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									2010 USABILITY REPORT




Wednesday, July 04, 2012
Change Control


                                       Related Documents

   Description                      Function                  Location


                                     Healthcare Plan (A)

Field Study Plan       Field Study Plan


Debrief                Recapping usability observations


Healthcare Plan (A)
Notes from study
                       Collective notes




                                     Healthcare Plan (B)

 Healthcare Plan
                       Field Study Plan
(B) Field Study Plan


 Healthcare Plan
(B) Notes from         Collective notes
study


 Healthcare Plan
                       Results of the survey from users
(B) Demographics


Healthcare Plan (B)
                       Results of interviews
Interviews


Quotes from            Collection of quotes in my usability
Customers              travels to customer sites


IT Problems
Reported from an       Outside firm observations
outside firm


Outside firm log       We went over this spreadsheet in
description            our meeting with Healthcare Plan
                       (B) and outside firm IT problem
                      logs


Healthcare Plan (B)
                      3 hour collaboration with user on
Workgroup Session
                      three exercises
Results


Number of Case
                      Spreadsheet with the total number
Manager Users
                      of users by line of business
using CA



                                      Healthcare Plan (C)

2009-2010 Call
                      Call handle times in seconds
Handle Time


                      This document is an inventory of
Master Quantifier
                      all Lean UM Quantifiers.


Training Notes for    Notes taken while observing the
CM & UM               CM & UM folks for the week.


UM Testing with       Testing results with Healthcare
Healthcare Plan (C)   Plan (C) done for UM 4.7 design




                                          Change Record

     Date                    Author              Version    Reference
5/25/2010          Kimberly Lovely             1.0


6/04/2010          Kimberly Lovely             2.0




                                            Contributors

             Name                                  Name                          Name


Kimberly Lovely                      Colleague 1                   Colleague 2




                         Deliverable Review/Sign-Off Requirements

            Role                         Reviewer                Signed Approval        Date


N/A                           N/A                          N/A
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  TABLE OF CONTENTS
  Clients Studied: Healthcare Plan A, B and C .............................................................................................................6

  the Field Study story ...................................................................................................................................................6

  1. Understanding the users ........................................................................................................................................9

  2. Demograpic questionnaire results ....................................................................................................................... 10

  5. Identifying usability issues & inefficientcies (findings) ......................................................................................... 29

  6. results from the interviews of supervisors & Cms Healthcare Plan ..................................................................... 34

  Closing Remarks ..................................................................................................................................................... 50

          Friday Workgroup session - notes .................................................................................................................. 50

          Value Captures – Reported IT problems ........................................................................................................ 63
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   2010 Usability Report
  CLIENTS STUDIED: HEALTHCARE PLAN A, B AND C

  Details of the usability report.

  Healthcare Plan A – March 29th – March 30th, Resumed on May 21st, May 27th and June 15th, Kimberly Lovely,
  Colleagues A, B & C

  Healthcare Plan C – March 22nd – March 26th, Training, Colleague A observing UM training and Kimberly Lovely
  Observing UM and CM training.

  Healthcare Plan B– April 26th – 30th, Colleagues A, B and Kimberly Lovely

  THE FIELD STUDY STORY

  Healthcare Plan (C)

  The Healthcare Plan (C) one week training I observed was a mixture of UM and CM supervisory roles.
  CM users were not extreme power users like UM folks. They really aren’t measured but soon will be
  they stated. They mouse clicked and took their time. Whereas the UM users were power users tabbing
  forward, backward, using the mouse right click, and the arrow keys to navigate from field to field. UM
  users are highly measured.

  “It’s like going from a Yugo to a Beemer.” - CM student

  “The product is over engineered in places.” – UM Student

  “There are a lot of moving parts.” – UM Student

  “To many places to look for the same thing.” – CM Student


  Healthcare Plan A
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  60 Total Number of CM Users of Product at Healthcare Plan (A) Medicaid

  The Healthcare Plan (A) site visit was with users in supervisory roles and care managers. First two
  users work in Content Editor and the third works in the product 50 percent of the time. The forth user
  works in the product and is a true end user. 8 Care Managers and two supervisors were observed.

  “We tell everyone that they are forbidden to use the back button in the product.” –CM & Content
  Manager

  “There are a lot of thing we don’t use or is completely useless to me. We may not be using the product
  like it was intended.” – CM Pediatrics

  “It’s floats! It scales!” (She didn’t know the Member Overview icon floated)– CM

  “It’s so easy to do something wrong in the product.” – CM


  Healthcare Plan (B)
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                                                                           Out of these 366 users only
                                                                              21 of them are men.




  366 Total Number of CM Users of Product at Healthcare Plan (B)

  Healthcare Plan (B) was breath taking. A fortress up on the hill along the banks of the mighty TN river.
  Will these CM users be like the users observed thus far I wondered? It will be interesting to see the
  three lines of business Commercial, Medicaid and Medicare all under one roof and in one state. I have
  already met my users prior to landing. I received many demographics surveys and questionnaires back
  from them.

  Our team started the week off with first Commercial, Tuesday Medicaid then Thursday a two person
  interview with Medicare. Medicare opted out of the observation part of the study last minute. In the
  morning Care Manger Supervisors came down from each line of business. The forum was round table
  discussions and a Q&A session. Next we split for observation of the end users. Thursday we met with
  an outside firm to go over their findings which were minimal and mostly resolved upon an upgrade to
  4.7. The most exciting day was of course the Workgroup session. This is where we discovered we had
  an innovative bunch of folks. We witnessed the birth of AWESOME 2.0.



