Installment 2: The ‘state of the art’ of Case Management
When asked, local health departments (LHDs) report overwhelmingly that case management is a service that is universally provided at the local health department level. Of course there are many types of case management – Women and child health, TB, STD, HIV, Diabetes, Elder Care, Social services, etc. In each of these examples, there are services that are provided and ‘case managed’ by the health department and there are services that are provided and ‘case managed’ by other entities. However, care coordination is the key to success. In this age of electronic health records, new ways of electronic messaging and managing care are cropping up and have the potential to improve efficiency and in return improve outcomes.
Today, case management often starts behind and struggles to catch up to what the client is experiencing. The client may receive care and be referred to case management or become eligible for case management by diagnosis and the referral can take hours to a month to get to the public health case manager. It can then take precious time and resources to find the client and encourage them to take advantage of the resources the case manager has to offer – resulting in missed opportunities for help.
However new technologies are coming along to change this picture. In Olmsted County Minnesota, (part of the MN ONC Beacon Community Project) public health case managers are electronically connecting at the point of care. So a patient could leave the emergency room and at that moment, the local public health case manager is informed electronically of the visit and given some summary as well. This electronic connection makes the public health case manager a member of the care team – bringing a community focus to the point of care that has been absent in most communities. This allows the public health case manager to impact the plan of care and connect the client to community resources when they are needed.
In support of this emerging trend, The Public Health Informatics Institute (PHII) has, with NACCHO’s assistance, partnered with local public health case managers to develop a requirements document for case management. This document is useful in two ways: 1) It looks across case management types for commonalities and best practices and can be used to improve local case management programs; 2) It can provide a unified view of requirements for vendors to use when building systems that will support and enhance case management. This document can go a long way to building consensus among local public health case managers about how an electronic case management support system should support their work. Once there are agreed upon standards and requirements, vendors will have incentive to sell products to this new and growing market.
So what should I do?
NACCHO would love to hear your comments and stories. How have you utilized technology to support case management? What successes and/or challenges are you having? What can we do in order to promote and improve this area of important local public health work?