The information technology (IT) revolution, which has transformed industries across the economy, has arrived in full force in health care. Health IT is on the radar of clinicians and professionals from every discipline, as a means to improve quality, patient safety, and cost-effectiveness-and is squarely on the radar of board-certified case managers who act as the "hub" of multidisciplinary care teams.
According to a recent survey conducted on behalf of the Commission for Case Manager Certification (CCMC), nine out of 10 board-certified case managers reported that their organizations use health IT to support care coordination activities. While the most common health IT use is to coordinate with other members of the care team (53.7% of respondents), nearly half track quality improvement as well (49.7%).
Such a response rate shows that board-certified case managers and their organizations are increasingly at the forefront of best practices in health IT. In its briefing, Health IT and Patient Safety, the Institute of Medicine (IOM) observed that health IT, when effective, will "provide easy retrieval of accurate, timely, and reliable data; incorporate simple and intuitive data displays; and yield evidence at the point of care to inform decisions" (IOM, 2011, p. 1).
Health IT, though, is a complex subject, far beyond the scope of this column to address in great detail. In this discussion, we will focus on the importance of health IT knowledge to the board-certified case manager, who must do more than merely attend a training session to use whatever system the organization is putting in place. As a leader, the professional case manager must take an active role in assuring that the health IT system in an organization or within a particular practice is effective in achieving the desired goals.
The potential benefits of health IT are well known. According to the IOM, health IT has been shown to have a direct, positive impact on medication safety. As IOM observed, "For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use bar-coding systems." Furthermore, effective health IT has the potential to enhance workflow and allow easy transfer of information, while causing no unanticipated downtime (IOM, 2011, pp. 1-2).
The key word, though, is effective. The IOM has cautioned against poorly designed health IT systems that "can create new hazards in the already complex delivery of care," including "dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human-computer interactions or loss of data..." (IOM, 2011, p. 2).
It stands to reason that the board-certified case manager-working closely with multiple providers and various members of the multidisciplinary team, including physicians, nurses, social workers, physical therapists, occupational therapists, pharmacists, nutritionists, and others-has the potential to be on the front line of helping assess the effectiveness of health IT. If there is a glitch or breakdown in the health IT system-if people complain, for example, about data that are missing or incomplete-the case manager likely will know about it and therefore could be part of the feedback loop to improve the health IT system.
Knowledge of health IT does not mean that the board-certified case manager needs to be a technology expert. But just as the average business person today has at least a working knowledge of computers and smartphones, so the case manager needs to be conversant in health IT. Where familiarity is lacking, education (such as reading the latest literature on the subject) is imperative.
Health IT: A Vocabulary Lesson
A lot of conversation around health IT today centers on accessing IT platforms and databases of patient information. But health IT is an umbrella term, with very important components. To contribute to meaningful discussions in any practice setting, the professional case manager must understand the meaning and implications of specific terminology. For example:
* Protected health information (PHI). Refers to health information that can be linked to a particular person such as past, present, or future physical or mental health or condition; provision of health care to the individual; and past, present, or future payment for health care. Protected health information is subject to the privacy and security rules set under the Health Insurance Portability and Accountability Act of 1996 (HIPAA; Health Resources and Services Administration, n.d., p. 1).
* HIPAA Privacy Rule. A set of national standards for the protection of certain health information, with specific requirements for "covered entities," meaning those entities and organizations, is subject to the privacy rule. The privacy rule seeks to assure that individuals' health information is properly protected, while allowing appropriate access as needed to provide and promote high-quality health care and to protect the public's health and well-being (Health and Human Services, n.d., p. 2).
* Electronic medical record (EMR) and electronic health record (EHR). An EMR is a digital version of a paper chart, containing patient history from one practice, and is used mostly for diagnosis and treatment. An EMR allows data tracking over time, identification of patients who are due for preventive visits and screenings, and monitoring of patients, and may also lead to improvements in overall quality of care within a practice setting. Electronic health records go beyond the data collected in the provider's office and include a more comprehensive patient history. The EHR data can be accessed by authorized providers and staff across more than one health care organization. Electronic health records also allow a patient's health record to move with the individual, to other providers, specialists, hospitals, and nursing homes, even across state lines (HealthIT.gov, n.d., pp. 1-2).
As these basic definitions illustrate, there is much complexity and nuance within and among the various components of what is known broadly as health IT. To practice ethically and in accordance with the highest of professional standards (what we call practicing at the "top of one's license or certification"), board-certified case managers must know exactly what is meant by health IT in whatever context is being discussed-whether a particular platform or database or a policy on information access.
Health IT policies should address access to an individual's health information, the extent of that access, and for what reason. The rule of thumb for the case manager is "know what you need to know." An example is in workers' compensation, in which state law allows employers to have access to information related directly to the treatment of an employee who is injured on the job or becomes ill due to work-related causes. Thus, the employer would know the treatment being received, how long the individual is expected to be treated, and when the person is likely to return to work. However, if that person has other nonoccupational health issues (e.g., the person is being treated for substance abuse), the employer has no right to that information.
As we can see, health IT requires knowledge, understanding, and discernment on the part of all practitioners. Expectations for the board-certified case manager are included in the newly revised Code of Professional Conduct for Case Managers, adopted by the CCMC (2014) in 2014, which includes a section on "electronic media." As the Code states, "Board certified case managers will be knowledgeable about and comply with the legal requirements for privacy, confidentiality and security of the transmission and use of electronic health information" (Code, 2014, p. 8).
In summary, being knowledgeable about health IT requires more than simply knowing where to point and click on a laptop or tablet. It means understanding PHI, EMR/EHR, and the requirements of HIPAA. It is within the purview of every professional case manager to know what the implications of health IT are for the case manager, for members of the multidisciplinary team, and for the individual and his or her support system or family, for whom the case manager advocates.
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