  Details of the work group session

  We invited the users we studied to this session to gain the following:



  1. To learn how they would ideally like to assign members.

  2. To understand how they would ideally like to design a Care Plan.

  3. To collectively understand what they would like to see on their personal Dashboard (Homepage).
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  Our team was armed with cards for them to work with. However they did the opposite. They took
  matters into their own hands. I guess by telling them that they have to create it from scratch ignited the
  flow of innovative thinking. They were told that nothing existed out there. There was no existing product
  in their world. It was up to them to create their “Blue Sky.”

  What we learn was they like to spend Healthcare (B’s) money for touch screens and voice recognition
  technology.

  Care Managers are like no other user I have ever observed before. They carry a heavy heart and it’s
  personal to them. They take on the member’s stress. They comfort families whom lost a love one. They
  are resourceful and make sure members are educated. They do not work 9-5 but 24/7. On the
  weekends they drop off toys for the children of the dying parent. These Care Mangers care for you and
  your family.

  I think the reason why many or all of us are at the Healthcare IT company is to make a difference in the
  health care industry. This is a commonality we share with our Care Managers of our product.



  1. UNDERSTANDING THE USERS

  With that said I would like you to meet Patricia. Patricia out of all the users of our product struck me the
  most. Her confidence and style on how she works with her members caught my attention. Patricia is
  very computer savvy but set in her ways.

  Patricia starts her day off by launching Outlook to check on her mail. She launches Word, Excel and
  two products owned by the Healthcare IT company. She has been using CCA for 1 ½ years now. Her
  role is dual, she does the UM case for members seeking bariatrics surgery, which is a process, they
  must meet several goals before the surgery is approved. Once they have the procedure, she follows
  them in a Care Management case long term to help ensure success of the procedure. She may have 2
  years’ worth of data per member.

  50 percent of her day is going on the hunt for the member’s phone number. She has her methods to
  hunt it down which varies from each user. But her main goal is to care for her member’s. She first tries
  product (F). No luck. So she launches a template for a form for missing phone number. She has to
  reach this member within 7 days according to the business process. Knowing that in 24 hours this
  maybe resolve is comforting to her. Reaching that member however is delayed one more day.

  When she is creating a Care Plan it’s all in word. She copies from word to product CCA. She is more
  comfortable and productive in doing so she states. She is like many that I have observed in Care
  Management. Many feel they are doing the same task over and over for 30 minutes when a simple task
  should take less than 5 minutes. An example given was of something that is so simple but takes them
  time of having drop downs for a selection in alphabetical order. Condition list and medication list you
  can’t sort alphabetically. Another example was the ability to select multiple milestones at a time to
  import into a Care Plan.

  In conclusion in observing Pat and the others we are seeing a pattern that is worth noting. The system
  is creating a behavior in the users. The behavior is one of trust. Many have lost important information
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  and time entering in notes on a member when the system would quit on them (C). So they rely on a self
  generated paper base system or they record in notepad and or word. They enter in the information
  ONLY after they have captured the information needed of a member in these aids. This is duplicating
  the workload for the users and doubling the amount of time doing the tasks.

  The users want to be as efficient as possible and feel the product wastes a lot of their time when not
  necessary. Time they would rather spend with more members.

  Users expect technology to be integrated into the product to enhance their workflow. Our users are
  savvy and would love to use right click menus, drag and drop capabilities, tear off tabs to enable them
  to work on more than one member at a time.



  “My job should be to work for the member not the documentation.” – Healthcare Plan (A), Care Manger



  2. DEMOGRAPIC QUESTIONNAI RE RESULTS

  33 questionnaires have come back so far from our users whom are all female except for one. They
  will continue to trickle in. These results are from Healthcare Plan (B). A consolidation of those results
  can be seen below.

  Education — level of schooling our users have completed. (33 respondents)

  Users were asked: What level of schooling have you completed?




  Education Level of Healthcare Plan (B)
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  Training on Product CCA

  Users were asked: When were you trained on the product, what version of the product and for how long
  was the training?

  What we learned from this question was that training varied. Healthcare Plan (A) and Healthcare Plan
  (B) users felt that they could use more training. The range of training was from 2.5 days to 2 weeks.
  Some training reported consists of PowerPoint Presentations or webinars for 1 – 3 hours. Mentoring
  also took place learning from others on their team the product. Cheat sheets where also created by
  Care Manager Supervisors to expedite efficiency in workflows and aid the users starting out in the
  product after training.

  Job role length of time

  Users were asked: How long have you been in this role?

  The majority are seasoned in their current job role.




  Length of Time in Job Role (Healthcare Plan (B)



  Total years of experience our users have in the healthcare industry.

  Users were asked: How many total years of experience do you have in the healthcare industry?

  What we discovered was the majority of the users had ten plus years in the healthcare industry. So
  they are educated and very experience in their field.
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  Experience in the Healthcare Industry at Healthcare Plan (B)



  User Self Rating in CCA product.




  User Self Rating in CCA at Healthcare (B)

  Users were asked: How would you rate yourself as a user of the CCA Product? Novice, Average or an
  Expert?

  As we have discovered in previous questions these users have been using the product for a long period
  of time. Many factors come into play as to why they only feel that they are average users of the product.
  Lack of lengthy training as noted may be a key component. As observations were made of users in the
  product they seem sluggish in comparison to other products such as word or note pad. Certain tasks in
  the product were interrupted by resorting to tangible aids for task completion.
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  Tools & Technology used in our user’s work.

  Users were asked: What tools and technology do you use in your work? (Please include any software
  tools, as well as phone, PDA, paper forms, equipment, number of monitors etc.)

