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Incorporating Decisioning Software into Your Healthcare Case Management Process

May 28, 2020

When the phrase “case management” comes up in healthcare, the common assumption is that the case is patient-related. The reality of healthcare case management is that it can apply to many types of ‘cases’. Yes, patients may be managed through this process, but there are many other healthcare processes that benefit from workflow and task management.

Patient care is just one aspect of healthcare operations. Other processes, such as patient complaints, scheduling, and referrals, all need to be organized and managed. This requires a workflow that can account for various business rules, support collaboration, and facilitate effective management, even when individual cases take an unpredictable path.

If you’re interested in using decisioning software to support case management at your healthcare organization, here are some of the most important features you’ll want in this solution.

Easy Customization for Specialized Use Cases

A static case management tool has no place in healthcare. Given the variance in how case management might be applied to different processes within a healthcare company, those organizations need a case management solution that can accommodate a wide range of use cases—while enforcing the governance and business rules to handle highly specialized instances in which privacy and other compliance issues must be observed.

Case management must account for the context of certain data and processes, business logic and rules to direct workflows based on any outcome, and the ability to keep in line with the many regulations healthcare organizations face when dealing with patient data.

Flexible Case Management Models

Traditional case management solutions force organizations to adopt one of two approaches: either a case-style, event-guided process, or a process-based workflow wherein the management steps are fixed. But neither of these approaches fully serves the needs of healthcare case management, which is why decisioning software needs to integrate both when building workflows and evaluating next steps.

This allows an organization to build processes that account for predictable operations and sequential steps, while also accommodating alternate paths and exclusions—such as patient care or technical troubleshooting—that may require an unstructured series of steps driven by event triggers, business rules, and other ad hoc decisioning.

Every organization will require a different mix of case management models, depending on their unique circumstances. The mix of structured versus unstructured data is one important variable to consider, as is the overall case lifecycle and past case management history, if applicable. With a flexible case management model in place, none of these criteria will inhibit your ability to build an effective system for case management.

Collaboration Across Departments

Where healthcare and case management meet IT, there’s inevitable overlap in the departments and professionals involved in the case management process. Collaboration is crucial to the efficient management of these cases, as well as the design of workflows and protocols developed for specific use cases.

Depending on the specific instance for a case management process, these collaborators can include healthcare IT, HR, legal, and professionals on the patient care side. Collaborators need access to tools to manage unstructured data, such as documents and images, whenever the case management instance is relevant to their role in the organization.

Because collaborators will also provide input when implementing case management models, they need to have full access to this case data. Having this access makes them more integral members of the case management team, which enables smart, more effective case management, regardless of the use case.

Managing an Unpredictable Path

Large organizations and complex processes need structure. Decisioning software can support case management to address the challenges that come with disorganized processes that can’t be easily predicted. Traditional workflows and case management models can help in this regard, but they can’t provide the complete case management experience that today’s healthcare organizations need.

Patients are only a small part of case management. To support smarter, more efficient operations, you need to implement modern, flexible case management throughout your organization. Request a demo to see exactly how Decisions can benefit your company.

Beth Meyers
Beth is passionate about improving the value of healthcare through innovation, simplification and informed decision making. After too many years of studying decision making, she's happy to be empowering business users to see, understand and edit business logic with the DECISIONS no-code platform.

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