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Wallace J. Gingerich, Ph.D.

[Treatment Today, Vol. 10 (Summer, 1998), p. 50.]

Consider the well-equipped case manager, who carries a battery operated computer weighing less than a pound and no bigger than a paperback novel. With it, she can access any client record from her office, her car, the consumer’s home, or even the street. She can conduct a standardized assessment on the spot, determine what medication a client is currently on, schedule a follow-up appointment, graph the client’s behavioral change over time, and enter a progress note. For new clients, the computer helps the case manager select treatment goals, suggest intervention strategies, and identify available community resources. Is this scenario just a dream? Not at all! The technology to do this is available and feasible, though perhaps not implemented just like this anywhere currently.

Today only about one fourth of behavioral health care providers use computers in their practice – in most cases for billing and record-keeping tasks. But this is about to change dramatically. Computer technology is becoming much more capable in the tasks it can perform for providers, including the ability to transcribe voice to text and to offer "intelligent" advice. At the same time, computers are becoming smaller, less expensive, and more networkable using cell phone and internet technology. In addition to these technological advances, the forces at work in managed care are pushing us rapidly to make use of information technology to improve the efficiency and cost-effectiveness of care.

Although computerization has the potential to improve the quality of care, it is not at all certain that this will happen. The forces driving computerization are concerned mainly with efficiencies in billing and reimbursement, and in standardizing the types and levels of care. Further, behavioral health software programs are usually designed to address the agency’s needs, with little attention given to how the program will work for the actual users of the system – the case manager and the client. Yet these systems are dependent on the case manager to use the system conscientiously and in a timely manner. To be successful, computer systems must fit in naturally with the case manager’s work flow, and should add value to the case manager’s work. That is, the computer should be able to actually help the case manager keep her records, plan treatment for her cases, and manage her caseload. Many well-intentioned attempts to computerize case management have failed over the years because the systems added to the case manager’s workload while producing little or no benefit. Fortunately, this does not need to happen but careful planning is needed to avoid creating more failures.

So what should a computer-assisted case management system be able to do for the case manager? Here are some suggested functional requirements, based on careful analysis of earlier systems and intensive fieldwork observing how case managers use information in the course of their work.¹

1. Real time entry of information – – you should be able to enter each new piece of information directly on the system at the time you receive it. (If you work in the field this means it must be a batter-operated portable machine.) Systems that expect the case manager to fill out paper forms and then enter the information on the computer later are destined to fail – they add to the case manager’s work.
2. Pre-programmed routine reports – regular reports should be pre-programmed into the system so that the case manager doesn’t have to spend valuable time filling out tracking down and compiling data, and filling out report forms (helps the case manager do his/her work). Intuitive search functions should be built in so information about a particular client, or the entire caseload, can be located easily and rapidly.
3. Prompting for case management tasks – the system should be able to keep track of routine case management tasks such as periodic reviews and reports, authorizations for care, schedules of visits, etc., to relieve the case manager from remembering such details and make sure care is delivered and documented in a timely manner.
4. Assist with treatment planning – a well-designed system should contain assessment tools, libraries of goals, and treatment protocols to help the case manager plan treatment for the client. The technology to enable systems to make "intelligent" recommendations on treatment strategies is becoming increasingly available, and may be included as well.²
5. Track client progress – if information in the progress notes is entered in a structured (i.e., quantified) format, the system will be able to track each client’s progress over time, and advise the case manager on which clients need additional service based on their lack of progress toward goals.³ Further, graphs showing actual client progress can be very reinforcing to the client, acting as a natural incentive to further change behavior.

While all of these functions are practicable with today’s technology, few if any currently available programs provide all of them. Nevertheless, this is a reasonable list of functions that you should expect your computerized case management to be able to do for you.

A good place to start investigating the possibilities out there is to look at the off-the-shelf packages. Several excellent sites on the world wide web provide comprehensive listings of available case management software, along with reviews, links to vendors, and sometimes actual demos of the programs (c.f., http://www.ex.ac.uk/cimh/ and http://www.shrinktank.com/otrsoft.htm). Once you’ve identified several programs you are interested in, it is time to speak directly with the vendors and try out demo versions of the program. Also, it is advisable to speak directly with current users of the software. If you don’t find an off-the-shelf package that meets your needs, you may need to work with a computer consultant to design and program the system for you. This is usually a more costly route to go, but if your needs are specific it may be worth the added cost.

Whether you purchase off-the-shelf software or have your system custom-designed, it is essential to involve case managers in the decision-making process. Case managers should be able to enter several cases into demo versions of several programs under real-world conditions to test out their usability. And, case manager feedback should be taken seriously, since the ultimate success of the system depends on its conscientious use by case managers. With today’s computer technology, and our current knowledge of the case management practice, case management systems should be able to help case managers do their work, as well as add to the efficiency and quality of care from the agency’s perspective. But it is likely to happen, only if you see that it does.

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Last  updated:  11/29/07
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