Avoiding Failure: How to Successfully Implement a Medical Management Software

Pat Stricker, RN, MEd, Senior Vice President
TCS Healthcare Technologies

Many case managers are now tracking how U.S. health care reform efforts are promoting information technology (IT) system integration to improve patient care, clinical outcomes, business efficiencies, and medical savings. In addition, it is no secret that procuring and successfully implementing such IT systems can be a formidable undertaking. Keeping up with expanding synergetic interfaces between technology and care management workflow processes is essential in order to offer effective medical management programs.

David E. Avison an internationally renowned professor, consultant, and researcher of Information Systems states, "In healthcare IT implementation, systems need to have well-defined standards for interoperability and terminologies and comply with legal requirements. Ideally these systems also improve workflow, reduce cost, and improve quality of care, all the while maintaining long-standing beneficial patterns of communication, collaboration, and healthcare delivery."

Not surprisingly, there is no shortage of literature focusing on health IT project disasters — some sources reporting as much as a 70 percent health IT failure rate. Case managers need to be aware of key health care trends, features and functions while taking into consideration the horror stories of failed IT projects and learning how to select and implement a new medical management software system.

Here are some key IT attributes to keep in mind when looking for a new medical management software system:

Interoperability. Does the medical management system interface with other critical systems? For example, data from electronic health care records including medical charts, claims, pharmacy data, lab data, health risk assessments, gaps in care, and other data should be able to be viewed from, linked to, or imported into your medical management system to optimize the flow of information. You should not have to train staff to use multiple systems to obtain data and then copy/paste the information back into your medical management system.
Automated Workflows Based on Business Rules. Does the medical management system promote dynamic, rules-based workflows resulting in automated tasks to eliminate users having to do them manually? Many examples of setting up automated work flows exist: establishing letter queues, creating follow-up interactions, using pre-defined templates that can be quickly modified to meet the patient’s needs, or creating tasks for a co-worker. Streamlining and automating tasks and workflows allows you to spend more time with patients, while at the same time improving efficiency, increasing productivity, and providing standardization and consistency in workflow processes.
Evidence-Based Decision Making. Does the system seamlessly integrate with industry standard, evidence-based medical necessity criteria to assist with authorization decisions? Does the system utilize standard assessments that automatically trigger suggested pre-defined, evidence-based care plans with identified problems, goals, interventions, and outcomes? Does it give the case manager the ability to select only specific portions of the suggested care plan that meet the individualized needs of each patient, rather than provide a "cookie cutter" care plan that can’t be modified? This is essential!
Enhanced Communication Links. Does the system allow you to communicate with patients, providers and other collaborators (and document those communications) using encrypted emails, texting, or member portals? Is it capable of even more emerging technologies like social networking? Can the system be used remotely on laptops and tablets? How about from a smartphone? Years ago communication occurred face-to-face, by phone (land-line), or by letter (snail-mail). Email was "taboo" and no one even thought of texting. Now these are commonplace. Just think of what the next 10 years will bring.

Identify your organization’s technology needs. You need to identify existing and needed workflow processes and system capabilities, as well as desired processes and capabilities. Gap analysis is a useful way to compare your organization’s current situation with its future goals using a new software. List factors that define the current state, outline the factors required to reach the target state, and then determine what requirements a new medical management system would need to fill those gaps.
Involve key stakeholders. It is important to assemble a group of people from all areas of the organization to evaluate and choose the technology. The team should not only include individuals from all functional areas who will be utilizing the system, but also team members from the IT department, a claims representative, a product marketing representative who understands the service agreement with customers, and also individuals who understand the quality and legal/security aspects of the decision to ensure compliance with industry and government regulations.
Take an IT system test drive. Narrow down the list of potential systems by issuing a Request for Information (RFI) that allows you to gather more information about the products. A checklist type questionnaire listing your key requirements is the best format, rather than asking open-ended questions that are hard to interpret and compare. Schedule vendor demonstrations for those that seem to meet your key requirements.

Vendors demonstrate their product to highlight the strengths, but they may also be masking the deficiencies. To counteract that, send the vendor exact workflows that you want to see, rather than allow them to merely show the system highlights. If these workflows are provided to them a week or so in advance, they should be able to configure the system to show your workflows during the demonstration. And don’t accept the answer, "Yes, we can do that." Make them show you how they would add or change something to meet your requirements.

Prepare a checklist for all participants in the demonstration that lists the key features you are looking for. Ask them to note, during the demonstration, whether the features were adequately validated. Also ask them to add comments about the products, the company, and their perception of how the vendor would handle the implementation and project management. Collect the checklists and comments immediately after the demonstration. If they aren’t collected right away, the information will be forgotten or they will mix up the vendors and their products.
Promote a smooth implementation. Once you have selected the medical management system that will best suit your organization, and negotiated the cost and contract terms, the implementation phase will begin. From a technical perspective, the implementation will include system set-up, data imports and exports, and establishing workflows. Make sure you have thoroughly vetted each vendor during the selection process regarding their project management plan, the technical and clinical skills of their implementation team, and their implementation success rate. How many clients have they implemented? How many were implemented on schedule? If not on schedule, what were the reasons for the delay? How do they handle issues or delays? And most importantly, have they ever had a failed implementation? You’d be surprised how many vendors have had failures. Once implementation begins be sure to continuously monitor for problems and address issues as they arise, so you do not become a victim of a seriously delayed or failed implementation.
Create a learning environment. After the user acceptance testing has been completed, user training is a must. The clinical sponsor will need to work with the project managers to identify adequate training space, work with the vendor in the development of training materials, and manage trainees’ daily workflow and proficiency to ensure success. An article from the Joint Commission notes, "Learning to use new technologies takes time and attention, sometimes placing strain on demanding schedules ... Develop and communicate policies delineating staff authorized and responsible for technology implementation, use, oversight, and safety review."