What the EHR means to case managers

June 29, 2010 | Barbara Aubry | Comments 3

What the EHR means to case managers

The Office of the National Coordinator for Health Information Technology (ONC) has released a final rule establishing a certification program for health information technology. The rule released June 18 describes the temporary certification program for electronic health records (EHR) and what organizations must do to be authorized to test and certify EHR technology, according to an HCPro.com article.

As a busy case manager you might think “well, that’s nice, but what is the big deal about the EHR?”

Most case managers have more work than they can handle and no time to think about their facilities’ adoption of EHR. Some case managers probably doubt that EHR will make their lives any easier.

Actually, case managers are invested in use of EHR. I want to share information compiled in a 2006 study by Eclipsys Systems entitled Eclipsys EHR Success Case Studies: Improved Operational Efficiency with an EHR. I don’t endorse a particular product, but I think this information demonstrates how EHR affects case managers.

The study found that EHRs helped:

Reduce the need for full-time case managers while also increasing the number of reviews completed.
Improve the process for managing concurrent denials because they allow clinicians to review medical records in their office or other locations within the hospital.
Decrease the number of denials due to better management of avoidable days
Improve staff effectiveness. Staff can access the entire chart and prioritize their workload.
Enhance the ability to perform trend analysis by avoiding the need to manually enter data into an Excel® spreadsheet.

Users also commented that EHRs save time, reduce missed orders, provide better and safer care, and improve communication with physicians with legible notes.

While I wonder whether EHRs will reduce the need for full-time case managers, it would be wonderful if case managers had more time to focus on Medicare admissions, especially with increased scrutiny from government auditors. It also makes sense that legible records will reduce confusion and time spent verifying orders and outcomes. Also, EHRs with built-in utilization criteria may help providers reduce concurrent denials.

The ability to perform concurrent trend analysis with an EHR will allow case managers to actively prioritize their reviews and work more efficiently. Case managers could focus their time and energy on cases that need intervention most, which could reduce denials, improve quality of care, and increase cost effectiveness.

Case managers should be active participants in their organization’s process of reviewing and rating prospective EHR systems. EHR technology should facilitate communication between case management and computer-assisted coding software.

Case managers should be involved in all process improvement initiatives as payers move toward pay-for-performance reimbursement models. There are exciting opportunities for the practice of case management in the digital era.

Entry Information

Filed Under: News

Tags: communication • electronic medical records • patient flow

About the Author:

As Regulatory Analyst for 3M Health Information Systems, Barbara Aubry RN, CPC, CHCQM, FAIHQ is responsible for analyzing CMS and other payor rules and regulations and communicating that information to product development, continuous product improvement, marketing and sales. Additionally, she is responsible for creating and maintaining data for specific 3M software applications. Previously, Barbara was Utilization Review Manager at Holy Name Hospital, where she was responsible for supporting nurse case managers and working directly with payers. As Director, Peer Review and Audit for a privately owned company, she was responsible for managing a department of registered nurse auditors who examined hospital and provider claims and medical records. In that capacity she worked with the FBI and state fraud and abuse investigators on cases identified as suspicious. Aubry was the Manager, Department of Utilization Management for an east coast HMO and a national E/M auditor for 26 managed medical and surgical specialties. As managing clinical editor of an e-health website, she wrote and edited a body of over 300 disease, wellness, care giving, managed care, Medicare and veterans benefit articles.

She is a is a registered nurse, Certified Professional Coder, certified in health care quality management and a Fellow of the American Institute of Healthcare Quality with a core focus on compliance by the American Board of Quality Assurance and Utilization Review Physicians.

Comments: 3 | Post a Comment | Trackback URL

Stefani Daniels | Jul 14, 2010 | Reply

With all due respect to Ms. Aubrey, every ‘benefit’ she cites appears to be more applicable to UR specialists reviewing charts than case managers coordinating progression-of-care. While I agree that an EHR is a valuable tool and a hospital case manager needs to be able to easily access that tool, formal chart review activities are peripheral to the practice of case management and do not constitute the focus of a professional case manager’s work activities.
Barbara Aubry | Jul 14, 2010 | Reply

Hi Stefani –
Thank you for the comment. I believe the intent of the Eclipsys study was to demonstrate how an EHR can improve the operational efficiency of case managers – not necessarily focused on chart review – but rather on efficient access to legible, widely accessible and predictably organized clinical records. It is my hope that involvement by case managers in the review of prospective EHR systems could lead vendors to include tools that would increase efficient documentation of their interventions and outcomes
Ehr vendors | Apr 4, 2011 | Reply

I totally agree with you and the basic idea of great work.