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Ensure your system meets current and future needs
Involve stakeholders in planning, implementation
When you choose an information system for your case management department, make sure it will meet your future needs, as well as your current needs, advises Vicky Mahn-DiNicola, RN, MS, CPHQ, vice president for clinical design support services at ACS Healthcare Solutions, Midas+ with headquarters in Tucson, AZ.
"An information system represents a sizeable investment, many weeks of implementation, and often involves a comprehensive training process," she says. "To ensure a return on their investment, case managers should plan further downstream, looking at what their needs are likely to be like in three to five years in additional to what they are doing now."
Before starting the process of evaluating candidate systems, clearly define what your case management model is today, what functions you perform, and how your case management program aligns with your hospital’s short-term and long-term goals, Mahn-DiNicola advises.
For instance, today you may be doing discharge planning and utilization review, but it may be possible that in the future, the case management role will evolve to include outcomes management responsibilities or integrate with other departments such as quality management, risk management, or patient care services, she points out.
"People are realizing that case management is about managing a particular population of patients and tracking whether they’re making things better or worse, looking at opportunities to improve processes of care, ensuring delivery of evidence-based practices to maximize efficiency. That starts to integrate the case management role with quality and performance data and puts a whole new light on the kind of case management software you need," Mahn-DiNicola says.
Case management directors should make sure their hospital administration understands the benefits of case management and how automating the case management process will affect the bottom line and the quality of care being delivered, adds Rodd Padden, MBA, vice president of business development for Canopy Systems, a provider of web-based case management solutions, which is now part of A4 Health Systems in Cary, NC.
The most successful implementations of automated case management systems occur when the hospital’s information technology and case management departments collaborate on the choice and implementation of the system, Mahn-DiNicola says.
"Where I see problems is when the information technology department leads the search for case management systems and serves as the principal owner. If the people in information technology don’t really have a clear vision of what case managers do, they will look for a technical solution to the strategic goals of the IT world but not the long-term needs of a clinical department," she adds.
All hospitals are different, with different case management models, a different set of problems to solve, and different information needs, says Patrice L. Spath, BA, RHIT, a health care quality specialist with Brown-Spath & Associates, based in Forest Grove, OR.
Before you start looking for a system, think about what problems or issues you are trying to solve and determine what data you need to get out of your system, then evaluate the case management system on its ability to help you do the job, she advises.
For instance, there may be delays in referrals for case management, or the case manager doesn’t know a patient was admitted from the emergency department (ED) overnight and doesn’t see him or her until later in the day, Mahn-DiNicola says.
Evaluate each system you are considering as to how likely it is to improve your case management referrals and your case identification. Evaluate the software as to how it is likely to improve your case identification.
Patients who fall through the cracks
Patients who fall through the cracks may be another problem in your hospital. For instance, you may want to track pediatric patients who are readmitted with asthma but also track those who were treated in the ED and released. You may want to know who your sickest patients and highest utilizers are. In that case, look for a system that supports rules-based processing so you can customize it to identify the patient population within your organization that require case management interventions, Mahn-DiNicola says.
List everything you need for each case management function you perform. For instance, for a patient assessment, you’ll need the patient’s past history, demographic information, occupational history, past illnesses and surgeries, social and family history, and current health status.
"A computerized information system should assist case managers in making decisions about patient care requirements and expected resource use, and allow for monitoring of the results of care planning choices," Spath adds.
As you plan your software system, keep in mind the four major functions of case management: assessing your patient’s health care needs, developing an effective plan of care, arranging for and coordinating needed services, and evaluating the effectiveness of the plan of care.
Avoid a software product that does not appear to include the "must-have" features that allow for assessment, planning, implementation, and evaluation, Spath says.
Keep in mind that if you adopt a stand-alone case management system that doesn’t integrate with other information systems in your hospitals, such as finance, cost accounting, risk management, or quality, you will create an information silo, which won’t serve the hospital well in the long run, Mahn-DiNicola points out.
For instance, the case management department may run one report on heart failure readmission rates, while the quality department and the finance department may run the same kind of reports using their software system, and arrive at three different readmission rates.
"All systems can define something as basic as a readmission rate, but they all have different values because the criteria to construct the measure is different. This type of data schizophrenia not only jeopardizes the credibility of the data generated by the case management department, but it also requires extensive time and expertise to explain the data reported by the various systems," Mahn-DiNicola says.
To avoid this, it is helpful to consider all the information stakeholders during the selection process in addition to the functional users who will use the software for daily case management operations, she adds.
Case management software should be plugged into the large hospital information system infrastructure so all of the information can be integrated.
For example, the risk management department tracks medication errors and patient falls, the infection control department tracks surgical infections, and the patient advocate tracks patient complaints. Case management can leverage those types of information to create triggers so when patients are admitted with a history of MRSA, previous falls, or a prior complaint about nursing care, the case manager is alerted and begins to implement a plan of care to reduce the risk points for the patient, Mahn-DiNicola says.
"If each functional department houses their information in a separate system and case management can’t access it, they are working blindfolded and have missed an opportunity to impact the clinical course of care," she adds.
This doesn’t necessarily mean the risk management department has to be directly involved in the selection of a case management system, but it does mean that you should clarify how you need to share information so the information technology department can make sure it will happen.
Make sure the system you choose will interface with the rest of your hospital’s information systems. "One of the problems with a case management system is that some are basically stand-alone and you have to re-input patient demographic and insurance information into them," Spath says.
Once your system is in place, don’t fall into the trap of spending a lot of time collecting information you don’t need, just in case somebody asks, she advises.
"Quality data have been collected for years by medical records and the quality department, and they have input it into a system. Just because all of a sudden, case managers are data collectors, that doesn’t mean they have to have their own system. They should have access to optional data fields in another system," Spath says.
Rely on your clerical staff to key information into the computer, she adds. "I have been in hospitals with rooms off the nursing unit where RN case managers with great clinical skills spend a lot of their time sitting at the computer doing something that someone who is not so skilled or well paid can do."