CMSA Today - Issue 4, 2016 - (Page 17)
Finding the "Right" Care
"Must Have" Requirements + Structured
BY PAT STRICKER, RN, M.Ed., SENIOR VICE PRESIDENT, TCS HEALTHCARE TECHNOLOGIES
hat would you do if you were
asked to be responsible for
finding a new care management
system or to be on the selection committee
to decide which system to choose? Would
you know where to start? What to look
for? Would you feel comfortable with this
responsibility, or would you be a little
You probably have business goals for the
new system, such as improving workflow
efficiencies (business and administrative
processes), increasing the quality of care,
enhancing patient outcomes, improving
healthcare delivery, providing patterns
of communication and collaboration,
reporting and analyzing data to improve
efficiency, easily integrating with other
systems, and reducing costs. However,
those high-level goals don't really identify
exactly how the system should work or
what features and functions it needs to
have to assure the goals are accomplished.
So how do you determine that? Where do
Keeping up to date on healthcare and
technology trends and the plethora of
systems available today is not easy. So your
first task it to research vendors' websites,
trending articles, and comparison studies
available on the internet to help you become
familiar with what products, features, and
functions are available.
And when it's time to actually begin
finding a system, don't panic! Simply break
the process into two basic steps to make it
easier and more manageable:
* Determining the "must have"
* Structuring the demonstration process
NOTE: These tips are based on a series of
articles, published in the CMSA Today online
cmsatoday) last year, in which I highlighted
key factors to consider when looking for a
care management system. Keep in mind that
while this article is focused on selecting a care
management system, the process can be used
to look for any type of application.
"MUST HAVE" REqUIREMENTS
A requirements committee needs to be
developed, consisting of representatives from
the clinical, business, and IT areas that will be
using or interacting with the system. Their
key goal is to develop a list of "must have"
requirements for each functional area (UM, CM,
PHM, intake, TOC, IT, claims, client services, etc.).
It is essential to identify exactly what is needed
before starting to look at systems. All workflows
and processes, especially those that are timeconsuming, difficult, or not working well, need
to be reviewed to determine how they should
be done, not what is currently being done.
Define each step and be specific about what
requirements are needed. Include automation
steps throughout the process, even if you think
they may not be possible. Set your goals high
and let the vendor tell you if they can't be done.
Once all the "must haves" are identified, add
the "nice to haves."
Your requirements document needs
to include the key attributes all medical
management systems should have (you should
have found these when doing your online
research). Each attribute needs to include your
organization's detailed, specific requirements,
as shown in the first example:
* Flexibility and Adaptability: System can be
easily modified (configured) by the client to
meet required workflows.
0 Drop-down lists are configured to include
0 Customized care teams and functions can
be set up in the system.
0 Work can be distributed from one team
member to another or from one group
0 A basic workflow can be configured
differently based on a user, team, or
* Ability to View or Link to Other Systems:
Necessary to eliminate copying/pasting
information, the need to learn/use multiple
systems, duplication of work, convoluted
workflows and "silos" of information.
0 Interface: A bridge between systems that
uses custom code and import routines
and/or utilities to transfer information.
Data is maintained in both systems, so
data mapping is required, but it results
in a unified system that is easy to use.
Issue 4 * 2016
Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2016
CMSA Corporate Partners
Triple Aim Requires Case Management “Target” Practice
Finding the “Right” Care Management System: “Must Have” Requirements + Structured Demonstration Process
Understanding the Health Insurance Appeals Process for Case Managers
Keeping the “Professional” in Professional Case Management
Patients Get Better Care When Doctors, Hospitals and Insurers Share a Common Interest
Index of Advertisers
CMSA Today - Issue 4, 2016