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Is Technology Changing the Practice of Case Management? October 12, 2010

Posted by garrycarneal in Case Management, Health Information Technology, Medical Management.
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With the recent publication of the bi-annual Health IT survey (see http://www.tcshealthcare.com/press), we are reminded that there is a whirlwind of change when it comes to how technology is changing the practice of case management. 

Clearly, the field of technology can be overwhelming and challenging for many healthcare professionals, patients, and other key stakeholders.  Although many of the 2010 findings showcase the potential on how leveraging IT can help case managers support patients, many areas still need improvement.  Some of the survey findings include the following: 

  • More integration.  The majority of respondents use two or more health IT applications supporting clinicians and care managers at some level.
  • The need for standardization.  Information technology platforms supporting the care management process still are not standardized in the industry and have many different orientations and attributes.
  • Slow adoption rates.  The adoption of electronic applications seem to be taking longer than originally anticipated, even in light of healthcare reform funding.
  • Satisfaction levels could be improved.  Satisfaction levels including “Very Satisfied” and “Satisfied” are:
    • 35% for care management software systems
    • 45% for electronic medical record applications
    • 40% for nurse triage systems

But signs also are emerging that some positive change has arrived and more is coming.  Survey respondents indicated that:

  • 23% have information technology systems that are fully integrated and interoperable with other external IT applications;
  • 23% have moved to a completely paperless environment regarding patient or care management records;
  • 54% scan medical records, documents, or communications into their medical management information system;
  • 35% can share clinical data electronically with other providers; and
  • 26% allow providers to access report cards that show physician and patient specific compliance with reporting initiatives.

In addition, the survey participants were generally positive about embracing emerging patient communication strategies within the next two years.  For example, respondents anticipate: a three-fold increase in the use of text messaging, smart phones, and wireless remote monitoring; and a doubling in the use of online personal health records, patient portals, remote monitoring, and social networking.

Although the practice of nursing and medicine has been transformed with the advent and adoption of health IT systems as a tool to support care management, these applications are still evolving.  As a result, leveraging technology to improve medical management intervention strategies should remain a high priority in terms of both improving public health and reducing medical costs.  Clearly, HIT applications are changing the practice of care management in profound ways. 

 Pat Stricker, RN, Med

Vice-President, Clinical and Client Services

TCS Healthcare Technologies



Genomic Testing May Help Colon Cancer Screening and Treatment Strategies July 16, 2010

Posted by garrycarneal in Clinical Issues, Colorectal Cancer.
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Thanks to a decade of advances in science and therapy innovations, individuals have more screening and treatment options to fight against colon cancer. One of the more significant advances was the international effort to map the human genome. The Human Genome Project helped unlock the mystery behind the organization of hereditary biological information in human DNA (deoxyribonucleic acid), including both the coding or active and non-coding segments of genetic instruction called genes.

This effort has opened up a whole new field of testing and treatment options for many medical conditions, including preventing or treating colon cancer. Here are some examples:

Stool DNA Testing. Although colonoscopies are still the gold standard, DNA testing of stool (fecal matter from bowels) is an emerging technology in screening for colorectal cancer. Researchers use sensitive laboratory tools to learn the gene sequences of DNA in stool by identifying DNA from cells shed from cancer and precancerous polyps present in the intestinal tract. For example, pre-malignant growths and cancers shed certain DNA genes intact because these segments are not degraded during the digestive process. Clinical studies that use the marker genes have shown a cancer detection sensitivity rate of at least 71% and up to 91%. Although the American Cancer Society endorsed stool DNA testing to detect colorectal cancer, the test is not perfect. Concerns remain about the reliability of stool DNA tests and others of this type relating to the difficulties in detecting the presence of such minute amounts of tumor DNA. Reliability difficulties mean that tests can produce a false positive result if the test indicates cancer is present when it is not or a false negative result if the test indicates cancer is not present when it is. However, for many patients, stool DNA testing can be a helpful resource to a patient that adds to the tests physicians study to fully assess their diagnosis and treatment options.

Gene Expression Testing. Several new tests are being introduced that look at predispositions, or the likelihood for certain biological behaviors to emerge from an individual’s set of unique genetic instructions. Gene expression tests can help doctors predict events like the rate of occurrence of colon cancer or the risk of the spread – or recurrence – of cancer once a malignant tumor is found. For example, one gene-based diagnostic test that has been approved, the Oncotype DX® Colon Cancer Assay, can help patients with stage II colon cancer learn more about how the biological features of their specific tumors might function and how likely it is that a patient’s cancer may recur in the future. The Oncotype DX® Assay analyzes the activity of a specified set of 12 genes within the cells of a patient’s tumor to help predict the likelihood of whether or not that patient’s cancer will recur within three years. Specifically, this test uses RNA (ribonucleic acid) analysis of tumor tissues to measure the presence of genetic products from, or expression of, these 12 genes. This information can help patients and oncologists make more personalized treatment decisions based on the tumor’s specific biological characteristics.

