Electronic Health Records: An Audit and Internal Control Guide

CHAPTER 3

Impact of E-Health on Case Management

It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.

—CHARLES DARWIN (1809–1882), ENGLISH NATURALIST

The market's response to managing patient care is critical if we are to survive our current healthcare crisis and provide cost-effective quality-driven healthcare. Adapting the discipline of case management to the e-health environment could have an evolutionary impact on healthcare. This chapter discusses traditional case management and introduces the need to subdivide it into two separate orders: financial case management (FCM) and clinical case management (CCM). In addition, the chapter discusses informatics and its integration into case management. An understanding of case management and informatics is important for auditors conducting reviews anywhere within the healthcare continuum.

What is case management? How is it currently applied? What needs to change? Case management describes the science behind the multidisciplinary approach to managing the health plan of a patient. CCM, the management of patient health from a clinical perspective, has been in existence in various formats within the healthcare community for some time. FCM, the management of patient health from a financial perspective, is a new and emerging component of patient healthcare management. The Association ...