            Software/Technology              Paper Based Tools                    Equipment


   CCA                                  CM Checklist                   (1- 2) 19” Monitors


   Products (F) & (Q)                   Paper Forms                    Phone/Headset/Blackberry


   Triage Log                           Note Pads                      Computer/Laptop


   SharePoint (Triage)                  Paper Forms                    Calendar


   Outlook                              Folders                        Keyboard/Mouse


   Word                                 Facets Face Sheet              Modem/Comcast w/Nortel Box


   Excel                                Drug Handbook                  Printer

   Note Pad                             Cover TN Handbooks             Scanner


   Juniper                              Transplant Forms               Desk/Chair


   Thin Client                          SharePoint Member Info         Fax


   Right Fax                            Paper Aids                     Coping machine


   CareGuide                            Policies & Procedures          Calculator


   Amysis look-back                                                    Rolodex


   CITRIX


   MEDAI Database
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   HCS Provider Viewer


   PeopleSoft Finance


   Care Guide


   Live Meeting


   BC Member Appeals Automation


   Carekey Bridge


   PowerPoint


   Language Line


   FEP Direct


   Report Manager


   Next Gen CM


   Genesys


   CM Referral Database


   XenDesktop


   SnagIT


   Personal Templates


   Internet/ Browser IE

      1. MrDocMan.com
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      2. Yellowbook.com

      3. Government Sites

      4. Access TN

      5. CoverKids.com

      6. EncoderPro.com

      7. CareGuide

      8. Google

      9. Intranet

      10. Healthwise

      11. Smart Neighbor

   DCS Websites


   Intranet / Sites, Crossroads,


   Windows

   IH250, IH728 Main Frame


  It was interesting to see that each Care Manager had a tangible folder on each member they cared for.
  This folder contains the product (F) Face Sheet, written notes, printouts etc. Many users went outside
  CA to sites that aided task completion. Medicaid users spend 50 percent of their time hunting down
  phone numbers. In doing so they went to yellowbook.com and some Googled the names. Other sites
  users went out to a lot were Encoder.com as a direct result of CCA not having a usable search for
  drugs and MrDocMan.com. Tools such as the calculator were used to do cost savings tasks. A widget
  would come in handy that they could use in this type of task.

  Monitor Resolution and size.

         Users were asked: What size are your monitor(s)? What monitor resolution are you viewing
         CCA?

  The size of the resolution varied based on the setup in home offices and in the office. The physical size
  range of the monitors was 11” to 24” in size. Some users work just off their laptops. The recommended
  monitor resolution based off the user guide is 1024x768. What we found also is that even at the
  recommended size of 1024x768 the users were still scrolling horizontally which is causing strain on the
  wrist. This is an important point to make as WellPoint has a strict accessibility policy for workmen’s
  comp. Unfortunately not all users adhere 1024 also. Having the resolution at 1280 causes a void and
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  waste of space. Majority of the users were viewing CCA in 1024 and 1280. There were some at 1154
  and 1440. The screen layout should be liquid both horizontally and vertically.




   VOID – As a result of having the resolution at 1280 there is an empty area created. Liquefying the layout
   would serve beneficial.


  1280 x 1024 Monitor Resolution
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  1024 x 768 Monitor Resolution – Even at the recommended size the tabs below are cut off and a
  scroll bar is added to the right. This also may explain why users are not using the tabs at the below.
  Keeping everything above the fold will reduce the scrolling. For many users they don’t have the top
  browser bar but have to scroll horizontally also which is straining them. Users are having problems with
  their wrist will all the scrolling.
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  1152 x 864 Monitor Resolution – Users have adjusted to this resolution perhaps because the layout
  shows the tabs below and eliminate the scroll bar to the right.

  Loading all the tools also in the browser menu bar takes up time and adds to the visual clutter. The
  recommendation is for no browser bar at the top. Use open window method only. There is no value to
  the user having this at the top. In fact the browser back button is being hit. This causes error messages.
  Some users also are using right click back which also causes the same issue.

  Right Click Contextual Menus & Tabbing

         Users were asked: Do you right click with the mouse in applications? Example would be for
         menu items in Microsoft Word. They were also asked if they tab into fields with the keyboard.

  The goal of this question was to see if contextual menus for the right click function would be intuitive to
  users of CCA. We discovered that most of the users surveyed use right click contextual menus for
  functions such as cut and paste except for 5 out of the 78 surveyed. They also added they can’t do that
  in CCA and would love to see that functionality integrated.

  For the tabbing field to field only 8 out of the 78 surveyed said they don’t. So what this is telling us is
  that the tabbing in the product has to work and work logically to support this behavior in the user’s
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  workflow. It is also an accessibility issue and with Healthcare Plan (C) a workman’s comp. compliance
  issue as I noted in the Healthcare Plan (C) UM testing documentation.

  Ages of our users

  Users were asked: There age range.

  The majority of the users surveyed are between the ages of 36 years to 55 years. The youngest 13
  users were 26 years – 35 years of age. The oldest 13 users were 56 years – 65 years of age. There
  was one user in the age group 18 years – 25 years of age.

  Eye Sight

  Users were asked: Describe your eye sight, Good, Okay, Poor or 20/20, 20/25, 20/30, 20/40 etc.

  The majority of the users surveyed had okay vision with the help of glasses or contacts. Only ten users
  had 20/20 but they had 20/20 vision mostly with corrective lenses. In observation also I asked these
  questions again when they were working because I noticed them squinting and moving forward with
  their body to the monitor. It’s funny when you see this behavior then ask them what their eye sight is. A
  lot of them say oh my eye sight is perfect. Then the body language says the opposite.

  Job aids

  Users were asked: Describe what aids your job outside CCA?