Genetic Counseling. The numbers and availability of genetic counselors has grown in recent years. These trained professionals provide information and support to patients and families who may be at higher risk for certain hereditary forms of colon cancer, such as hereditary nonpolyposis colorectal cancer (HNPCC) or familial adenomatous polyposis (FAP). Simply put, genetic testing can help indicate which family members have an inherited a defective gene — and thus an increased risk of cancer. Genetic results combined with family histories can arm individuals and families with actionable information that can help them become more informed decision-makers.

One thing about the future is certain. The development of gene-based tests and assays will continue to expand. Advancements in the various DNA and RNA expression analysis tests and in correlating these tests with disease states and stages will improve our knowledge about the incidence of colon cancer and other medical conditions. As genomic knowledge grows, communication strategies and touch points between patients, their families, and health care professionals need to grow – to enhance the sharing of information about the dynamic array of screening and treatment options for all cancers, especially colon cancer.

Garry Carneal, JD MA

President & CEO

Schooner Healthcare Services, LLC

The Caseload Project: Phase II May 14, 2010

Posted by garrycarneal in Case Management, Clinical Issues, Disease Management, Medical Management, Utilization Management.
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Over the years, case managers in a variety of healthcare settings have struggled with optimizing their case management caseload workflows and sizes.  In October 2008, CMSA and the National Association of Social Workers (NASW) published an overview of the caseload issue, entitled “Case Management Caseload Concept Paper:  Proceedings of the Caseload Work Group.”  This analysis represented a two year effort to try to identify the potential variables that can influence a clinician or social worker’s caseload.  The 22-page issue brief can be downloaded at www.cmsa.org (click on the Individual portal, and then Membership Toolkit). 

 This research paper was well received by the case management community as a solid first step in understanding how clinical workflows, business requirements, and other factors can influence the amount of time case managers spend with their patients.  However since then, many have inquired about the development of a “caseload calculator” that could help provide guidance to both individual case managers and care management organizations. 

 Earlier this year, a number of individuals began working on Phase II of this project – which includes the development of a basic caseload calculator for CMSA’s membership and the development of one or more enterprise solutions.  The effort includes a partnership with several health care leaders and is being funded in part by CMI, Inc. and Schooner Healthcare Services. 

 A comprehensive update of the “Caseload Phase II” project will be presented at CMSA’s annual conference through a “third” Town Hall meeting, scheduled for Friday, June 11th at 4 p.m. (ET).  A primary goal of this session is to provide an update on what Phase II entails and to solicit feedback on the project.  If you cannot attend the session, a summary of the proceedings will be made available.  In addition, there will be representatives available to speak about the new project at the CMSA exhibit booth in Orlando. 

 Over the coming months, CMSA also is hoping to collect some additional data from case managers, which in turn will be used as a basis to develop the “calculator” or algorithms supporting the new tools under development.  This is another great example of how technology can support the practice of case management.  Stay tuned for details. 

(Note:  Reprinted from the CMSA Membership Newsletter, 5/13/10)

Pat Stricker, RN, Med

Vice-President, Clinical and Client Services

TCS Healthcare Technologies

Fun Facts: Key Terms Used In The New Federal Healthcare Reform Law May 8, 2010

Posted by garrycarneal in Health Information Technology, Healthcare Reform, Medical Management.

This past spring, the President signed “The Patient Protection and Affordable Care Act” (PPACA). Health care experts are now trying to sort out the details of the new law along with the complex implementation schedule.  Below are the frequency of some key terms used in the PPACA:

Phrase or Term

# of References

“Care Coordination”


“Care Management”


“Case Management”


“Chronic Disease Management”


“Demonstration Project”


“Disease Management”


“Electronic Health Record”


“Health Information Technology”




“Patient Safety”




“Population Health”




“Readmission” or “Readmissions”






“Utilization Management”




Prepared by Schooner Healthcare Services

Send me a comment about what terms that you would like me to look up, and I will post the results.

