Care Management and Documentation Tools

A professional in any field needs the best tools of the trade. Along with new diagnostic technologies and pharmaceuticals, care management and documentation tools are required to plan, organize, monitor, and evaluate care. Under the umbrella term, Structured Care Methodologies, come a variety of tools. CCM helps organizations determine the type of Structured Care Methodology most needed, as well as develop the format, content, and policies.

Definition: DataMap® is a multivariate data display of executive-level data adapted from the methodologies of Value Compass, Data Dashboard, and other Balanced Scorecards. A full description may be found in CCM's New Definition newsletter, Volume 16, Number 1 (Spring 2001).

The Problem:

• The executive team has major decisions to make, but is only looking at isolated parameters or indicators.
• The executive team wants to have a, comprehensive, "whole brain" understanding of operations related data.
• The organization wants to identify the types and sources of data that are critical to its self-evaluation.
• The organization requires a customized DataMap® that reflects its unique concerns and mission.
• The organization needs a roll-out and/or roll-up of its data.
• The board wants more clarity of the position of the organization.

The Process

• Development of a simple data dictionary to custom-develop the DataMap®.
• Assimilation and documentation of the available data.
• Identification of data needs.
• Development and execution of new data sources (such as surveys).
• Research of benchmarks.
• Interpretation of individual data points, and the synthesis of the data points as one organization.
• Training of the executive team and others to use DataMap®.

Deliverables (Negotiable):

• Same as above.
• Team lead by CCM Principal or Senior Consultant.

Client example:

• CCM produced a DataMap® for an academic medical center that reflected its recent data related to four areas of concern to nursing, physicians, finance and case management. The document clearly showed the medical center's strengths, including being at national benchmark levels for several indicators. The DataMap® also clearly pointed to a few areas of potential vulnerability, for which CCM led a discussion and provided recommendations.
• The Family Advocacy Program (FAP) of a large US Naval Base engaged CCM to train its case managers. As a comprehensive overview, CCM developed a draft of a DataMap® to describe potential goals for a successful case management program for Domestic Violence. The FAP leadership team planned to use the DataMap® for continuous quality improvement initiatives.

Definition: Clinical Documentation is the use of various types of structured care methodologies in the medical record. CCM was the originator of critical paths, CareMap ® tools, CareCalendar, and other structured methods for care planning, delivery, and evaluation. Clinical documentation can be developed or revised for acute, home care, SNF, community agencies, disease management programs, social service programs, etc.

The Problem (one or more may apply):

• The clinical paths have been too labor-intensive and a decision needs to be made about what to do with them.
• The clinical paths have had merit, but need an evaluation as to next steps for them.
• We have purchased a Clinical Information System and want to use the clinical paths on software.
• There is a need to update and upgrade clinical documentation before the next JCAHO or other agency's visit.
• We are opening a new clinical program with some type of structured care methodology.
• Variance data is not documented or used well.

The Process:

• Review of current documentation strengths and weaknesses as compared to new standards, expectations, and practices.
• Design of revised clinical documentation tools, using algorithms, critical indicators from evidence-based practice, etc.
• Development of policies and procedures.

Deliverables (negotiable):

• Brief written report of current strengths and weaknesses.
• Facilitation of decision and development sessions, augmented by samples from successful organizations.
• Set of Critical Indicators from Evidence-based Practices for 20 acute care casetypes (by M. Parmer, MD).
• Final drafts of custom-designed tools.
• Training for implementation.
• Evaluation.

Client example:

• CCM developed case management tools with a city-wide program to end homelessness in the elderly by outlining the process used to help eligible elderly people get off the streets and into independent housing within 18 months. After several meetings, multiple agencies were able to agree not only on the process that works best for them, but also on the way to conceptualize the process, document it by a wide variety of case workers, and orient new staff and clients to the process.

The Problem:

• As each new regulation and requirement has been imposed on the organization, a new form has been developed. Now there are too many forms with similar and overlapping data needs, and no sign of relief.
• The organization is several years away from purchasing the clinical component of an information system.
• Documentation is taking over 20% of valuable nursing time, not to mention the time of other professionals.

The Process:

• Review of current documentation strengths and weaknesses as compared to new standards, expectations, and practices.
• Identify core principles of the new documentation system.
• Design of revised clinical documentation tools, using algorithms, critical indicators from evidence-based practice, etc.
• Development of policies and procedures.

Deliverables (negotiable):

• Brief written report of current strengths and weaknesses.
• Facilitation of decision and development sessions, augmented by samples from successful organizations.
• Set of Critical Indicators from Evidence-based Practices for 20 High-volume, acute care casetypes (by M. Parmer, MD).
• Final drafts of custom-designed tools.
• Training for implementation.
• Evaluation.

Client examples:

• A large Managed Care Organization on the West Coast conducted a 20-hospital project of identifying a new superstructure for clinical documentation that would incorporate measurable outcomes and critical process indicators. CCM provided an onsite information session as well as consulting support through the process.
• A large academic medical center in the Midwest wanted to reduce its paper documentation load without losing valuable information. Following several months of internal discussion, CCM was engaged to directly observe current documentation practices, provide information to the various committees involved, set core principles, and develop a strategic plan. Physicians and 200 other key stakeholders approved the changes made over several days. As a result, daily nursing system assessments and case-type specific, outcome-driven collaborative CareMaps® were developed for adult, pediatric, and generic populations. CCM supported the project leader with training and other revisions. The medical center now has 100% patients managed through this method, and achieved a reduction of nursing documentation time from 15% to 9%. Other important goals were met as well.