MyAssistant:
Computer-Assisted Record-Keeping for the Case Manager1
Wallace J. Gingerich, Ph.D
[Symposium on Computer Applications in Medical Care,
New Orleans, LA, October 1995.]
MyAssistant is a computer-assisted record-keeping
system designed for use by case managers serving persons with chronic mental illness.
Designed as a personal productivity tool expressly for the clinician, MyAssistant
operates on a notebook computer that can easily be used in staff meetings, on field visits
and in the car. The system manages most record-keeping tasks for the case manager and uses
the information contained in the case records to assist in efficient management of the
caseload.
MyAssistant was developed using a design and
development (D & D) procedure similar to the research and development
(R & D) procedure used in industry. The initial design for the system was
based on careful analysis of the real world needs of case managers and the technology
available to address those needs. Case manager feedback was incorporated during each phase
of system design and development to modify the system until it performed satisfactorily
and was compatible with normal case management practice. MyAssistant is
programmed in Visual Basic and incorporates a standard Windows "look and feel"
and familiar visual metaphors such as file folders. The system can operate on low-end 386
computers running Windows.
MyAssistant records (1) basic demographic information
in a face sheet module, (2) structured information on client goals and treatment plans in
the service plan module, and (3) information on current client functioning and services
delivered in the contact note module. A search function is provided to help the case
manager locate a record based on incomplete information. A tickler system reminds the case
manager of tasks to do for specific clients. Routine reports are preprogrammed and
incorporated as menu options.
The distinctive feature of MyAssistant is the
structured format for recording client-specific goals. Each client may have one or more
goals, each of which describes a client outcome in observable terms. Goals are expressed
in 2 to 10 levels of performance. A goal may have predefined behavioral anchors for each
level. For example, the goal "Taking medication to manage symptoms" could be
defined as: (1) not taking any medications, (2) taking medications only with close
supervision, (3) taking medications with minimal supervision, (4) taking medications on
own but somewhat sporadically, and (5) consistently taking medication completely as
directed. Alternatively, a goal can be defined simply as a global 10-point rating scale.
For example, "Feeling suspicious" could be scaled from (1) not feeling at all
suspicious to (10) feeling very suspicious all the time. Goals can be selected from a
standard lookup library or may be written individually for a particular client.
When a goal is established in the service plan module, the
client’s current level of functioning is indicated along with the expected level of
functioning and the expected date of attainment. In addition, the case manager may
indicate what service is to be provided and the frequency of service for each goal. Then,
when entering contact notes, MyAssistant prompts the case manager to
record the client’s current level of functioning on each goal along with information
about the services provided. Free-form narrative notes may also be entered in relation to
each goal.
The structured information on client goals enables MyAssistant
to help the case manager track client progress and plan treatment. For example, the system
can identify which clients are not making sufficient progress toward their goals, and
which clients have already met their goals. Client functioning in relation to each goal
can be displayed graphically so the case manager and client can visualize the
client’s progress. MyAssistant also performs caseload management
functions such as maintaining a to-do list of up-coming tasks for the case manager,
compiling routine reports, and conducting ad hoc queries of the caseload.
Upon completion of development and field testing MyAssistant
will be evaluated for its impact on case management services. The system is expected to
reduce time spent on paperwork, increase the accuracy, completeness and timeliness of
reports, increase the goal-relatedness of services, and improve the efficiency of caseload
management.
1Support for this project was provided in part by The Cleveland Foundation,
Cleveland, Ohio, and Family Service Milwaukee, Milwaukee, Wisconsin.
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