The overall purpose of the Clinical Case Management Software (CCMS) is to be an integrated solution that will create an overall improved quality of care. The benefits to the healthcare organization that chooses to use CCMS are the consolidation and centralization of information. Many applications within the wide scope of the CCMS have difficult and cumbersome processes of administrative tasks. CCMS attempts to do away with much of the redundant paperwork created through administrative tasks and uses information technology to automate and store these tasks. Information technology greatly increases the speed and efficiency of administrative tasks and can be done at a lower cost. All of these improvements in administrative tasks free up more time for the case managers to spend with their clients. There has been opposition to implementation of CCMS due to issues of security and ensuring the safety of the client’s personal health information. Clinicians who were once opposed to CCMS become supporters after seeing that it can increase overall efficiency of work and more time working with clients and less time on administrative tasks.
Benefits of Clinical Case Management Software
Finally, from a macro perspective, data retrieved from a clinical case management system can be used to run reports in order to improve public health. This has many applications, a simple example being monitoring immunization levels for children in a certain area.
At the patient level, clinical case management software allows patients to take a more active role in their own care. By having access to their own medical records, patients can make more informed decisions when consulting with their clinicians.
Secondly, clinical case management software allows for the automation of back-office functions. By automating functions such as scheduling, billing, and back-office work, the software can offset the high cost of implementation. Furthermore, comprehensive data storage reduces time spent filling out paperwork and retrieving information. This improves overall clinician satisfaction and allows them to spend more time with patients.
The implementation of a clinical case management system provides benefits that encompass all levels of the organization. At the administrative level, the system can provide an efficient means to store and retrieve clinical data. This kind of industry-wide data access allows for the coordination of care among different healthcare providers, ensuring that the patients receive high-quality care across the entire continuum. By allowing healthcare workers to access information from other agencies, the system can prevent duplicate testing and treatment, saving the patient and the system money.
Key Features of Clinical Case Management Software
The feature rich and flexible functionality of clinical case management software is among its most appealing attributes. This kind of tool offers an efficient way to manage patient records. A feature such as Document Management offers a way to attach documents directly to a patient’s record. This allows for instant access to things like test results and insurance information. This is especially appealing to large organizations with many specialists. By having instant access to this information, redundant tests can be avoided, saving the system money. Appointment Scheduling is another feature that is very useful to have centralized within a case management system. It is all too often the case that appointments made while at other specialists are forgotten or lost. Having a centralized scheduling system helps to avoid this. This, in turn, increases revenues to the practice as missed appointments can be rescheduled. The increased revenue from a system as simple as appointment scheduling can pay for a case management system in a very short time. A feature that is not found in all case management systems is Medical Billing. This feature offers a way to bill patients and submit claims directly from the case management system. It can dramatically improve turnaround time on patient billing and can decrease workload by eliminating double entry. This again can result in increased revenue to the practice. Clinical case management systems come in many shapes and sizes, so they offer different combinations of these features to address the needs of different types of organizations.
Implementation Process
First, it is important to identify a system that meets the needs of the user. Users should start by trialling the system from the free trial that is offered on the company website. This will allow for basic navigation of the product. It is then beneficial to get the vendors in the users location to demonstrate a webinar of the product, and to ask any questions that have arisen from the trial. This will give a better understanding of the capacity of the product without too much time invested. After this, it would be wise to contact companies who have used the product. A site visit would be most beneficial, however at the least an interview over the phone would provide insight on the capability of the product. The implementation of case management software is a complex process that in itself requires management. It is a process that is best achieved using a method that has been proven effective with similar systems. It is recommended that a project manager be assigned specifically to the task of implementing the case management system. This individual should also have knowledge of the case management process and be able to affect change in the work practices of others. This individual will be responsible for the coordination of the following implementation plan:
Using Clinical Case Management Software
Information obtained from Patient Data Management is important when initiating a case management intervention. Wyszynski’s study revealed findings of 6% of identified study subjects that had serious or deadly pregnancy outcomes. These outcomes would prompt case management within the attempt to prevent future occurrences on females exposed to the same or other teratogens. Classification and follow-up of all identified study subjects can simply be completed with the use of patient data management such as tracking spreadsheets. Data management software will give simple identification of study subjects, and ways to efficiently and effectively track them throughout important.
