Technology can bring case management into the 21st century
New tools can increase efficiency, effectiveness
If you’re not using technology in your case management practice, you’re doing yourself, your organization, and your patients a disservice, experts say.
"There’s no question about it. Case managers are behind their peers and are not performing at an optimal level if they don’t use technology," says Marcia Diane Ward, RN, CCM, PMP, a case management consultant based in Columbus, OH. It’s time to put down the pen and paper and start using laptop computers, tablets, and even smartphones as you assess patients, develop care plans, and create reports to show your progress, she adds.
"No matter what kind of case management someone does, technology can make their job easier. As healthcare continues to evolve, technology is going to be essential for case managers to do their jobs," she says.
Technology in healthcare has taken a giant leap forward in recent years and now it is mandated for accountable care initiatives, Medicare demonstration projects, and reimbursement, points out Teri Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM, a case management consultant based in Holbrook, MA.
"Technology is no longer a choice for organizations. How they proceed to purchase and implement it is definitely a choice, but healthcare organizations still have to go down that path to survive," she says.
Using technology in healthcare, particularly in case management practice, is important because it improves quality of care and outcomes, helps case managers better engage patients and provide patient-centered care, and helps prove the value of case management, says Mary Beth Newman, MSN, RN-BC, CCP, CCM, case management director for CareSource, a Dayton, OH-based insurer.
"It’s clear that technology can help case managers in so many ways. It improves communication, leading to better coordination of care. It helps case managers identify and eliminate gaps in care, and helps with patient engagement," she says.
Case managers are becoming major players in the healthcare environment and they need technology to leverage their position, Ward says. "Case management promotes a balance between quality care and cost-effective outcomes. Case managers need access to information in real time in order to do their job successfully," she says.
In the past, the technology focus in many organizations was getting the physician orders written and transmitted to the laboratory, pharmacy, and other areas. "Historically, technology has not been specific to case management, but now there are several systems out there that have tools designed specifically for case management and disease management," Treiger says.
Case management software helps case managers in every setting capture all their interventions, document care processes, promote comprehensive assessments, and produce reports that track everything from at-risk patients to outcomes for specific interventions, whether they work with clients face-to-face, by telephone, or a combination of both, Ward says.
Good case management software helps case managers provide greater continuity of care, saves money, and provides a repository of data that can be used for research and analysis, Ward adds. "With just a few keystrokes, case managers can use software to aggregate patient data and write reports that show the results of interventions. With paper records, it could take days," Ward says.
One of the big advances in case management software is assessment in an electronic form, Treiger says. "Case managers still need to do the face-to-face interview and may still use paper if they don’t feel comfortable typing the patient’s responses into the computer," she says.
But when they complete the interview and use the case management software, they will capture all the information they collected from the patient and family members in a uniform way, she says. "Now, instead of having to sort through thousands of pages of documents, case managers can easily access the information and find out what they need to develop a plan," she says.
Most case management software produces a guide to a case management plan based on the information the case manager inputs, she says. For instance, if a patient is worried about losing his utilities and is on home dialysis, an associated problem is on the top of a to-do list while education about a diabetic diet would be lower on the list.
If transportation to physician visits is an issue, the software may suggest that the case manager check to see if the patient has transportation benefits, or make phone calls to the family, or check to see if the patient has a supportive social group.
The data also can be used to measure the intensity of the intervention needed and identify which patients are taking the most time and which case managers are coordinating care for those patients. "You can track not only the depth of patient complexity but the intensity of the interventions. Capturing the intensity of the case management effort is a major step forward," Treiger says.
For instance, if the patient has transportation benefits and the case manager can line up rides easily, it might be an intensity of 1, but if a case manager has to call numerous people to arrange transportation, it might be an intensity of 3.
"This is just the tip of the iceberg," Treiger adds. Case management software can be used to record and report case management interventions and outcomes, identify at-risk patients, develop short-term and long-term goals and track patients’ progress. "Case management software has the ability to aggregate data and put it into usable information. It’s a powerful tool, but it is up to the director of case management and the case managers to harness that power," she says.
Case management directors will find software invaluable when it comes to showing the value of case management and making the case for more staff, Treiger points out.
"It’s easy for management to wave off a case management director who requests hiring more staff. Now, instead of just saying the case managers are working 10 or 12 hours a day,’ and giving anecdotal examples, they can use data to show that the staff is working beyond regular hours and demonstrate the value in what they are doing," Treiger says.
When your organization is purchasing technology, insist that case management has a seat at the table to make sure the software is going to work for them, Ward says.
A lot of times in the past, it’s been the organization’s management that chose technology without a lot of input from the frontline case managers who had to use it, she adds. "Companies are starting to wise up and involving end users in the decisions about medical management technology," says Ward, who worked as project manager with two large healthcare organizations to help them implement an electronic medical record.
Case managers need to meet with the software designers and educate them on how case management will use the software, she adds. "Often they don’t have a realistic idea of what case management entails and what the case managers need the software to do," she says.
No matter how good the software is, it still has to be easy to use and work with the other technology you are using, she adds. "As the clinical informatics people design the way the medical record will look, they need to keep in mind that they are asking people who already have huge workloads to enter information, so it has to be concise and intuitive. If case managers have to go through 10 or 12 layers that connect one system to the next, it can be extremely time-consuming," she says.
Make sure any kind of case management software you consider is compatible with and can be connected to the other technology in your organization. Talk to your technical people to make sure it will work. Develop a good long-term relationship with vendors. You’ll be working with them on training, upgrades, and more training, Ward says.
"One of the biggest challenges in implementing new technology is getting the staff trained," she says.
Some case managers are reluctant to try technology, mostly because they have never been trained to use it, Treiger says.
"There are a lot of case managers over the age of 45 who have not worked in an environment that incorporates information technology into their job. When faced with learning technology, their stress level is very high. It’s like trying to learn a new language and you know you are intelligent but you have a tool that you don’t know how to use and it makes you feel inadequate," she says.
Clinicians may feel overwhelmed by the new hardware and software products on the market, but today’s healthcare environment makes it imperative for them to keep up with cutting-edge technology, Ward adds.
Newman suggests working closely with case managers who don’t want to use technology and explaining the benefits.
"When people resist technology, we have to help them understand and appreciate how beneficial it is. This means mentoring people and teaching them to use all the technology that can help them become better case managers," she says.