  The following is a list of those aids:

      1. Product (F) & Product (F) Face Sheet

      2. Product (Q)

      3. PNC Reporting Tool

      4. Co-workers

      5. Reports that are ran

      6. Calculator

      7. Note Pad

      8. IH728, IH250

      9. TCRT

      10. Search Engines

      11. Meetings

      12. Consultations
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     13. Contact List on Intranet

     14. Patient Focused meetings

     15. Educational conferences

     16. Medical Conferences

     17. Medical references and periodicals

     18. Community Resources

     19. Smart Neighbor

     20. Templates for referral to the Asthma Home Program

     21. The NIH Asthma EPR-3 Guidelines

     22. FEP Direct

     23. CM Referral Database

     24. Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)

     25. Medical Dictionary

     26. Topical conference calls

     27. Newsletter

     28. Advocacy networks

     29. Websites:

            a. DocMan

            b. Google

            c. Yahoo

            d. SharePoint

            e. Mass.gov

            f.   WebMD

            g. Company.org

            h. NEHEN

            i.   TN Anytime
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            j.   Encoder Pro

            k. Intranet (BCBST Policies & procedures, CM Workflows, P&P’s etc) Milliman, CareGuide

            l.   Genisys

            m. PeopleSoft Finance

            n. HCS Provider Viewer

            o. Imaging & Right Fax

            p. Next Gen CM

            q. Genesys

            r.   Igenix Coder



  Users favorite sites

  Users were asked: What are your favorite websites?



  Search Engines

     1. Google.com

            a. Comments: It's very easy to look up medications, medical conditions, etc.

            b. Use Google to research a new medical procedure or medication to familiarize myself
               with them

     2. Google scholar

            a. Search for medical info research

     3. Ask.com

     4. Bing.com

     5. Yahoo.com


  Medical Resources

     1. http://www.mayoclinic.com for educational support

            a. Comments: They have accurate information.
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     2. Medical-Web MD

            a. I can access it and google to look up info not found in CCA, many drugs not found there.

            b. Fast, user friendly, easy to navigate

     3. http://www.nlm.nih.gov/medlineplus/druginformation.html

            a. Comments: Website for medications. Assists with looking up unfamiliar medications.

     4. American Cancer Society site.

            a. Good resource for members.

     5. Disease.org

     6. Medscape.com

            a. Up to date information on health and medications

     7. Medscape.com

     8. Medical Policy

     9.   Tennessee.gov Rules

            a. TennCare exclusion list

     10. TennCare Quick guide

     11. Medical Abbreviations

            a. Approved to use

     12. Breastfeeding.com

     13. Kellymom.com

     14. Lactnet.com

     15. MassNurses.org

     16. County information

     17. BMI Calculator

     18. Weight calculator

     19. Height calculator

     20. Creatinine
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             a. Clearance calculator

     21. Medical abbreviations

             a. Research meanings of medical abbreviations

     22. Drug interaction checker

     23. Rand McNally

             a. Mileage info for member reimbursment

     24. RX list for medication information

     25. Transplant information

     26. AccessTN specialty drug info

     27. Air ambulance info

     28. National Institute of Health clinical trials

     29. Clinical Trials listing service

     30. TennCare Contractor Risk Agreement

     31. Online conversion

             a. Convert just about anything to anything else

     32. Online.Epocrates.com

     33. CPT codes for medicai tests

     34. Disease database

     35. Doctors guide

     36. Food and Drug Administration

     37. FDA - medications

     38. Drugs

     39. E Medicine from web MD

     40. Health grades

             a. Healthcare rating organization

     41. UptoDate.com
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     42. Lab tests results and info

     43. Rates healthcare providers

     44. Medical library of the National Medical society

     45. Tenn Dept of Health Licensure verification

     46. Medical Lexicon

            a. Dictionary, medical news, medical abbreviations

     47. Medical info from the US National Library of Medicine and NIH

     48. MELD PELD calculator for transplant

     49. Quackwatch guide to health fraud

     50. VSHP Resource contacts

     51. Encoder pro,Drug information,Prime

     52. ModernMedicine.com

     53. Haynes.com

     54. Joslin.org

     55. American Diabetes Association

     56. Mass. Department of Public Health



  Other Resources

     1. United Way website. http://www.uwchatt.org

            a. Good resource site for members

     2. Tennessee.gov

            a. Can find benefits and rules

     3. Office of Elder Affairs

     4. Company.org

     5. http://www.NICUniversity.org

            a. Up to date information on NICUs
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     6. Thesaurus.com

     7. MyPyramid.gov

            a. Resources for nutrition, rxlist.com/drugs-great resource for looking up medication
               information.

     8. TNAnytime

            a. They all help me to do my job faster and easier

     9. EPA.gov/asthma

     10. CDC.gov/Asthma

     11. AFA.net

     12. Workflows

     13. Switchboard.com

     14. Bellsouth.com

     15. Bureau of TennCare

            a. To find out whether the TennCare Bureau has member listed as eligible, and what MCO
               the member is with, has been with or will be covered by, as well as alternative forms of
               coverage.

     16. Salary info

     17. Superpages

            a. For phone numbers

     18. Transplant info for patients

     19. Bomb Threat Call Checklist

     20. Tn.gov

     21. Yellowbook.com

     22. www.rx.list.com

     23. State Department of Childrens Services

     24. MapQuest

            a. Helps with locations and dirctions for members and providers
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     25. BC member appeals

             a. To find out what is going on with appeals for my case members

     20. Wikipedia.org

     21. NICUniversity.org

     22. NANN.org

     23. NHI.gov

     24. CommunityServings

     25. MassHealth

     26. Cover TN info

     27. Case Management Resource guide

     28. Case Management Society of America

     29. Center for Disease Control



  Intranet sites

     1. Medical Policy website for Healthcare Plan (B)

             a. For looking up current medical policy, Milliman Guidelines

     2. Healthcare Services Website, Healthcare Plan (B) website for CM policy/procedures

             a. Helps, and workflows

             b. It provides member information regarding in network providers and other useful
                information for members.