Research has demonstrated the potential of employing clinical case management software to support the care of sufferers with health-related issues. This could contain useful psychological wellness disorders, higher risk pregnancy, and diabetes. Though the wants of those populations are distinct, the tools and methods to case management are relevant to any population with chronic health-related issues. In a current study by Wyszynski, Stead, and Chung, an alarming amount of teratogenic exposures amongst girls at childbearing age were identified. The authors implemented an automated data warehouse method to determine potential study subjects for case management. Data had been obtained from the record of pregnant females within the final five years that had been exposed to a identified teratogen.
Patient Data Management
The management of patient data can take on various forms, from electronic filing systems in the form of MS Word to fully templated EHR systems. Initially, entry level systems might not require a dedicated case management solution. However, as your patient list grows and the complexity of cases increases, it is highly beneficial for clinical psychologists to adopt software to better organise their patient data. CCM software offers a platform to store all client/patient data in one location. This can include contact details, case notes, treatment history, medical history, medication records, treatment plans, assessments and any other information relevant to the care and treatment of a patient. Having this information stored in one central location can greatly aid psychologists in delivering more informed care to their patients. It can also save a significant amount of time and effort in finding and collating information that might be scattered across various word documents and handwritten notes. Ease of access to all patient data in a CCM system is also beneficial in situations where psychologists are working in teams or where there is a need to hand over a case to another clinician. This is particularly relevant to the field of Clinical Psychology where case presentations to supervisors, peer consultation and case handovers are common practice.
Appointment Scheduling
When a new appointment is made, the appropriate clinician is able to quickly identify it and its essential details. To schedule an appointment, the clinician simply clicks on the appropriate time slot in the schedule and activates the New/Edit Appointment function. The system can be set up so that all appointments need to be confirmed with the client at a later date. When an appointment is scheduled, the system can be set up to automatically notify the client by phone, email, or text message. The appointment details are then signed off and the appointment table is updated. At GPsych, an efficient appointment reminder system has reduced the rate of no shows to less than half the industry average. Another feature of many scheduling systems is the ability to assign specific codes and colours to appointment types. This makes it easy to differentiate between different types of appointments by simply glancing at the schedule. For example, psychologists may decide to use the colour red with a code of ‘W’ for all weekly appointments with work cover clients. In this instance, both the psychologist and the client can easily identify when their next appointment is. This may be helpful to the psychologist when viewing the future appointments of multiple clients offered differing appointment frequencies.
Treatment Planning
Treatment planning is an integral component of any behavioral health practitioner’s clinical responsibility. In its most basic form, treatment plans are considered a map or a guide that will guide the course of the individual’s treatment. It is often in the form of a written document and is constructed by an experienced therapist. The treatment plan involves detailed information concerning the following aspects of treatment. Steps of the treatment process are to be clearly identified and the anticipated outcomes to expect. Treatment plans are developed using various methods and one of those methods is by using the Wiley Treatment Planner books. These are a series of books that provide a comprehensive resource of pre-written treatment plan components for the mental health professional. This particular method offers the mental health professional a quick and easy resource tool to construct effective treatment plans. Treatment planning will always include an evaluation of the progress shown by the patient/client and follow-up with the current treatment to measure its effectiveness. A good treatment plan will also include provisions for if the patient/client does not progress as anticipated, or else this plan would provide an adequate course for intervention and its effects on the current treatment. Steps in a treatment plan may vary dependent on its method; however, it is important to document the progress of treatment and create a roadmap to which the patient, the mental health professional, and if necessary, referral agents will be able to follow. If progress on a treatment plan is for a child or adolescent, it may be necessary to involve the parent in the process and a separate portion of the treatment plan may be devoted to changes in behavior that the parents are looking to resolve with the child.
