Keep case management out of cyberspace void
Keep case management out of cyberspace void
Learn the basics or become extinct
Implementing an automated health care information system doesn't mean that case managers must become proficient in computer programming or software installation -- but learning some simple survival skills will keep your case management program on the ground and not in cyberspace.
Health care's migration to the information superhighway undoubtedly will leave case managers with new or revised roles both within the hospital and beyond.
Be prepared to adapt and grow as automated patient information systems, outcomes management systems, and other computer system developments become more common in hospitals, warns Toni Cesta, PhD, RN, director of case management for Long Island College Hospital in Brooklyn, NY. Cesta currently is evaluating several programs for her case management department.
Beware, the products on the market aren't even keeping up with all of the demands coming from hospital case managers -- particularly those who are expanding their roles into more sophisticated outcomes management. "The vendors have not been keeping up with the needs of the industry," Cesta says. One area where computer vendors are falling behind is in the ability to analyze variance data, she adds. "The vendors are trying to keep up, but the software packages often fall short of their promises."
No more telephone tag
Despite the setbacks and hurdles associated with implementing any new computer system, case managers say that the new technology is enhancing their roles. Among the top benefits are improved communication and detailed care plans.
For example, case managers at the University of Chicago Hospitals no longer play telephone tag with utilization review staff and third-party payers when questions arise regarding a patient's certification or length of stay.
That's because the University of Chicago Hospitals and its payers are connected via modem and electronic mail through a program called MedExchange, developed by InterLink Services in Westerville, OH. The program started two years ago, and users of the system agree that the biggest benefit is improved communication between the hospital's case managers, utilization review staff, and payer staff.
Here's how the system operates: InterLink developed and installed the software in the hospital's computer system in the utilization review department. In addition, InterLink provided the software to other provider facilities and to the insurance and review companies working with the University of Chicago as part of the agreement negotiated.
InterLink's system is set up with a modem so that the coordinators can do their reviews on the units, enter demographic and medical information into the computer system, and then transmit it electronically to the insurance and utilization review companies using the same system. The payer then responds with the certification approval, the approved length of stay (LOS), and any additional questions or concerns through the same system.
"We also have the ability to send e-mail messages, that are not necessarily linked to the record. We're able to complete continued stays faster," explains Gail Patinos, RN, BSN, director of utilization review who oversees the use of the system at the hospital.
"One of the features I especially like about the system is that we are able to transmit any information we want anytime during the day," continues Patinos. "So, if I have staff who stay late to enter information, they can do that, whereas if we were working on the telephone, offices may be closed. And with some payers, our staff are not able to leave voice mail messages with the medical information."
While Patinos has been happy with the advantages the system has brought to the hospital, she also expresses some concerns. Because the system does not interface with other departments within the hospital, "we are doing duplicate work now. The fact that we have to enter all the demographic information is time-consuming," she says. "Right now, we have a paper trail, so the coordinators document everything on a piece of paper and then they come down, and rather than making a phone call, they're typing in all of the information into the computer and transmitting it. That is a duplication of work," adds Patinos.
One problem already has been rectified, however. Staff using the system could electronically transmit from one terminal only. "The UR department started out using a local area network to run the system, which meant there was one computer used to transmit the information. Now, however, all of staff members have the program on their individual computer. My hopes are that we can somehow connect [the hospitalwide] system to our computer system so that data entered by admitting, for example, will automatically appear in our system," says Patinos.
"We're very close to being automated and I would like to see at some point, if we continue with this system, that the systems are somehow tied together, so that once the medical information is entered, it will somehow get into the MedExchange system so that we don't have to enter the data twice," notes Patinos.
Program piloted first
Nebraska Methodist Health System in Omaha has been using Atlanta-based ALLTEL's system for almost 20 years, but has been using its newest product, CareMinder, since April. In fact, the facility is one of the first in the country to use the system, which so far, has enhanced the staff's use of their critical pathways, explains Donna Carlin, RN, senior management information systems analyst.
Currently, staff are only using nursing and therapy documentation portions of the system. The physician order-entry component will be implemented at a much later time, says Carlin. "We felt that [using all of the components] was too much to bite off at the same time because we have not handled the critical pathways on a manual system here yet with our prior system."
Starting small
The hospital began testing the system on a small, controlled unit of obstetric floors, explains Carlin. At this point, kinks are still being worked out of the system. The facility still receives weekly visits from a computer programmer because all of the features are not yet working properly. However, "we do plan to enhance and use all of those components to their largest degree," notes Carlin.
One of the biggest challenges in implementing the software was making it user-friendly, notes Carlin. A lot of the data were technically sound, but designing the applications to get the information to flow naturally was a big challenge, she adds.
The new program will allow case managers to enter the care plan or critical pathway, document with the path, and generate a worklist from the plan. "The areas we need to enhance are the variance tracking tools to say, 'Now what has deviated from that norm?'"
Carlin expects the case managers to benefit from having "a true schedule and a true worklist that they can work off to be a powerful and beneficial case management tool. This system has caused them to reflect more on their plans because if you don't have a well-developed plan, you're going to have a poor worklist from which to work.
"We always believed that the charting and documentation against the plan was going to be a piece of cake, but we still need to evaluate the plans. We never said we wanted to take away the thought process that occurs with that to make sure that the patient is progressing correctly, and we don't think we have. In fact, there is more accountability because it has caused us to look at how we do our plans and be a little bit more realistic," says Carlin.
Another benefit Carlin observes with the system is that it has triggered more thought and planning across the continuum of care. "Previously, we were very good about progressing the patient on the first few days of their stay, but once they became a bit stable, that's where the plan ended. We didn't seem to work enough to make them get out of the hospital," says Carlin.
The computer program increased awareness among staff to create more close-ended plans. "In the past, we could say, 'We're going to this procedure every hour,' and we knew we had some leeway. Now if we say every hour, boom, it's going to happen every hour."
[Editor's note: Pricing and product information is available for both software programs in this article. System requirements for InterLink's MedExchange program include: 80486-based processor, stand-alone DOS version 5.0 or above, Novell network version 3.1 and 4.1, 4 MB RAM, 120 MB hard disk, VGA-compatible color monitor, and Hayes-compatible modem with 9600/14400 baud.
ALLTEL's CareMinder system requires operational software from ALLTEL and uses a Microsoft Windows graphical user interface (GUI). ORACLE is a type of operating system that gives the system its ability to transfer information from application to application.
Contact: MedExchange CaseManager System, InterLink Services, Inc., 775 Brooksedge Blvd., Westerville, OH 43081. Telephone: (614) 895-5866. Fax: (614) 895-5873. CareMinder, ALLTEL Information Services, Inc., 200 Ashford Center N., Atlanta, GA 30338. Telephone: (404) 847-5000. Fax: (404) 847-5086.] *
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