Spending Time with Patients

Pat Stricker, RN, M.Ed.
Vice-President, Clinical and Client Services
TCS Healthcare Technologies

(Reprinted from CMSA Monthly Newsletter, August 2010)

A good care management professional is able to encourage patients to embrace healthy activities and lifestyle choices. One way to gauge success in this area is by assessing “the amount (and quality) of time” case managers spend with patients – whether face-to-face or on the phone.

Many public policymakers and industry leaders assume that health information technology (HIT) systems, especially care management software applications, allow case managers to spend more time with their patients. Unfortunately, this assumption may be incorrect, based on recent research results.

On September 1, the long-awaited 2010 Health Information Technology Survey was published by CMSA along with its research partners, TCS Healthcare Technologies (TCS) and the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP). The 65-page report provides in-depth insights about how a wide variety of HIT systems are having an impact on the practice of case management (see summary of the survey findings on page 1).

One of the more surprising findings is that HIT systems may not provide more time for case managers to spend with their clients. This outcome was first identified in the 2008 study, and was re-affirmed through the 2010 study results. While 22% of the 521 respondents in 2008 reported their care management applications allowed them to spend more time with their patients, only 18% of the 670 responding noted the same effect in 2010. Unfortunately, this trend also is seen within various types of care management services, as highlighted in the table below.

SPENDING TIME WITH PATIENTS Does your care management software application allow you to spend more time with your patients? (Respondents could select more than one option)
	2008  Large Pool	2010 Responses
		2010 Large Pool	Case Mgt	Disease Mgt	Utilization Mgt	Nurse Triage	Independent Review	Pharmacy Benefit Mgt	Behavioral Health
N = Respondents	521	670	174	86	104	45	31	35	49
Allows you to spend more time with your patients	22%	18.5%	19.5%	15.1%	15.4%	13.3%	9.7%	14.3%	16.3%

Clearly, the business and clinical goal of care management software is to empower case managers to spend more time with their patients, rather than on paperwork. Based on a number of narrative responses in both the 2008 and 2010 surveys, barriers to doing so include the need to: document activities via the electronic software; navigate through various computer screens; produce a myriad of reports; and follow-up on a number of other demands. Clearly, more thought needs to be put into the workflow associated with care management software tools.

To help address this challenge, one initial step must include active involvement by the clinical management and end-users in the selection, design and implementation of medical management software. They need to ensure the system is built to accommodate their workflows, rather than creating work-arounds to simply accommodate the software.

As a quick aside, the 2010 HIT Survey does show some progress in a few key metrics towards HIT integration and interoperability. For example, over half of the respondents report they scan medical records and other key information into their respective medical management systems (i.e., 54% in 2010, an increase of 14% from 2008).