By Mike Allen
For risk managers who feel trapped with a clunky mainframe or client-server platform, help has arrived. Internet powered software platforms are bringing powerful new tools to the treatment and prevention of workplace injuries. Most visible are mobile health applications which deliver high-value information to clinicians when, where and how they want it. Equally important are cloud-based replacement systems for core claims, policy issue, case management, RMIS and analytics processes.
Medical applications running on tablets and smartphones are truly a new phenomenon and are enriching care-related communication with instructional videos, anatomical photos, high-resolution diagnostic images and timely medical information all delivered at the point-of-care. There are currently over 20,000 medical apps; here are six representative examples of how they are being used to improve treatment:
Evidence-based guidelines at the point of care:
Mobile health starts with the injured workers' visit to the physician. Using a smartphone application, the doctor accesses evidence based guidelines at the point-of-care and then prescribes appropriate treatment. This improves the probability of a good outcome and reduces the likelihood of expensive utilization review.
communication: For a serious injury, the physician pulls up detailed anatomical diagrams on a tablet and uses them to explain the injury and treatment options. Also, patient engagement systems offer professionally developed, tablet-delivered descriptions of common procedures which often provide a better explanation than the physician while saving time.
Improved compliance with treatment programs: A physical therapist demonstrates stretching exercises in the office and then provides the patient with tablet-based instructional videos for home use. Similarly, smartphone apps track compliance with prescription drug regimens and in some cases communicates with the physician's "patient engagement system." Lack of patient response can trigger an escalation or perhaps a call or visit from a case manager.
Accelerated return-to-work: At the time of treatment, the physician uses his or her smartphone to access estimated disability durations factoring in age, occupation and co-morbidities. Scientifically established return-to-work expectations are discussed and agreed to with the patient and the treatment team.
Improved modified duty design:
As the injured worker heals, management re-designs their job to accommodate modified duty and then uses a phone to film the modifications and share them via tablet with the supervisor, physician and physical therapist to validate the modified duties. Then, a field case manager uses a tablet in the workers' home to explain the proposed job design and develop a back-to-work plan.
Prevent future injuries: Back at the job site, the plant's safety rep uses a smartphone to photograph the accident scene. This enhances the written report and helps the home office safety team visualize the problem and develop changes to the workplace.
In addition to the improved communication and information access provided by mobile health apps, the internet is also spawning a generation of cloud-based enterprise platforms which manage policy issues, claims, medical management, health and safety, RMIS and analytics. Generally marketed as SaaS (Software as a Service), these subscription systems are designed so that the cloud vendor maintains the software, databases and infrastructure and the customer accesses the application through their internet browser. Cloud applications are gaining credibility as leading companies like General Electric and Hewlett Packard are replacing client-server based human resource platforms with SaaS options like Workday and WageWorks.
The risk of storing sensitive information "outside the company" is frequently cited as a reason not to implement these new solutions. However, as Fortune 500 firms have embraced the cloud, vendors are employing increasingly sophisticated disaster recovery and performance management tools that are often more advanced than those used by the IT departments at most TPAs, managed care organizations and mid-sized companies. These improved data-center tools combined with lower costs, and superior functionality are combining to tip the risk/reward ratio in favor of the new applications in many situations.
Cloud-based systems are 48 percent less expensive than comparable server solutions according to research by IDC Technologies. That's because mainframe and server-based systems require costly, dedicated servers, a workstation and software for each worker, switches and routers and expensive software upgrades. Cloud solutions keep hardware costs low by renting racks of servers in giant colocation facilities and spreading these costs over many clients. Since the computing power and data are accessed through the internet, no software is required on workstations, just an internet browser. Upgrades are made centrally for all customers so no one falls behind on the upgrade cycle. Cloud vendors also keep costs down by developing standardized applications which can be configured by client staff rather than the vendor's engineers. This can be a real advantage to risk managers whose important projects are caught in a lengthy queue in the IT department of their third-party administrator or their own company.
Of course, not all cloud-based systems are equal; some merely transpose server solutions to the new medium and require expensive customization. The best solutions are designed for the cloud from the bottom-up. They can be quickly implemented, configured largely by the client, have professionally developed user interfaces which minimize training, include well-thought out reporting packages and are meant to be used by a broad group of clients. The best evidence of good cloud design is the flexibility of the administration panels which should enable non-technical people to configure the system for state, customer and other requirements.
Potential vendors should be willing to share a road map of future developments that can be checked against your requirements. Don't be afraid to dig deep -- when you check references, confirm that the road map was not put together just for you and determine whether previously committed projects were delivered on time. In addition to the road map, give strong consideration to the ability of the organization's management to deliver growth. Subscription-based cloud companies depend upon a broad base of clients using well-designed, low maintenance platforms to keep costs down and create the profits needed to invest in timely enhancements.
Organizations that want to move beyond the limitations of a server-based system should consider moving forward in phases. First, assess current platforms which you, your TPA and other partners use for claims, policy issue, RMIS, health and safety, wellness, predictive analytics and determine where a cloud option will get the most bang for their buck. For mobile apps, identify situations where the new tool will provide a clear benefit or make a better workflow possible. With the enterprise solutions, a good place to start is with either a RMIS or a cloud-based analytics system. The work you do to determine the data needed for these systems will help provide specifications for upgrading production systems. Work with your customers, operations team, actuaries and other consumers of information to determine necessary information outputs.
Technology is driving a transformative shift in healthcare and business operations which is creating new tools and new ways of managing risk. Organizations that delay in adapting to the new world and remain stuck in the client server world run a far greater risk than those who embrace the new world of mobile health and cloud computing.
Mike Allen is principal of Allen Management Consulting, after
heading up business development for DataCare, a cloud-based provider of case management, utilization review and other workers' compensation solutions
and spending nine years as a senior
vice president at Guarantee Life Companies.
Read his blog Tech Talk for Workers' Comp.
January 30, 2013
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