     3. Crossroads

             a. Because I can go to so many other sites from there

                     i. BC Online help

                    ii. Healthcare Plan (B) Find a provider

                    iii. DME guidelines

                    iv. Language line

                             1. To interpret incoming and outgoing calls
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                    v. Important phone numbers

                   vi. BDCT

                           1. Transplant centers and information

                   vii. Procedures requiring prior auth

                   viii. BDCT Attachment A

                           1. For AccessTN transplant members



  Personal Sites

     1. Local and national news

     2. Hotmail

     3. CNN.com

     4. NYtimes.org

     5. Noc.com

           a. This site does not apply to the job but what I like about it is when I place my cursor over
              the catagories at the top it branches out underneath. Once I hold cursor on one of those
              categories it branches out underneath for more specific information. I only have to go
              where I want to and do not have to make multiple clicks.

     6. MSN

     7. Yahoo

     8. Pandora.com

     9. FoodNetwork.com

     10. SparkPeople.com

     11. MetroSouth.com

     12. Facebook.com

     13. BostonChannel.com



  Favorite Colors & Social Networking
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  Users were asked: What are your favorite colors? Do you use social networking sites?

  The users surveyed were almost equal in numbers on usage of social networking sites. 35 said they
  were not and 29 said they were. In the workgroup session we heard ideas such as I want to be tweeted
  when a member is in the hospital. Again out of 366 users at Healthcare Plan (B) & 60 at Healthcare
  Plan (A) of our product only 64 responded to this question. In 5 years we could see more social
  networking usage among our users as the next generation of nurses is hired.


                      Colors                                    Social Networking Sites

  Green/Celery/Dark Green/Sage Green/ Neon           FaceBook
  Green/ Sea Green

  Blue/Royal Blue                                    Twitter


  Peach                                              www.boatertalk.com


  Yellow/ Gold                                       http://groups.yahoo.com (Local & International)


  Purple/Lavender

  Pink

  Red/Burgundy/Dusty Rose

  Black

  Brown

  Burnt Orange

  Emerald/Turquoise

  Fushia

  Gray
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  White

  Orange




  5. IDENTIFYING USABILITY ISSUES & INEFFICIENTCIES (FINDINGS)

  Restrictions in the current system

  Our users are innovative and savvy on the computer. They ability to multi task is essential in the
  workflow of nurses in general. We discovered that they need to work on more than one member at a
  time. Having multiple members open in perhaps tear off tabs would be a solution. Users get call backs
  from members with data they need to enter in. However they are in the middle of creating a care plan
  for another member. The current system restrains the user to only work on one member at a time.



  “I should be assisted by my Care Management system and not prohibited by it.” – Care Manager



  Care Plan attached to the Member NOT the Case

  Care Plan needs to be, in the end, attached to a member . Currently in the system the care plan is
  attached to a case, which agreed, there is an association of a case to a care plan, however overall a
  care plan should be member based. A health practitioner who has permissions and who needs to care
  for a member needs to see a holistic view of the member. This includes all their medications, all their
  utilization, all their conditions and includes being able to view the whole care plan. A CM case may
  have a CM nurse and her care plan she created with member, a DM case may have a DM nurse and
  her care plan she created with the member, a UM case may have a UM nurse, who does not create a
  care plan but could benefit from seeing all the problems created and being worked on. They all are
  caring for the same member. For collaboration between the disciplines, increased communication
  between the disciplines and to reduce duplication of effort, team members of the member need to be
  able to view the whole care plan. Adjuvant team members may need to add to the care plan on a case,
  like a social worker or a dietician. They may not own the case but they contribute to the care plan.
  Whoever enters the problems, goals and interventions should be identified. There may be a reason to
  lock some problems, such as a behavioral health issue that laws protect confidentiality, this would
  require market research.
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  Spring Cleaning (Deprecation and control frequency evaluations)

  Deprecation can be done creatively also because I know there are concerns on deprecating features
  and controls. They can fade gradually in the user interface by lowering them in the hierarchy. The
  supporting data collected from customers on what to deprecate would be the determining factor on
  what to get rid of. The product design should conform to the customer commonalities. A process should
  be in place as to what should be Pro Serve vs. making it into the product.
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  “It’s a beautiful product if you use it correctly.” – CM



  I found that there are a lot of useless functions in the product. Either the users don’t know they exists or
  they are too complicated to figure out and buried in the hierarchy. Perhaps there has been one off
  requests for functionality in the product that have driven the current state of the UI. Design should be
  driven by the commonalities then built off of the commonality framework in modules catered to that
  client’s needs, goals and or process. Visual affordances are lacking or current ones are confusing.
  Users are expecting functionality they see in other UIs to be implemented into the product. Example
  would be when they do a search the data inputted into the search fields would pre-populate into the
  forms. To keep building on the existing framework is causing it to collapse.
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  Healthcare Plan (C)


  “The product is over engineered in places.” – UM Student


  “There are a lot of moving parts.” – UM Student


  “Too many place to look for the same thing.” – CM Student



  Case Lock 4.4 in CM get rid of it ASAP

  Observations made of this control were very interesting. Users would release at the end of the day
  because they forgot. Interruptions happen. The thing about the control it’s stopping other workflow
  because the case is locked. Users have to yell over the cube to release the cases, send emails and ask
  the supervisors to unlock them.

