A Scenario

Imagine a small agency dealing with employment skills training for people on welfare.

The first process a CM application must perform is a collection of the client’s demographic information (Ben Smith), eligibility and level or type of service required. The system must be able to store the demographics, enable an eligibility assessment and determine the appropriate program Ben is suitable for based on an analysis of his demographics, education, work history and eligibility assessment. As you can see, this is already a far more complex procedure than simply recording a name and address.

Next the agency may want to store documentation relevant to Ben’s file: Ben’s resume, his physician’s assessment of his back injury, an employment insurance eligibility form, etc. This may all happen at the process of intake and can be processed manually through scanning documents or receiving them electronically via email or more directly through data transfer from another organization.

The next step may be to assign Ben to a case worker who will act as the case manager/counselor. The CM application must be able to maintain privacy on all the notations and information presented to the case manager in confidence while at the same time be able to report on the activities in either an anonymous aggregated form or personalized form.

The case worker may want to schedule Ben into one or more sessions/groups/activities, counsel or perform assessments. The case worker may also want to add additional workers to Ben’s file.

The CM application will need to record Ben’s participation and produce financial information for billing purposes. The system needs to be compliant to all Privacy legislation including HIPAA.

The CM application will need to produce outcomes reports on Ben’s success in the agency and account for resources Ben has used.

This one scenario accounts for a single client moving through a program in a single agency and provides a fairly complex set of data security and management issues for a CM application to overcome. If we extend this set of issues to a multi-program agency where Ben is moving between case managers in different programs, you have added the complexity of multiple cases for Ben and multiple parties and multiple relationship’s. This also needs to be straightforwardly accounted for in the case management application.

The next scenario should give you an idea of the extent of a useful case management application as it can be applied within a community context outside of a single organization. things to think about in this scenario is the standards of terminology that must be applied to share the data, the privacy protocols that need to be in place, the ability of different systems to talk to each other and the clinical context within which the scenario takes place for future reference in social policy research.

A CM application should facilitate all the following information flow, produce the assessments, referrals and case transfers, care planning, activities tracking and reporting:

A department of human services social worker working with Ben, who is suffering from rapid disc degeneration due to work-place injuries and is also involved in a child custody case, refers Ben to a vocational rehabilitation program.

The vocational rehabilitation program has access to Ben’s general demographics and contact information and relevant notes, resumes and skills certificates, but no access to the social worker’s case concerning Ben’s child custody case. They put him on a waiting list.

After taking him off the waiting list, the vocational rehabilitation program produces relevant skills and health assessments on Ben and provides access to those assessments (with Ben’s consent) to a benefits company or relevant government program for retraining/rehabilitation financing.

The benefits company produces a financial eligibility report and attaches it to Ben’s retraining case and notifies the department of human services social worker who can access the report.

The social worker draws monthly reports on the success of the assessments and Ben’s activities within his program involvements. The vocational rehabilitation program transfers Ben’s case to an employment assistance program that assigns a training counselor who then uses Ben’s assessments for job search skills training and produces a training plan. The employment assistance program refers Ben to a back pain clinic for mobility assessments and rehabilitation care planning. The care-plan can be accessed by the employment assistance counselor and the department of human services social worker.

The back clinic works weekly with Ben recording his progress. This information is available to the social worker and employment assistance counselor.

In Ben’s child custody case, he was referred by the social worker to an alcohol and drug counselor for assessment.

The alcohol and drug counselor has access to Ben’s demographics and health assessments produced by the vocational rehabilitation program and the back clinic, but not to his vocational assessments or activities within the employment assistance program.

Only the social worker has access to Ben’s planned and ad hoc activities with the alcohol and drug counselor, but no direct access to the assessment. The alcohol and drug counselor produces an assessment report for the social worker’s child custody case only.

All relevant government funders can then draw reports relevant to Ben in these cases as necessary and governed by legislation and privacy ethics. They will recognize\ that Ben is accessing services across traditional services boundaries and therefore have the ability to quantify general services delivery against Ben as an individual. They may also access aggregated reports from the various services delivery agencies detailing services delivered, number of discreet individuals, outputs and outcomes; and quantify services costs against particular demographic groups, diagnostic case mixed groups, and geographic areas. They can evaluate and review services costs and performance measures between delivery agencies and monitor waiting list times, service bottlenecks, and so forth.

Case management applications should give agencies the ability to perform as above. And while they are the next wave of sophisticated technologies which will assist organizations manage their client base, the underlying social model of health has yet to be defined which will enable such wide spread sharing of relevant information.