't have a clue as to what goes on in the information system's databases to collect data on their patients. So we really have to start from scratch, saying: 'Here's what data elements are out there, and here's how they're collected.'"
The two-hour follow-up meeting delves more specifically into issues surrounding clinical pathways and patient populations. "We talk to them in a little more detail about statistical selection of which outcome indicators or quality indicators they would like to track," Grzybowski says. "This is done with a lot of input from the medical staff, the quality assurance department, and nursing."
Case managers may then spend a day or two receiving additional hands-on training in the use of technical spreadsheets. Following that, information specialists work with the case managers at various committee meetings to help analyze and interpret data. "There's a lot of back and forth," Grzybowski says. "We'll keep in touch with them every week and send them data every month. It's that kind of an ongoing process."
Grzybowski stresses that health information management professionals can be a valuable resource for case managers, but are underutilized at too many institutions across the country. "The message we want to get out is that we're here to help people understand data," she says. "Let's put the expertise where it belongs, then educate where appropriate, and work together."
For more information, contact Darice Grzybowski, MA, RRA, director of health information management at Hinsdale (IL) Hospital. Telephone: (630) 856-8537.