How Health Information Technology Is Impacting the Practice of Case Management

With the rise of digital health and the impact of the COVID pandemic, these and other forces have changed almost every phase of healthcare in recent years. How case managers interface with their patients and the tools they use to do so is one prime example of the changing landscape. The arrival of telehealth and the constant opportunity to use emerging technology applications only adds to the complexity and excitement.

Periodically, the case management community takes a moment to examine how health information technology (HIT) trends are changing the practice of case management – both positively and negatively.

THE 2022 HEALTH INFORMATION TECHNOLOGY SURVEY

Last year, CMSA and Schooner Strategies administered the fourth survey examining how HIT trends are impacting case management programs. Earlier versions of the survey were published in 2008, 2010 and 2012.¹ This effort has been supported by a wonderful team of case management experts.² Starting with the CMSA annual conference (associated with this issue of the magazine), the research team will start publishing the 2022 results.

As with past years, the 2022 HIT Survey findings will be published in separate issue briefs, allowing case managers and others to focus on different aspects of technology in a sequential manner – in large part because there is so much content. The 2022 survey was filled out by a total of 391 healthcare professionals, 210 of whom were identified as case managers. Topics will focus on:

• Communication and social media trends ranging from traditional communications to emerging computer-based trends.
• Case management software functionality related to documentation, automation, clinical assessments and care plans – among other attributes.
• Information technology infrastructure such as integration with claims systems and hosting configurations.
• Key workflows including caseloads, transitions of care, readmission prevention and patient engagement strategies.
• The ability to track data analytics and report on return on investment (ROI), reviewing dashboard functionality, predictive modeling and outcomes reporting.
• Satisfaction levels including both the advantages and disadvantages of medical management software applications.

The goal is to publish a new issue brief every six weeks on each topic listed above and report on the key trends associated with the entire respondent pool and the case manager respondent pool.³ As highlighted below, some trends will be compared over the past 10 to 15 years depending on the issue. Several webinars will also be scheduled later this year to discuss the survey findings.

TECHNOLOGY AND POPULATION HEALTH

Over the years, front-line case managers have undergone a number of significant changes in how they manage their patients (sometimes referred to as clients). The framework for case management has been established by groups like CMSA and its Standards of Practice, the Case Management Model Act and a variety of other educational resources.

In addition, clinical and business workflows used by case managers on a daily basis are influenced directly by HIT resources in so many ways. This is why conducting the HIT studies is so important. The issue briefs help us study, understand and respond to how technology promotes clinical outcomes and job satisfaction levels. The results also give CMSA a chance to assess what needs to change from a public policy perspective to ensure the integrity and productivity of care management interventions are optimized for the foreseeable future.

Below are a few examples of how HIT research studies have tracked changing trends and generated important observations about the field of case management.

COMMUNICATIONS SPOTLIGHT

The Demise of the Written Letter

To demonstrate how HIT has shifted practices associated with case management, one only has to look at the use of letters. Historically, patients often received updates regarding their health plan coverage via mailed letters, especially as it relates to reimbursement issues or adverse benefit determinations. But beyond this type of information exchange, how often are written letters being used today to support care management programs? The 2022 HIT Survey shows a continued decrease in the use of letters by healthcare professionals and case managers:

• All Respondents. In 2010, three-fourths of the general respondent pool (76%) reported using letters to communicate with patients. In 2012, the percentage decreased slightly (74%), and in 2022 the use of written communications dropped dramatically to just above half (54%).
• Case Managers. For the case manager respondent pool, we see a similar trend over the last 10 years. In 2012, seven out of ten case manager respondents (70%) reported using letters to communicate with their patients. In 2022, this percentage decreased to just over half of case managers (54%) reporting using written letters, with an even smaller percentage (44%) predicting they will use letters two years from now.

Of course, we really should not be surprised based on the move to the digital world that we live in today.

The Downward Reliance on Facsimiles

In a similar vein, it is noteworthy to see how reliance on facsimiles (faxes) has changed as well. Faxes have been routinely used by health plans and providers since the late 1980s, primarily to verify the medical necessity of a procedure through the UM process. The 2022 HIT Survey also shows a continued decrease in the use of faxes by healthcare professionals and case managers:

• All Respondents. In 2010, four out of 10 from the general respondent pool (42%) said they used faxes, and in 2012, only about one-third of the participants (32%) indicated they used this mode of communication. In 2022, the percentage dropped further to one out of three respondents for faxes (30%), and only one out of five respondents (19%) believe they will be using manual faxes in two years.
• Case Managers. Although about the same percentage of case managers, three out of ten, reported using faxes both for 2012 (29%) and 2022 (33%), case managers reported an expected drop in the use of manual faxes in the future (21%).

Although faxes have not traditionally been used between case managers and their patients for care coordination activities, they have been used for other business functions. Clearly other digital forms of communication are replacing facsimile communications.

The Dramatic Rise in Texting

The advent of text messaging has changed the way we communicate both personally and professionally. No longer is communication restricted to face-to-face conversations, a phone call, a letter or even an email. Over the past 20 years, the ability to communicate in 140 characters or more (smartphones allow more characters) has revolutionized the way people interact.

In recent years, text messaging has taken off in the healthcare arena. Many programs are now supporting the healthcare needs of patients through text messaging:

• All Respondents. In 2010, only a small percentage of the general pool of respondents (7%) reported using texts as a way to communicate with patients or clients; in 2012 usage doubled (13%), and in 2022, texting increased dramatically to more than half of all respondents (55%), with this trend expected to continue two years from now (56%).
• Case Managers. One out of ten case managers (10%) reported using texting in 2012, and this number jumped to four out of ten (43%) in 2022. In addition, three out of four (74%) case managers predict that they will be using texting over the next two years, which is 20% higher than the general population of respondents.

The significant increase in the use of text messaging is a prime example of how communication links between providers and patients are changing. In large part, the growth of digital communications like texting has been spurred on with HIPAA-compliant technological solutions.

Moving to virtual care and telehealth

Not surprisingly, the reliance on video conferencing has surged over the past 10 years, with telehealth fueling this expansion. Among other factors, the U.S. Centers for Medicare & Medicaid Services (CMS) has led the charge in reimbursing for telehealth consults during the pandemic, with private payers now following CMS’s lead. In addition, the major accreditation program for telehealth (originally established by the American Telemedicine Association and now operated by URAC) recognized virtual case management as a form of telehealth.

Only one out of 20 healthcare professionals (4%) and case managers (3%) reported using video conferencing in 2012. The percentage of respondents relying on video conferencing services in 2022 increased dramatically, with almost one-half of the general respondent pool (45%) and one-third of the case manager respondent pool (36%) reporting using telehealth links in 2022. Respondents from both groups predict a slight increase two years from now (50% and 41% respectively).

CONCLUDING THOUGHTS

This article has provided a short preview of the changing world case managers and their patients live in today. Please stay tuned as CMSA publishes the 2022 HIT Survey findings, which will focus on the opportunities and challenges associated with technology and the new innovative ways technology is being used to advance case management programs, clinical outcomes, caseloads, transitions of care, etc. The information learned from the study will also give us the opportunity to provide important feedback to case management software vendors and other stakeholders to optimize the practice of case management.

REFERENCES

Garry Carneal, JD, MA, is the president and CEO of Schooner Strategies and RadSite.