Pace of integration, automation move forward. Yet significant challenges remain.

The data is in, and it is having an effect on case management. From the findings of a new research report, health information technology (health IT) systems are having an impact on a number of medical management interventions—yet less quickly than anticipated.

Background

The new study, conducted by TCS Healthcare Technologies in conjunction with the American Board of Quality Assurance Utilization Review Physicians and the Case Management Society of America, is the second in a continuing series. The first study was conducted in 2008 to examine health IT trends in the field of care management.

The 2008 and 2010 surveys represent the most detailed attempt to analyze and identify trends associated with health IT innovations in the care management arena over a two-year timeframe. Both surveys reached more than 15,000 individuals each year through email communications via a nonrandomized, convenience sampling methodology. In 2008, 521 respondents completed the online questionnaire. In 2010, 670 respondents completed the survey.

A core objective of the research was to assess how software applications are impacting the practice of case management. The research further examines additional electronic applications used by providers, payers, care managers and others to support patient care.

A Look at Integration

Among a wide range of IT integration and automation findings, the 2010 survey results reported the following percentages in terms of respondent answers:

• 69 percent use multiple health IT systems, while 16 percent use only one health IT system.
• 23 percent of information technology systems are fully integrated and interoperable with other external IT applications.
• 23 percent have moved to a completely paperless environment regarding patient or care management records.
• 54 percent scan medical records, document, or communications into their medical management information system.
• 35 percent can share clinical data electronically with other providers.
• 26 percent allow providers to access report cards that show physician- and patient-specific compliance with reporting initiatives.

“Despite the slower than expected integration, the survey data indicates progress is occurring,” says Teri Treiger, RN-C, MA, CCM, CCP, president of CMSA. However, she says, “health IT trends related to interoperability, functionality and satisfaction levels indicate more work needs to be done to leverage best practices for medical care.”

Emerging Communication Channels

Regarding patient communication strategies, respondents sound a strong positive note about embracing emerging communication options within the next two years. They anticipate a threefold increase for using text messaging, smart-phones and wireless remote monitoring. A doubling in the use of online personal health records, patient portals, remote monitoring and social networking is also projected.

Cornering Caseload Levels

The survey results also offer interesting insights about the average number of caseloads handled per week. The most frequently selected patient caseload range is an average of 25 to 49 cases per week. Ironically, caseload size grew for case managers and others who see patients directly (i.e., time spent in face-to-face contacts with patients) with a reported 100 to 124 cases per week.

This last response conflicts with general wisdom about how case managers spend their time. For example, one would assume that the more face-to-face contacts a case manager has with patients, the smaller the caseload. But as it turns out, this does not seem to be the pattern. This result should be studied in more detail through additional analysis of the current survey and in future surveys. Are the nurses in each of these categories working in the same field, e.g., telephonic vs. on-site with patients at clinics? If so, the latter group would probably report more “face-to-face contacts.”
Generally speaking, the survey did not find much standardization in caseload levels within similar practice settings.

Studying Satisfaction

About one in three respondents (36 percent) report being “very satisfied” or “satisfied” with their respective care management software applications, and slightly higher satisfaction rates were reported for electronic health record and nurse triage systems.

“The detailed responses to the survey’s satisfaction questions indicate challenges remain for mobilizing care management software platforms that more fully satisfy the desires of case managers and other users. For example, only one in five respondents said that care management software helped them to ‘spend more time’ with patients,” says Cheri Lattimer, RN, BSN, executive director of CMSA. “A majority of the respondents reported feeling dissatisfied with past promises to upgrade IT functionality. As a result of these concerns, the reported dissatisfaction rates associated with the current care management IT platforms offer an important window of opportunity for vendors to upgrade their applications to meet case manager expectations and needs.”

Advancing Technology

The study concludes that many opportunities exist to leverage technology to enhance the care management process through the following principles:

• Implementing sound platform designs that support the natural workflow processes of the care management professional.
• Moving toward integrated and interoperable systems that minimize the need to identify and collate data manually across systems and platforms.
• Promoting automation that reduces the number of actions care management professionals need to perform while conducting the basic actions affiliated with their work.
• Leveraging emerging communication portals that include text messaging and social media as long as protected health information is properly safeguarded.
• Using the right information at the right time that enables patients, their providers and other stakeholders to access the patient’s health information, care plans, evidence-based protocols and other information to make meaningful decisions.
• Increasing workflow efficiencies that should allow care managers and other professionals to spend more quality-based time interacting with and supporting their patients.
• Increasing transparency and accountability that in turn enhances feedback loops in ways that can further improve care management interventions.

“One bright spot is that health IT systems in care management and other healthcare settings will continue to evolve,” says Dr. Joel V. Brill, AGAF, CHCQM, who serves on the board of directors with ABQAURP. “Well-designed IT systems that integrate care management with other business and clinical IT platforms and increase efficiency in communications will have a significant impact on population health management. These features are critically important for accountable care management programs and the patients they serve.”

For copies of the 2010 survey, log on to www.tcshealthcare.com and click the “Health IT Survey” button. Or log on to www.cmsa.org/healthITsurvey. For more information about the survey analysis and results, contact Carneal at gcarneal@tcshealthcare.com or Pock at rpock@tcshealthcare.com.

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Rob Pock is the Founder and CEO of TCS Healthcare Technologies based in Auburn, Calif. Garry Carneal serves as Vice President of Strategic Alliances of TCS Healthcare Technologies and runs Schooner Healthcare Services.