1) Price of devices are dropping + they now are all coming with bluetooth

2) Smartphone penetration is sky rocketing and costs are dropping. Mobile is the future - systems based on fixed-line will disappear.

3) New SaaS-based patient management systems developed on buisness process management platforms provide flexible, low-cost (virtually zero upfront investment) and the ability via web services to connect it all.

 The delivery of social care is going through fundamental changes.  Although budget cuts dominate the headlines (they will for the next 12 to 24 months), the real question is how to provide better, more cost-effective social care.  The future is personalised, outcome-based care at home or in the community commissioned jointly by councils and primary care trusts.  Flexible case management systems are required to capture outcome data and MI both for funders and providers.

Two big changes have occurred in England over the past 10 years.  Firstly, we have seen a significant shift way from institutions and residential care to home and community care.  Secondly, over the past decade local authorities have shifted from use of in-house staff to outsourcing the provision of homecare to a growing independent sector, thereby created a market of over approximately £5bn.

Whilst this outsourcing has been largely successful, it has led to a culture of measuring care in number of hours.  There has been little focus on increasing service users’ independence and measure outcomes.  However, this is about to change.  Reablement, a process by which a short burst of support, rehabilitation and training is provided to increase service users’ independence and reduce the need for ongoing care, will fundamentally change homecare.  A number of recent studies suggest that the need for homecare can be reduced by as much as 60% through Reablement programmes.

Legacy IT systems have been identified as a one of the barriers to implementing successful Reablement services.  Reablement requires a new process and new case management solutions.  Outcome reporting and good management information is absolutely vital.  In the new world, we expect key stakeholders to collaborate online and outcome reporting to be integrated into the Reablement process.  This will ensure value for money and provider benchmarking for councils and a tool to deliver effective reablement for providers.

What is the role of electronic call monitoring?  Electronic call monitoring to record how much time is spent by carers with individual services users will continue, however, with emphasis on outcomes, the tracking of time spent will become more a means to understand the effectiveness of Reablement.  Ultimately providers will get paid for generating good outcomes – not just delivering hours of care.

Given the severe fiscal outlook, councils and providers alike should look to fully-hosted SaaS (software-as-a-service) case management solutions.  Software providers, such as psHEALTH, deliver solutions with no upfront cost or investment in hardware or ongoing infrastructure maintenance.  The only thing stakeholders need is access to the internet.

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. 

Only a few years ago, comprehensive customised case management and work-flow solutions were the preserve of large businesses willing to spend millions of pounds on projects that were measured in years.

Good news! There are some exciting developments which are leading to a paradigm shift towards nimble, low-cost technology solutions – let us look at some of the buzz words:

SaaS

Software as a Service (SaaS, typically pronounced ’sass’) is a model where the software is rented rather than purchased. Instead of buying software and paying for periodic upgrades, SaaS is subscription based, and all upgrades are provided during the term of the subscription.

What is the benefit? Significantly lower upfront-cost and reduced project risk.

Cloud Computing
Cloud computing is considered by many to be the next great wave in the IT industry. It refers to applications accessed over the Internet. SaaS solutions are ideally suited for cloud computing over the Internet and Web browser-based applications. They can run on any desktop or mobile device, no matter the operating system. In this model, the applications and the data are maintained in the service provider’s datacentre.

What is the benefit? Zero investment in hardware/data centre; reduced people cost and system admin; and, lastly, benefits of scale in terms of investment in data security.

BPM Platform

A Business Process Management Platform is a software platform or system for rapid modeling and development of customised work-flow or BPM solutions. It typically includes Process/Work-Flow modeling and execution, Management Information and Analytics, Document Management and sophisticated Security and Access-Level Rules.

What is the benefit? Fantastically quick development of customised solutions (measured in weeks not quarters) and great flexibility as regards to adding functionality or modifying processes going forward.

We leave the shock and awe pandemic stories to the tabloids.

Our view is that a very small proportion of the UK population will have serious complications from the flu pandemic. With the exception of GPs and the NHS, the principal challenge for employers is to ensure the running of day-to-day operations under scenarios where maybe up to 20% of total staff is off work with flu or looking after children with flu.

The internet is a powerful tool. It helps facilitate home working which should minimise the spread of the virus and the NHS is relying heavily on the use of the internet to help people self-diagnose and thus avoiding clogging up GP waiting rooms.

Recently, powerful applications have been developed to enable large organisations to quickly set up processes whereby employees can report flu related absence via the internet and access support provided by their employer or occupational health provider.

Real-time information on infection levels and affected staff allow operations, HR and other people involved in Business Continuity Planning to have their fingers on the pulse. This real-time information, provided down to department or location, will help making resourcing decisions and minimise business disruption.

In addition to providing employees with support (e.g. ability to request a phone appointment with a nurse), the tracking of sickness absence should help enforce medical guidelines, so avoiding employees coming back to work too soon and increasing the level of infection. Detailed reporting will also reduce staff abusing the situation – a system that works well should pick up employees that repeatedly go off with swine flu this autumn and winter!