The digital revolution

By Jeanine Tome

We are embarking on a digital revolution of healthcare. The massive effort to transform healthcare began with the significant action taken on February 17, 2009 with the signing of the American Recovery and Reinvestment Act. Contained within the bill is the health care information technology component (HITECH). This legislation adds significant financial incentives for physicians and hospitals to join the digital revolution by adopting electronic health records (EHR).

“Preventing unnecessary readmissions to acute care will also be tracked. MedPAC in 2008 showed that the Medicare acute care 30 readmission rate was 18 percent”
-Jeanine Tome

By appropriating a net of $19.5 billion to modernize health care, the commitment has been made to support the adoption and meaningful use of electronic health records (EHR). HITECH offers incentive payments to hospitals and physicians to efficiently utilize an EHR. Physicians have already begun electronic medication prescribing, and further incentives from Medicare and Medicaid are in the bill to adopt and demonstrate meaningful use of the complete electronic health record.

The most important impact of HITECH on case management practice is in the draft recommendations put forth by the Meaningful Use workgroup of the Health IT Policy Committee. It is anticipated these recommendations will be finalized by CMS at the end of 2009. In the recommendations targeted for 2011, there are specific objectives to improve care coordination. This would be evidenced by the exchange of key clinical information among providers, and with the performance of medication reconciliation at relevant encounters.

Additional outcome measures included in the recommendations are reports of 30 day readmissions rates, demonstration of the ability to exchange health information with external clinical entities and measuring the percent of transitions of care where a summary care record is shared. Leadership needs to understand the important impact HITECH will have on case management practice in their organization. The case management process encompasses communication and facilitates care along a continuum through effective resource coordination (ACMA, 2002). Many decisions are made for safe home discharge, physician follow-up, post acute care and outpatient services. Care is planned, insurance coverage verified and options discussed with patients while managing length of stay.

How this planning and communication occurs will be changing and add to the organization's ability to demonstrate meaningful use. By using the expanded capabilities of accessing information in an EHR, sharing information electronically between clinical entities will become much more commonplace. Interoperability will allow more options for the exchange of information between settings without error. As this data is interpreted, a more clear and complete picture of the patient and family needs will emerge. Better decisions about the use of resources should be enabled in the coordination of care across settings with improvement in hand-off communication.

Preventing unnecessary readmissions to acute care will also be tracked. Med PAC in 2008 that the Medicare acute care 30 readmission rates was 18 percent. Attention was focused on the determination that 13 percent of these readmissions were preventable. Organizations have already begun to set targets to reduce the 30 day readmission rate. The inpatient case manager's role CHCHc

will begin to stretch beyond the walls of the hospital supported by technology to accomplish these targets. The result is anticipated to improve quality of care, further insure patient safety and reduce costs during all transitions of care.

In outlining the Seven Top Trends for Case Management Practice, Stanton (2008) reported that integrating informatics into practice was one of the top seven trends. Automation for current case management practice is a good starting point for helping case managers to see technology in their everyday workflow. Case managers will be continually learning how to apply newly integrated technology to transform case management practice as EHR adoption moves forward. Let the digital revolution meaningful use begin.

Jeanine Tome is Chief Clinical Officer for Allscripts Care Management with a focus on bringing technology innovation to the care management practices. Tome has 33 years experience with inpatient clinical operations leadership in care management, nursing administration, quality improvement and patient safety. She is a founding board member and past president of the American Case Management Association.