If you don’t have CM software, you can bet your competition will
Information systems are a must; so are informed decisions on what to buy
(Editor’s note: This is the first part of a two-part special report on selecting case management software. In this issue, our experts tell you how to choose case management software that meets your current and future needs. They also provide a list of features you should look for and a list of software vendors whose products have those features. Next month, we’ll take a look at software designed to support special case management functions, such as long-term care and workers’ compensation.)
Case managers must have the support of a good information system to survive in today’s competitive market. But with costs ranging from $25,000 to $200,000 for as few as five users, experts caution that selecting a case management software product is not a decision to be made in haste. "With the right software, a single person can be almost as effective as an entire company. If you are savvy technically, you have a definite competitive edge," says Barbara Luttrell, RN, BSN, ABQAUR, CDMCS, director of workplace health services for Cerulean Workplace Health in Atlanta.
The secret to gaining that competitive edge, say experts interviewed by Case Management Advisor, is to select the appropriate case management software. The product you choose should be flexible enough to meet both your current and future needs and be customized to fit your unique style of case management.
"Many case management companies have waited too long to make a software purchase, and now they are under the gun to buy fast. First, forget the notion that there is a software product out there that is ready right off the shelf to meet all your needs," says Marcia Diane Ward, RN, CCM, market segment manager for IBM Healthcare Solutions in Atlanta. "If there was a perfect case management soft-ware system designed just for you, we’d have thousands of software products out there instead of about 70. Remem-ber, you may have a few unique features to your case management model, but all case management is based on four principles: assessment, planning, implementation, and evaluation."
Buy product for the long term
Case managers should look for software that meets a minimum standard of sound architectural considerations, Ward says.
"You have to find a product that will go over the long-term, and that takes good architectural characteristics or programming features that allow you to customize and expand easily. Once you have that sound foundation, you can begin customizing," she says. (For a complete checklist of features to look for in case management software, see p. 99. For a list of software vendors with sound architectural products, see p. 101.)
Features that Ward says case managers should look for in a software product include:
• ability to share information concurrently with team members;
• ability to support encoding of data recorded for outcomes analysis;
• ability to support customized protocols, care pathways, and guidelines;
• ability to support rule-based criteria for identifying patients for proactive case management;
• ability to interface with other systems;
• adequate security, authentication, and encryption capabilities;
• compliance with and support of emerging and current industry standards for encoding databases.
Our experts say, however, that the first step to selecting the right software is to identify your needs and goals clearly. "You have to begin with the end in mind. There are many products available. Most of them may be much fancier than you need. And the fancier you get, the more likelihood you have of bugs in the system," Luttrell explains.
She suggests case managers begin their software selection process by asking the following questions:
• Why are we buying software?
• How large is our company?
• What type of case management do we do?
• What are our customers asking for in terms of outcomes reporting?
• Do we plan to implement disease management programs?
• Do we plan to have case managers and providers report from the field?
"There is client-driven software out there and claims-driven software out there. You have to know the goal of your company and fit your case management software into that," Luttrell says. "For example, if you are a rehab provider and work with the state board of compensation, know their requirements for managing a patient file and fit your software to it. If you are a managed care company, look at NCQA’s [National Committee for Quality Assurance] guidelines for managing patient files and select software that is compatible with those guidelines."
The buck stops here
Case managers are more likely to select the appropriate software if they draft a strong, multidisciplinary team, say Luttrell and Ward. However, there are many variations on the team concept and two important ground rules that must be established.
"First, set a time frame for the decision-making process and insist that the team make a selection within that time frame. Second, appoint one clearheaded individual to execute the final choice," Ward says. "You must have one person who can say, OK, everyone has had their say. Now let’s make a choice.’ It’s as important not to obsess too long as it is to shop wisely."
Luttrell sent out a companywide invitation to co-workers to join her case management software selection team, and only three individuals came forward. "I sent out a companywide e-mail invitation. But the response was rather low. So, I began researching on my own. When I got the choices down from 60 to five, I sent out another companywide e-mail message," she says.
In her second communication, Luttrell asked whether any co-workers were familiar with the five vendors. "I also asked whether they knew any case managers who were currently using the products I was interested in," she says.
An important preliminary step for case managers at the Channeling Project at Miami Jewish Home and Hospital for the Aged was to agree on a common language that could be used across disciplines. "We use a multidisciplinary team. Before we could select software to support our case management, we had to find a common language between disciplines that we could agree to integrate into the system for the purpose of sharing with patients and families," says Betsy Pegelow, RN, MSN, director of special projects.