Garry Carneal, JD MA

President & CEO

Schooner Healthcare Services

Leveraging Technology To Promote Real Communication April 21, 2010

Posted by garrycarneal in Case Management, Communications, Medical Management.
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With all the buzz today about social networking, traditional methods of communication are being re-thought and re-defined. Web-enabled platforms like Facebook and LinkedIn, to name a few, are creating new opportunities to stay connected.

I would like to think that TCS has been in the “connection” and “communication” business since the company was founded over a quarter of a century ago. With Acuity Advanced Care™ (ACUITY) and its predecessor applications, TCS has led the way in providing technology-based platforms to help clinicians do a better job communicating with and taking care of patients.

Part of this includes keeping case managers and providers connected with their patients or clients, and helping health plans, hospitals and others to facilitate coverage decisions. In today’s environment, this includes bi-directional communications to manage chronic illnesses and promote healthier lifestyles.

To that end, applications like ACUITY promote the aggregation of disparate data into useful information streams to promote evidence-based decision-making and to automate key elements of the medical management system.

 Charles Dickens reminded us over a century ago about some of the basic limitations associated with a technology-based solution when he said: “Electric communication will never be a substitute for the face of someone who with their soul encourages another person to be brave and true.” Now, in this case, he was probably talking about the telegraph, which of course is a very rudimentary technology-enabled communication platform. However, there is truth in what he says even today.

Therefore, to heed Mr. Dickens’ advice, TCS applications do even more than just promote “electronic communication.” TCS applications enhance all types of connectivity between providers and patients – including face-to-face interactions. His quote touches upon a primary goal within the practice of case management – to really engage a patient or client in a meaningful way to improve clinical and financial outcomes in a given population.

Yes, the world, including health care, keeps on getting more complicated – but enhancing communication links at all levels will remain a top priority as TCS supports its customers and their patients. 

Rob Pock

Founder and CEO

TCS Healthcare Technologies

Originally posted on April 7, 2010 at www.tcshealthcare.com

Evidence-Based Colorectal Cancer Screening April 21, 2010

Posted by garrycarneal in Clinical Issues, Colorectal Cancer.
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Having become familiar with colorectal cancer screening issues over the past year, the need for evidence-based guidelines and sound reimbursement policies, in my opinion, are more important than ever. It has been surprising to me how some screening and reimbursement policies are driven by ad hoc data or economic interests that don’t always focus on the patient’s best interests. Colorectal cancer still is the second leading cause of cancer deaths in the United States. Health plans and other payers need to promote a multi-tiered approach to preventing colorectal cancer. With emerging screening and care options, it is important to establish evidence-based protocols to establish the appropriateness of any particular intervention. Having read several peer-reviewed journal articles recently on sedation options for patients who are getting screened, I have been taken aback by some stakeholder groups that do not always appear to put patient-safety concerns first.  By working together and for the common good, we can literally save thousands of patients’ lives as new screening and treatment options are made available.  However, in the same vein, we need to be careful not to jump on the latest fad. Establishing evidence-based approaches are an important first step. Supporting appropriate, timely and consistent reimbursement policies is also essential – along with keeping patients’ educated on their ever-changing screening and treatment options. Please contact Preventing Colorectal Cancer.Org to see how you can get involved in promoting a fair public policy debate that creates sound coverage policies. 
Garry Carneal, JD, MA
PCC Board Member

Originally posted on January 25, 2010 at www.preventingcolorectalcancer.org

Evidence-Based Care Plans April 21, 2010

Posted by garrycarneal in Case Management, Clinical Issues, Medical Management.
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When managing patients who are suffering from a number of co-morbidities, clinicians are often challenged with the number of clinical guidelines and treatment options that are available through public and commercial resources (e.g., from the Internet, written publications, electronic software applications, or other resources).

If a case manager is treating a chronically ill patient with three or four disease states, it is very difficult to manually develop an effective care plan from various sources that includes a comprehensive review of the problems, a clear set of unified goals, and an integrated care strategy based on evidence guidelines. As a result, some case management programs only focus on the primary health condition or disease state. However, that approach can lead to other health issues being overlooked.

 Therefore, a central challenge for clinicians today is to identify the most appropriate clinical guidelines for the populations that they serve and then be able to customize those guidelines for each patient in an efficient and clinically appropriate manner. While finding and integrating different guidelines and other clinical resources into actionable information is paramount for the effective practice of case management, it is also difficult and time-consuming.

Traditionally, clinical guidelines have a specialized focused such as those that are developed by specialty societies covering a specific health condition or branch of medicine. Other guidelines may concentrate on specific business or clinical workflows, such as length of stay (LOS) or nurse triage.

