The potential of case management systems to improve outcomes AND reduce cost is significant and rarely disputed.  A good case management system will reduce the cost of communication between stakeholders, ensure compliance with policies and generate rich management information for further process improvements.  Based on our experience there are 5 key challenges that must be addressed when designing a case management software:

Poorly defined processes:  Processes have typically grown incrementally and the organisation has not had a culture or the tools to drive standardisation of service delivery.  Also, process owners typically have little experience in articulating and documenting system requirements.   What to do?  Facilitate system development with rapid prototyping (first prototype in 5 days!) and highly iterative process allowing all stakeholders to touch and feel the solution.

Multiple service lines:  Providers often deliver an array of different services from screening and assessments to the provision of ongoing case management or care.  Operating complexity is high and it is not uncommon that processes vary by region or even by client.  What to do?  There is no easy fix to this.  Good modular design and extensive use of configuration is key, however, the organisation needs to be willing to drive towards standardisation within defined service lines.  The development of a case management system offers a great opportunity to take standardisation to the next level and implement ongoing process control.    

What to do with all the paper?  All the processes we encounter (occupational health, rehabilitation, drug compliance, homecare, reablement etc) still involve a number of stakeholders that extensively use paper and - despite increasing digitalisation - paper forms and documents will remain part of any case management process for the foreseeable future.  What to do? Integrate document management and scanning into the solutions to enable digital storage and deploy smart template letter writing to avoid re-keying.  You can’t fight the paper but you can make it easier for your organisation to deal with.  

The man vs machine debate.. From a system & IT point of view it is easy to get carried away believing that processes follows mechanistic paths and that ‘the computer’ can make every decision.  That is clearly not the case.  Case management in health and social care combines clearly defined guidelines and protocols with significant reliance on the professional judgement of case workers and clinical staff.  What to do? Break the process into tightly defined activities or tasks (e.g. conduct occupational health or homecare assessment) but allow the case worker to a large degree to determined the sequence of the events or tasks.  This approach combined with Red Flag/Next Step pointers as worked well for psHEALTH clients.

Data Integration…sorry but it really is the future.  In the development of software for occupational health, rehabilitation, drug compliance, homecare, reablement,  etc data integration is becoming increasingly important.  Most providers will have a number of system with which the case management software needs to communicate.  Historically the focus has been on integration with back-office and finance systems – however, except the future to including increasing integration of medical devices and equipment.  What to do? Working on a robust platform with good integration hooks is important, including out of the box web services.  With web-services integration is getting easier and cheaper.  At psHEALTH we recently integrated with RFID (in this case to allow attendance tracing of nurses) – the whole project was completed in less than one day!

Let us know what your experience has been.  In due course we will come back and look at some of the benefits of ‘next generation’ case management.