One of the primary software goals of the Channeling Project case managers was to switch from handwritten care plans to a more standard computerized version that could be used as a central working tool for all clients, explains Pegelow. "But we soon found out that there are many different ways to say that a patient has difficulty bathing. We had unable to take a bath independently,’ needs help in the bath,’ and impaired to do self-bathing.’ We forced ourselves to sit down together and analyze what we do and why we do it until we agreed on a common language."
Not only did the members of the multidisciplinary care teams have input into the new software purchase, but representatives from information systems and fiscal departments provided feedback on the case management software purchase, Pegelow says.
"The clinical team was looking at what we are doing now and the things we’d like the system to do for us now, but we knew we had to also look at what we plan to do five years from now. We needed the input from information systems and fiscal to help us select a product that could continue to serve us down the road," she says.
The big guns
When she worked on the case management selection process for a large payer in Florida, not only were system users and information specialists part of the selection team, but high-level company executives were as well, says Emily M. Anzinger, RN, BSN, product manager of managed care for the CareWare division of the SSI Group in Tampa, FL.
"Our vice president of operations and our vice president of product development were in on the selection. Only your senior management knows where the company is headed," she says. "You need your users there to look at whether the product meets daily needs. You need senior management to know if the product will meet the company’s future needs."
Of course, case management companies hoping to make a quick decision may be tempted to put their software selection in the hands of a consultant. "Whenever there is a rush on like there is now for case management software, consultants crawl out of the woodwork, and they charge big fees for their services," Ward says. "There is no need for you to entrust all the information you already know about your needs to a consultant. Don’t panic."
Consultants are useful on a short-term basis to educate case managers with little technical background. "A good consultant should be able to tell you in a very limited time what you need to know about interviewing vendors and selecting case management software. In that type of limited capacity, a consultant might be useful to you," Ward says.
Selecting a vendor
After your case management selection team has clearly identified your needs, the real work of selecting a vendor begins.
Identifying a list of five to eight vendors to concentrate on can be done a number of ways, say our experts. The most obvious is to send vendors a request for proposals (RFP) and see what materials they send back and how the information fits your needs.
"I started with 60 vendors, and I narrowed it down to five by creating a table of the features I wanted and checking each vendor’s RFP against my specs," Luttrell says. "I did it on my own and spent about five hours a week on it. It took me about three months to narrow my search to five vendors."
With her list down to five, Luttrell began checking references and carefully scrutinizing the vendor’s service record. "I placed calls to the company’s service line and took note of how many times I got a busy signal. I wanted to know how long it took me to get through," she says.
In addition to carefully interviewing system users about their satisfaction with the product, Luttrell also talked to the vendor’s employees to gauge their commitment to the product. "If you talk to a programmer, a marketer, and a service technician at the vendor, you will get three different views of the product," she notes.
Knowing what to ask
When she interviewed users, Luttrell used a list of prepared questions to determine not only the user’s satisfaction with the software, but also how close the user’s case management was to her own. "I was looking for comparable users. One reference a vendor gave me was for a claims company. Their case management and mine are like night and day," she says.
Questions Luttrell asked users included:
• Who uses your system: nurses or data entry personnel?
• What do you like best about the product?
• What do you like least about the product?
• How long have you been using the product?
• Was it worth the money you spent?
• Would you purchase the product again, if you were starting over?
In her interviews with users, Pegelow focused on service issues. "The one reason we chose the product we use now is that users told us the vendor was very responsive and could answer lot of questions over the telephone," she says.
The final step to the selection process is a hands-on demonstration of the software. Pegelow’s team had a long-distance demonstration of the software they ultimately purchased. "The vendor was in California. We didn’t want to pay for someone to come out until we were reasonably sure that this was the vendor we wanted to use," Pegelow says. "They were able to set up a demonstration for us in our office using a modem link to bring their software up on our system, so that our users could play with it."
In addition to asking for about 10 vendor demonstrations, Luttrell made site visits to two case management companies using the software she was interested in.
"I wanted to watch the case managers work with the system to see how it really performed," she explains. "In the end, I made a decision based on price. With all other things equal, one of the two vendors in my final cut was much higher than the other, and I chose the least expensive one," says Luttrell.
Price is indeed the bottom line. "The final choice boils down to this," says Ward. "Which vendor at the most reasonable cost in the most reasonable time frame can fine tune its product to my specific, tailored, customized need?"