The good news is that technology now offers case managers and other caregivers new opportunities to develop higher-level care plans that incorporate a wide variety of evidence-based guidelines. Several of the leading care management software systems now do this. Information about a patient can be collected through health risk assessments, patient interviews, clinical data or other sources and then manually entered, downloaded, and/or synchronized into an integrated database. Identified risk factors in this data can automatically trigger a proposed, customized care plan. The case manager can then accept, change, or reject each suggestion or add other specific components that address individualized patient needs.

This standardized process provides up-to-date guidelines, standardization of practice, improved documentation, increased efficiency and productivity, improved reporting capabilities, and improved patient and program outcomes. Of course, clinical oversight is imperative throughout this process to make sure that the care plan is optimized and individualized for each case. In addition, some systems are better than others, so it is important to have these information technology (IT) solutions peer-reviewed and validated.

Because of the continued development of new clinical guidelines and medical advancements, health IT systems will continue to assume an instrumental role in helping clinicians develop, integrate and customize care plans that are flexible, transparent and contemporary. In addition, the practice of case management is beginning to develop its own “evidence-based knowledgebase” by effectively integrating disparate guidelines into coherent care plans that support chronically-ill populations. This is especially needed to help patients navigate the healthcare system and to promote better transitions of care and health outcomes.

Pat Stricker, RN, M Ed
VP of Clinical and Client Services,
TCS Healthcare Technologies

posted at www.tcshealthcare.com on 4/11/2010.  Article featured in CMSA’s April 2010 membership newsletter.

Health IT Survey Assessing Care Mgt Trends April 15, 2010

Posted by garrycarneal in Case Management, Health Information Technology, Medical Management.
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Understanding the Impact of Health Care IT

The health care system as we know it today is undergoing rapid transformation. A major driver of change is the introduction of new health information technology (IT) solutions that cover applications such as electronic medical records and care management software solutions.

The primary goal of this survey is to better understand how various health IT applications are impacting the medical management field.

Completing the Survey

In order to serve you better, the survey sponsors including TCS, CMSA and ABQAURP appreciate if you would complete the survey linked below. The survey should only take 15 to 20 minutes.  You will have the opportunity to receive a complimentary copy of the survey results in a few months.  The online survey is open through 4/23/2010.  Results will be available through the TCS website by mid-June 2010. 

Click here to fill out survey: 


Garry Carneal

President & CEO

Schooner Healthcare Services

The Impact of Social Networking on Case Managers March 22, 2010

Posted by garrycarneal in Case Management, Communications, Medical Management, Social Media.
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According to several reputable resources, over 2.5 billion text messages will be sent today in the United States alone.  Texting has now become the most prolific form of mobile communication in the United States, overtaking cell phone calls.   Social and professional networking platforms also are spreading throughout the United States and in many other countries faster than most ever anticipated just a few years ago.  

Case managers are getting into the act by signing up for a wide variety of social networking sites.   For example, user groups for the Case Management Society of America have about 500 members on LinkedIn and about 250 members on Facebook.  These type of social networking platforms are allowing a greater level of professional and social networking on a wide array of issues impacting case managers – ranging from multi-state licensure to specific clinical intervention strategies for targeted populations. 

In addition, patients are becoming more comfortable with connecting electronically with their providers to schedule appointments, re-order prescriptions through an interactive voice response system, and track key health information through a personal health record (such as Microsoft’s HealthVault, Google Health or through many other offerings).  

 Of course, many patients still don’t use computers and are not comfortable with these emerging communication options.  However with each passing year, the percentage of the population that does not use the Internet or electronic media is shrinking.

With all of these new ways to communicate with colleagues, providers, patients, friends and others, case managers will need to be mindful of what types of communications are appropriate in the right circumstances.  For example, apparently a few providers are giving relatives of patients undergoing surgery updates via Twitter through periodic “tweets”  (we assume with the patient’s signed consent) – which of course highlights the potential danger of private health care information getting into the wrong hands.   

In addition, the emerging communication and social media platforms are redefining how to advertise.  In fact, traditional marketing approaches are being rethought as the Internet and various online communities allow us to reach out to prospective customers in new and more targeted ways.   President’s Obama’s election campaign serves as one illustrative example where he reached out to voters through a myriad of social networking and Internet sites with dramatic success.    

 The expansion of social media is creating new ways for case managers to connect with their patients and other targeted audiences in dynamic and cost-effective ways.   This trend is creating opportunities to improve clinical and financial outcomes by offering options to engage and communicate with patients and others.