Case managers: Take up the baton now to orchestrate automation
Case managers: Take up the baton now to orchestrate automation
Moving from paper to PC more than just technology
(Editor’s note: This month, Hospital Case Management takes an in-depth look at implementing automated critical pathways. This is the first in a two-part series on how one hospital developed an in-house automated pathway system. Next month, we’ll examine how the hospital trained its staff to use automated pathways.)
As a case manager, you want to be more than just another player when automated pathways are introduced in your facility. Now is the time to seize the baton because the push for automated pathways is slowly becoming a reality, and early involvement in the development process ensures that case managers help conduct the process.
If the bandwagon hasn’t reached you yet, chances are that you’ll be faced with orchestrating the ’automation concerto” in your hospital’s case management department sooner than you think. The 1996 Hospital Case Management Reader Survey, for example, reveals that 32% of the respondents are currently evaluating information systems for automated paths and patient records. And 10% of the readers said that the information system will be implemented during the next year.
Sentiments from this year’s reader survey are echoed in the 1996 Annual Healthcare Information and Management Systems Society (HIMSS)/Hewlett-Packard Leadership Survey. Respondents to the survey are information specialists within the hospital who case managers would work with most closely in designing automated pathway systems. According to the survey’s 1,200 respondents, 32% believe the top clinical force driving computerization is the need to automate patient records. When asked what top business or operating imperative is driving computerization, 49% of the respondents cited the need to control costs within their institution due to continued pressures from managed care.1 (To find out what respondents rank as the top priority for next year, see the chart, below.)
Critical pathway computer vendors, for example, are beginning to fine-tune their products by adding features and enhancements lacking in early versions of their software. Some case managers are taking a more industrious approach and forging ahead with home-grown systems.
Knowing how and where to start moving case management toward automation is the biggest obstacle facing the industry, say case managers who’ve automated their paths. Early involvement by department leaders in helping to design an automated system ensures that staff can use the system effectively.
Perhaps the biggest indicator that hospital staff should consider an automated system is data entry, says Sherry Lee, RN, BSN, MEd, an informatics and case management consultant based in Matthews, NC, with more than 12 years experience in nursing informatics. ’Some case management departments may find that they are paying a staff person more per hour to perform manual data entry whereas an automated system would manage the data at a lower cost.”
Lee points out several ways that a case management department can determine if the time is right for an automated system. First, consider the costs associated with data input and retrieval time. ’If [entry and retrieval] is performed manually, there’s the possibility that it has to be re-entered to retrieve it in a different fashion,” notes Lee.
A second sign for the need for automated paths is the amount of data that’s double-entered. ’If you have to repeatedly enter a patient’s identification number, social security number, or ZIP Code, then that’s a good sign that you’re ready for automation,” explains Lee.
Time associated with entering physician orders also should be considered, notes Lee. ’An automated system where physician orders are entered by exception will save a lot of time.”
Buy or build?
Portland (OR) Providence Medical Center, for example, is an alpha test site for Atlanta-based HBO and Co.’s new automated pathway product, Pathway Care Designs. The hospital has 15 pathways already automated, including cerebrovascular accident, transurethral resection of the prostate, lumbar laminectomy, and radical retropubic prostatectomy.
’Using the automated pathways has dramatically changed how we document for the better,” says Sandy Dancer, RN, nurse manager, who initiated the automation project. ’Automation forces accountability. If the computer prompts users that a particular intervention has not been addressed, they can’t ignore that.”
Case managers at Brigham and Women’s Hospital in Boston decided to take a different route and build a home-grown product. So far, the plan appears to be working.
Transferring from paper pathways to automated paths is more than just turning on the computer and entering data. Automated paths may be similar to paper paths in how they appear on the computer screen, but entering data and recording variances is more high-tech than the old pencil and paper system because staff must be trained. Additionally, case managers help identify problems in using the system and working through possible kinks. Automation does offer advantages, however, such as immediate access to data and physician profiling screens for easy access among medical staff.
The paper pathway was always seen as the interim product prior to automation, notes Cindy D. Spurr, MBA, RN, corporate manager of clinical systems, who spearheaded the internal pathway automation project at the 702-bed facility. Case managers, she adds, took a strong lead in developing the automated system and training the staff. Brigham and Women’s implemented its program in March 1995.
The uncomplicated cardiac surgical pathway, out of 10 paper paths currently in use, was the first selected for automation development. The cardiac paper pathway, in use since December 1993, was selected because of a strong ’desire and commitment from the case management department to work with the [information systems] staff to develop it,” recalls Spurr.
Reference
1. 1996 Annual Healthcare Information and Management Systems Society/Hewlett-Packard Leadership Survey. Chicago.
[Editor’s note: Complete printed copies of the 1996 Healthcare Information and Management Systems Society (HIMSS)/Hewlett-Packard Leadership Survey are available. Write: HIMSS, 230 E. Ohio St., Suite 600, Chicago, IL 60611-3201. Telephone: (312) 664-4467. E-mail: [email protected].]
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