Communication and Collaboration
This capability has been widely endorsed by many CM practitioners (see for example Shumway 2001; Unützer et al. 2002) and allows the case manager to more fully develop and explore client care options. Even higher levels of decision support are available with some systems offering the possibility of applying artificial intelligence (AI) algorithms to help support clinical decision-making. AI software has been found to be particularly valuable in case management for clients with chronic illness (Clarke et al. 2001) and resembling the major trend in current healthcare delivery for chronic disease management (Marsden and O’Neill 2007) it is likely that the utility of AI in CM will continue to grow. Tying in with evidence-based practice, certain systems grant access to extensive care libraries and resources which allow the case manager to programmatically link clients with needs of a specific nature to well-defined strategies and interventions. Although there is promise in such resources, current services are limited and there is no literature that we are aware of to describe the effectiveness of such strategies.
Integration and Compatibility
What is particularly important in the near future is conformance of EHR systems with a central national system. At present, individual areas of the UK have EHR systems which are not compatible with other areas, and this has become a barrier to implementation and the sharing of health information, especially for patients who may move around or use services in a different area to which they originally acquired their EHR. An example of this is a Scottish GP’s system not being able to access EHR records of an English patient. If functions are used UK wide and national data is to be shared UK wide, it is essential that the software has the ability to access data from various different EHR systems. This also applies for other countries which have plans for centralized health information. We therefore face a great challenge in creating and implementing clinical systems so that they may integrate and inter-operate with complicated legacy systems and also new systems that other areas may be using. In regard to this, existing EHR vendors who are providing EHR systems in complex health economies, should be questioned extensively about the infrastructure of their systems and what exactly it would take for an external system to access their data. This would obviously pose its own problems as EHR vendors are trying to market their own case management systems.
Integration with electronic health records (EHR) The modernization of health care in dealing with patient information has led to a more sophisticated approach to how patient data is used. Clinical case management software should be able to integrate with current systems which deal with patient information. One of the major information sources for a patient can be their electronic health record (EHR). This is an electronic form of a patient’s medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person’s care under a particular provider. The advantages to an EHR are the speed at which information can be accessed, the ability to access records from various locations with confidence in the record’s accuracy, and also the increased participation of patients in their own healthcare.
Integration with Electronic Health Records (EHR)
The EHR integrates limitless data sources from hospitals, clinics, and physicians’ offices. It helps healthcare providers access and store critical patient information in an effective manner. Upon discharge from the hospital, a patient begins an outpatient regimen. His or her primary care physician then accesses the data stored in the hospital system to administer continued care. The patient may also need to see a specialist. In this case, the specialist can access the same data to determine the treatment plan. With CCMIS, all of these different case scenarios fall under the same platform, so the setup for accessing this data is equivalent. Whether the goal is to link hospital information to a patient’s existing medical history, or to dictate discharge summaries and treatment plans on the same platform, CCMIS can streamline it. Linking data to a patient’s existing medical history is a staple in building the case. It enhances the ability to form assessments, treatment plans, and determining medical necessity for the patient. In mental health and substance abuse, individuals are frequently referred between primary care physicians, specialists, and therapists. Data linkage is vital in order to keep these patients engaged in care, so that they are not repeating the same process at each level. Electronic transfer of these records has the same implications. The ability to transfer data electronically is the way of the future, as we are moving closer to national standards on this. This includes any inpatient utilization, intermittent outpatient care, and appointments and medication management in between. Being able to effectively track each case level and determine periodical treatment decisions is a must for ideal case management.