  Font Size

  Font size is a concern. Observing users body language. They lean forward and squint while denying
  they can see the screen just fine. Accessibility issues brought up by usability when checking the
  contrast with the contrast tool.

  Customization

  The mere fact that in the workgroup session they started with a blank sheet of paper and threw out
  suggested cards to work with tells us they want the customize Care Plans. Blank template create your
  own. Our all customers using just guidelines from the library.

  Activity in a member when highlight should be tracking the time with that member automatically.

  The product’s UI design and training has altered normal human behavior

  The product fails to achieve the user’s mental model on different accounts. An example is how the
  tasks are to a case and not to the user. Many labels are confusing to the users. Pages sometimes are
  not clearly marked with an H1. Users don’t know how they navigated to a page. When they use other
  applications they are expecting the same behaviors in the product. Example if they do a search and
  enter in data that data should pre-populate into the fields. Another example is the Member Overview. It
  functions differently in the product. It floats with the icon in the top navigation but doesn’t in the left
  navigation. Product (F) is another example as users are used to double clicking in Product (F) and in
  CCA they can’t.

  Inconsistencies in the product made training confusing for users. Example was the Member Overview
  floating from the icon in top navigation and not floating in the left navigation. The training environment
  that the trainers use is riddled with bugs. The environment was slow and at times there was no
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  performance. This became frustrating for students and instructors. CM users often after they reviewed
  something still forgot how to navigate to an area of high frequency such as care plan. One user said,
  “Oh stupid me”.



  Health Plan (A)

  “We tell everyone that they are forbidden to use the back button in the product.” – CM & Content
  Manager

  Health Plan (B)

  The UI has caused a training style within organizations. “It takes time to explain the many paths to take
  to do the same thing. In the end it just confuses them.” – CM Trainer

  Health Plan (A)

  “It’s floats! It scales!” (She didn’t know the Member Overview icon floated)– CM



  Adaption rate and culture that the product has created

  Health Plan (A)

  “It’s so easy to do something wrong in the product.” – CM

  Adaption rate is slow for the product to be efficient at first. The culture that the product has created is a
  reflection of adaption rate. It will be interesting to see if other organizations took 12-18 months to
  implement the product and how they worked it into the existing process or adjusted their process with
  CCA in mind.

  Accessibility

  Reading font size small in areas.

  Technology

  “Ask meds first then issues later.” – Health Plan (B) – Screener

  A fed by a pharmacy into CCA would be of great importance at the assessment level prior to starting an
  assessment with a member. Users have indicated that before they start a Risk Assessment it would be
  beneficial and a big time saver to know what kind of medications the member was on up front. This
  would also reduce errors.

  Policy & procedure online was created in how to use the system. They use this instead of help.
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  Any assessment should have an add note feature next to the question to record information that the
  member gives outside of the question. Currently they write down notes to type into a progress note
  later.

  Progress note original usage is for what? They use it for everything. Barriers are entered via progress
  note with most users.

  Integration of widgets within CCA would be beneficial. (Calculator in cost savings) User was looking
  around for a calculator.

  To understand the workload of our users a comprehensive list of most frequent and important tasks
  needs to be identified. Then the list needs to be prioritized for the initial design work. Smaller
  enhancements to improve usability will be discovered and documented for design to enter in a queue.



  6. RESULTS FROM THE INTERVIEWS OF SUPERVISORS & CMS HEALTHCARE PLAN

  We had round table discussions with supervisors and one on one Q&A with care managers for an hour
  with each line of business with Health Plan (B). We collected responses from both roles.



  A Typical Day with Our Users
  Care Manager Supervisors:
  All open up multiple systems. 25 people telecommute in commercial. Commercial makes home visits. Complaints
  they get from their team are, working at home the system goes down after 30 minutes system. 1 week the whole
  system was down. Laptop users are only having these problems. They have letter printing issues and tracking
  issues. Some users are not reporting the issues in fear of having to come back to the office to work. Users have
  to send to the printer twice to print once.
  Most of the morning is spent with staff answering questions, giving directions, etc. They also spend the morning
  responding to emails. Medicare Supervisors FFS, PPO MAP and MAPD plans, all inpatient admits are referred to
  CM. Screeners are nurses. They look at diagnosis, claims, Product (F) UM notes, if readmission is it for same
  diagnosis? (We had discussion on HCC functionality; they were unaware of it and are not using it.)
  Disease Manager, Supervisor Open necessary programs including CCA and begin working tasks from my tasks

  Care Managers:
  Clinicians, Medicaid: Launch product (F), CCA, Outlook, Word, Referral Notes, MEDai risk drivers. ICD 9 Code.
  The ICD 9 is useless in CCA user states. They have to know the ICD-9 description to search, nobody knows that
  information. They need to be able to search heart attack not myocardial infarction. It does the same thing as
  product (F). So we Search in gene IX encoder Pro. Online users go to Encoder Pro.com. All cases are in
  spreadsheets. Imaging (claims scanned image system), Imaging Process Design, IPD pulls any claim on a
  member. Address, phone number and call provider. Weekly 70 to 75% of users’ time is looking for phone
  numbers. They navigate to CrossRoads, Mr. Doc Man. Notes are made on many note pads. Six screeners are on
  the Medicaid team. Every week workflow changes for each user on the team. They look to see what they have to
  do for the day. Reviewing day’s tasks, assignments, faxes and emails to plan the day.
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  Screeners, Medicaid: Clock in and open up the following systems they use every day. Product (F), CCA, HCS
  Provider Viewer, Notepad, and Soft Phones. Then they read any emails they have including the plan of action for
  the day from the supervisor. From there they work tasks, CTI outbound dialer, supply orders, reports on
  occasion, and any issues regarding letters with the nurses. They work the reports, set up cases for nurses. Drop
  call reports, inactive case report Facet bucket, create a task for nurse. They also direct assign a member to the nurse as well.

  Clinician Disease Manager, Medicaid: Open IH250, product (F), softphone, My Tasks – change filter to today
  Screener, Medicare: They look at product (F) bucket, research to find a member for CM then build a case in
  CAE. Check emails in Outlook, launch CCA, product (F). Builds the cases. Sometimes has to find a pharmacy
  that will take it. Out of product (F) UM bucket, customer service sends CM. Another user deleted cookies, files &
  clearing history on internet explorer, then opening all systems needed to begin the work day thru xendesktop
  (care advance, outlook, facets, word, next gen CM, ETG database –access based, genesys, screener list – excel
  based, CM database – access and web based, Encoder Pro, Crossroads and FEP Direct.
  Case Manager: Turns on computer and all the programs used, then determines who they need to call and who
  needs to be presented on rounds.

  Clinician, Medicare: Launch apps, CCA starts work on lists, calling people. Get verbal consent for CM then they
  have 7 days to get assessment done.

  Clinicians, Commercial: CCA Login, launch Outlook, product (F), Excel Spreadsheet, Word. Checks Resources
  for approval or denied. Checks to see any message from Supervisor. Driven by workflow. Process heavy. Another
  clinician pulls up all her members, all active members in the past month. Has a list of members in work file. Looks
  at CM for new cases, new referrals, hospital stays, new DM. Reviewing what callbacks need to be made, setting
  priorities of the day. Reviewing and approving authorizations and contacting new members/hospitals etc.

  Transition of Care, RN: Opens up programs, open up spreadsheets, checks my tasks in CCA, reviews member
  worksheet, checks hospital census once available, has daily worksheet available.
  Triage Nurses: Reviews emails and external work list/buckets (MrDocMan, Tasks in CCA for consults, and
  Outlook Fax GMM Folder) to see if any cases need to be triaged to appropriate area. This may include
  assignment, transition, or obtaining more information to process the case. Once the emails and the external work
  list have been completed, they start working the product (F) SGMM_CMREF bucket/work list.



  Users Personal Work Goals
  Care Manager Supervisors:
  To be as productive each day as possible. To ensure the department runs smoothly and the staff produces quality
  work.

  Medical Manager: Personal goals are to respond to read 100% of emails and answer telephone calls. To attend
  all meetings and allow time to complete my personal work and assignments.

  Disease Manager, Supervisor: Contact members within specified time frames as designated by program
  guidelines. Complete work in fashionable and timely manner.



  Care Managers:
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  Clinicians, Medicaid: Serve the member/customer – provide best quality healthcare. Get the nurses all the
  cases they need for the day. Doing job well and competently, done right and to go home.
  Screeners, Medicaid: Keep tasks within a two day turnaround time, maintain four hours a day on CTI, complete
  100% on phone and screen audits per quarter, keep brochures and supplies stocked, work any reports that
  supervisor requests, and handle any issues the nurses need assistance with daily. Get nurses “maxed out” 3 DM
  and 3 ESM cases per day. Literally it’s harder to do than you think because they have to go through many
  members before I find one appropriate for referral.
  Clinician Disease Manager, Medicaid: Open IH250, Facets, softphone, My Tasks – change filter to today.
  Urgent first then High with 7 days to get to.
  Screener, Medicare: Type A personality. Wants everything done right. Most driven on the Team. Get it done
  now. Task List. Driven and task oriented wants it done right now and right. Never has a late task. A screener is
  different than the day to day activities of a case manager. Personal work goal is production oriented and that is to
  be able to assign 25-30 cases/day, assign them to the most appropriate level of care we have to offer, and to
  ensure the receiver of the case knows why they are receiving the case.
  Case Manager: To increase case load to that of co-workers, To have all HRAs up to date and to continue getting
  and faster with the processes.
  Clinician, Medicare: Daily to meet member’s and providers needs quickly and efficiently and to be pro-active in
  solving problems before they start.
  Clinicians, Commercial: Basic, to keep caught up – pass audits- tight turnaround times. Leave here felling they
  did something that matters. Stay current on tasks for members and job requirement. Personal satisfaction that
  they have assisted member/providers to very best in providing and them receiving quality care-based on
  individual needs.
  Transition of Care, RN: Personal daily work goals are: to complete all tasks to the best of their ability for the day,
  review the to-dos for the next work day, assist co-workers, and treat everyone they come in contact with respect.
  Triage Nurses: Utilize functional and technical expertise by analyzing, entering, and routing member’s clinical
  information in an accurate and timely manner.



  What motivates Our Users
  Care Manager Supervisors:
  One CMS feels her department has a lot to contribute to the success of the company and she needs to do her
  part. Personal satisfaction. Salary.
  Disease Manager, Supervisor Open necessary programs including CCA and begin working tasks from my
  tasks. Their members and work ethics.
  Medical Manager: Working with a great team and having opinions considered and appreciated.
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  Care Managers:
  Clinicians, Medicaid: Putting their selves in position with the member. Getting the information, proper
  communication and education they need. Members have strong chronic conditions and are on a lot of
  medications. Personal work ethics and addiction to food, shelter, cats and grand baby.