Compatibility with Medical Devices
The criterion for inclusion of such device-derived data in the EHR presents an onerous challenge for software vendors due to the wide variation in medical devices and proprietary standards for device data. Vendors of device data storage systems are quick to point out the expense and complexity of interfacing with multiple EHR systems. Although device vendors are considered eligible providers for meaningful use incentives, the criteria for meaningful use of device data are phased, with certain objectives not yet fully defined or requiring successful demonstration by early adopters. This lack of immediate financial return combined with the perceived burden and cost to comply creates a market barrier for device vendors. It is therefore expected that clinicians and EHR users will be left with partial implementation of this criteria and minimal vendor involvement in the short term. Stepwise refinement of the criteria and continued research and success stories demonstrating the positive influence of device data integration will ideally lead to greater implementation and improved patient outcomes in the future.
This represents another example of disparate expectations amongst software vendors and the clinical community. While vendors view the device as streamlining data capture and entry into the EHR, clinicians expect the device data to be a fully integrated component of the patient’s record and accessible at the point of care. Consequently, many clinicians have expressed frustration with the current state of device data integration. Specialized software solutions exist for certain devices, such as an EKG, that allow for generation of an interpretable report and storage of the data independent of the scanned paper printout. These programs are not considered part of the comprehensive EHR, and the end result is further fragmentation of the patient record. Integration of device data has substantial implications for clinical decision support and quality measurement, as it is often the result of a deviation from evidence-based guidelines and directly correlated with specific quality indicators. Currently, however, there is limited research on the impact and value of specific device data integration on patient outcomes.
Another challenge in achieving the meaningful use criteria involves the use of electronic medical devices in the clinical environment. As medicine becomes increasingly technology driven, there are innumerable medical devices, such as vital signs machines, EKG machines, and infusion pumps, that are used to collect valuable patient data. Meaningful use criteria specify that such device derived data should be included as part of the patient’s problem list, incorporated into the progress notes, and stored in a manner that makes it accessible through the EHR. In a clinical environment using such device derived data, failure of the EHR to capture and store this information in a readily accessible manner creates a situation where the clinicians must rely on memory and alternate documentation methods to incorporate this data into the clinical decision process. The EHR is no longer seen as adding value to the process and paradoxically results in increased utilization of the device and paper documentation to support clinical decisions.
Interoperability with Other Systems
A less sophisticated and more aspirational requirement that we include for the software is that it will in the foreseeable future become the leading UK system for managing services for IAPT. Assuming that this transpires then there will be a requirement at some point to exchange IAPT service data with other IAPT systems, and it is conceivable that data sharing could be useful between IAPT services and mental health services that are using different systems or between IAPT and primary care services. In the longer term, it is highly desirable that the software has the capability to share service data with other systems in a cost-effective way without building and maintaining a large number of interfaces.
Clinicians do not work in isolation, and nor is their clinical work confined to one software application. They use a wide variety of software applications from different vendors to perform different aspects of their work. A particular application from another vendor may, for example, contain a psychometric test that a clinician wishes to deliver. A critical requirement of the software will be to allow the digital assets managed within the software to be reused at the right point in different applications across a wide variety of execution platforms. This will require the digital assets to be managed in a single store in a standardized way, with a standard method of accessing a particular asset regardless of the platform for which the asset is destined.
Security and Privacy
Data security in the clinical world is one of the most important components when dealing with patient records. Individuals have a legal right to require confidentiality of their records. This right also extends to the record’s contents as well as knowledge of whether the record exists. Data breaches happen frequently. A breach of data security happens when there is loss of information, unauthorized access to sensitive data, and/or viewing and theft of the data. In healthcare, the most common reason for a breach in security is due to human error. This stresses the importance of a system’s availability and the minimization of user complexity. Because healthcare data is so valuable, it can be a target of both internal and external threats. Whether it be someone from inside the clinical organization tweaking with patient records or an attacker trying to access the system from across the world, it’s important for a clinical information system to protect against all threats. Internal threats are usually due to problems with mismatch between job duties and access permissions. Because of this, it can be concluded that access control is one of the most important components to system security. Logging is the other key to data security. By creating logs of user activity, it is possible to both track and identify any unauthorized access or system changes. These concepts will be discussed further using MIT’s Clinical Archival System as a reference.
Data Encryption and Access Control
Encryption is a technology that encodes the data so that it is accessible only to authorized persons. This can be an effective way to protect the confidentiality of data. If the keys are properly managed, encrypted data is not accessible to processes that are not authorized to access the data in clear form. However, it is also essential to control access to the keys, and to ensure that encryption and decryption can only be carried out by authorized processes and never in any circumstances by unauthorized processes. Failure to control access to keys and the execution of encryption/decryption functions can nullify the protection afforded by encryption. Firewalls can be effective to prevent unauthorized transmission of clear data over networks and PSTN’s but are less effective when data has to be transmitted in decrypted form to enable authorized users and processes to access it. If there is no real-time encryption and decryption, all data on laptop computers and PCs is exposed to theft when equipment is stolen. Encryption can also add overheads to system performance and can also in some cases render data mining, searches, and sorting more difficult.
Access to data and applications, as well as data itself, are the lifeblood of organizations. Any access to data by unauthorized persons or processes can result in damage to organizations ranging from minor to catastrophic, and access to some kinds of data can cause serious damage to individuals. It is essential to prevent unauthorized access to data, and ensuring that any access is accurately determined and always in line with policy is a specific instance of a more general requirement to ensure that access to data is always safe and under control.
Compliance with HIPAA Regulations
As it is the responsibility of the case management organization to comply with HIPAA regulations, including software compliance, we want to inform potential customers that although CaseTrakker Pro meets many of HIPAA’s national standards, it is not yet a certified HIPAA compliant software product. It is difficult to find information on what exactly it means for a software product to be certified as a HIPAA compliant. We have contacted the HIPAA information line and several HIPAA consulting organizations, and it seems that only healthcare providers and health plans are able to be certified. It appears that the phrase “HIPAA certified software” is more of a marketing tool used by software companies. Obtaining clarification on this matter is an objective on our agenda.
Maintaining patient privacy and confidentiality is a critical responsibility of every case manager and mental health practitioner. Every clinician knows the importance of protecting their client’s personal health information and the potential consequences for failing to do so. HIPAA regulations should not be seen as a tedious demand causing extra paperwork and security measures, but rather as a shield to protect you and your clients. Although HIPAA regulations are complex and can be difficult to understand, CaseTrakker Pro helps make compliance less daunting. For example, consider the following from Anders (2004): “HIPAA strictly says in the absence of patient authorization, information can’t be given to anyone – even a family member – inquiring about the patient’s condition. If the patient’s family doesn’t understand why you can’t tell them, it can get pretty uncomfortable. But with us, you could just send everything to a locked family file that only the patient and family have access to…” This is exactly what CaseTrakker Pro was designed to do – protect your patient’s information.
Audit Trails and User Activity Monitoring
An audit trail is a sequence of events that captures all the activities of the user on the system. It tracks the date and time of user log in and log out from the system, event occurrence, and record deletion for the patient case or prescription. Steps to the next or previous while editing patient case or etc., and any data printout can also be recorded. This is important to track and identify any activities that affect the system. It can help troubleshoot the problem and take preventive action when errors occur. The records can also be used for data recovery when data loss in the system occurs due to any events; the lost data can be restored back.
Audit trails and user activity monitoring system is a feature which records all the events and activities done by the users and admin. The recorded events are stored in a file which can later be reviewed by the admin. It is an important feature for the clinical case management software to have audit trails and user monitoring system. This is because it allows the admin to monitor the usage of the system and ensure that the system is used for the right purpose. The events that are being recorded are useful for the admin to identify any unusual activities and investigate any errors that occur in the system.