  Screeners, Medicaid: Moving up in the company throughout the years learning different jobs and in the process
  being successful throughout the career at Healthcare Plan (B). A drive to get cases assigned and doing it right.
  Team players and being a morale officer at work. Payday.

  Clinician Disease Manager, Medicaid: Having a goal for the day and completing the goal.
  Screener, Medicare: To make a difference. Accomplish something.
  Case Manager: Personal satisfaction and knowing they have helped a member or provider. The love of their co-
  workers and the work environment. They really enjoy doing this job and feel like they are making a difference in
  the lives of members.
  Case Manager Screener: Personal satisfaction that they have given their best effort to Healthcare Plan (B).
  Clinicians, Commercial: A sense of accomplishment. Important to impact members and get them what they
  need.

  Transition of Care, RN: To make a difference in a member’s life.
  Triage Nurses: Work ethic and sense of pride in what they do.



  How Our Users are Measured on the Job
  Care Manager Supervisors:
                                                              rd
  CMS requires an HRA on new members (this is done by a 3 party, beneficiary fills out after signing up for plan).
  Monthly audits for accuracy. By the number of members assigned successfully each day. Commercial it’s by case
  load and turnaround times. Audits. Some cases are open for two years. 50 to 70 members/ per user. (Audit
  criteria they are sending via email.) CMS performance is measured on the staff’s productivity and quality. 40 CM
  caseload, they have turn-around time audits, some have members 2 years some 30 days. Average is 50-70
  member caseload. Some 100, is dependent on member acuity.
  Medicaid wants to see how they handle barriers to care, these are captured in a concept in the assessment. So
  Care Plan needs to address areas identified on Care Plan as problems. They want to see their HEDIS scores go
  up.
  Disease Manager, Supervisor: Job performance is measured by Quarterly audits and weekly productivity sheet.
  Member contacts will vary daily due to differing member needs and the amount of enrollments completed.
  Medical Manager: Annual performance review, biweekly 1:1 calls with the director, feedback from staff and co-
  workers.
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  Care Managers:
  Clinicians, Medicaid: Monthly quality and quarterly audits. Measured on goals, consents, number of open cases,
  cases built correctly, case phase, assigned to the right nurse, correct letters (errors). Phone audits. Checklist of
  tasks, and what is said on phone calls. Entering chronic conditions. Auditor has a check list. They pull up random
  cases and check them against these lines. Day to day it has to do with the numbers and acuity of cases, and all
  the Access TN people have to enroll in the CM program. Quality, compliance, workflow check. Documentation,
  required accreditations. Touching people and decreasing cost. State doesn’t know how to do it. I’m not measured
  by cost savings.

  Screeners, Medicaid: Measured by tasks, audit scores, phone calls, enrollments, projects completed, and
  attendance. To stay within a two day turnaround on tasks, complete around twenty calls in a four hour timeframe
  on CTI, keep brochures and supplies stocked, and complete any other projects a supervisor assigns in a timely
  matter. Enrollments can vary so much depending on whether or not they reach the member on that day. You
  could have anywhere from zero to six enrollments in a day. They also check to see if users maxed the nurses out
  every day.

  Disease Manager, Medicaid: Audits – daily summary sheet - # calls/attempts.
  Screener & Clinician, Medicare: Monthly audits – everything on checklist done, medication, medication list. Put
  into all progress list. Checkbox workflow. Care Plan update every month, calls, safety, barriers, progress note,
  address. Progress, Diagnosis concerns, barriers, outcome, Q&A to members. They care for 80–90 yr. old
  members. Screener has audits, nurse has audits. Documenting barriers to care in progress notes, things like
  that.
  Case Manager: Job performance measured in audit scores and feedback from my supervisor. Numerous
  member contacts-average patient load. Setting goals with the annual evaluation and must meet them. Also cases
  are randomly audited. They are free to ask for direction and feedback from their boss. The case load and
  members that are assigned to them are determined by who has the fewest, who’s up next, etc.
  Case Manager Screener: Audit tools. Audit scores are given monthly, they are also measured every day how
  many cases they have assigned.

  Clinicians, Commercial: Monthly audits. Supervisor audits. System training (3 audits). Quality audit, system and
  training, and supervisor audit. Audits. policy, procedures, turnaround times on care plans. Care plans in place 7
  days from time talk to member to consent.

  Triage Nurses: 90% on quarterly audits and if telecommuter 97% on quarterly audits. Attend all mandatory in-
  services. To have a general idea since they touch so many areas-Catastrophic Case Management/PDN-East and
  West, TOC-East and West, BH consults-East and West. They get feedback from different areas on routine basis
  since things at VSHP change so rapidly.



  Our Users View of Our Product
  Care Manager Supervisors:
  Good product but ongoing issues. Navigation confusing. It has serious problems at times. It has room for
  improvement but overall it’s a good program which meets their needs. It can be painful. Is it internal or CCA they
  wonder? I like it. Some feel like they have an iron blanket on them. Somewhat user friendly but some area could
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  be improved . Performance issues. Script scanner they took off. We use word and excel to aid in tasks. It is
  improvement over facets CM. CAE has quirky things that happen that cannot be explained:
      1. 278 user error when trying to put in migraine diagnosis, could do it yesterday but can’t anymore, another
         user can do it on member.
      2. In the morning has to print a letter 2x to warm it up.
      3. While printing or after printing went to go to another member and whole computer froze.


  Care Managers:
  Clinicians, Medicaid: Reminds a user of being in a doctor’s office where the nurse is taking notes. – great tool.
  Same view – not much has changed. (Locking of cases is a pain.) Performance an issue. CCA fills a very
  important need in the insurance industry. Users like it. User friendly then it was. One user likes the many ways to
  get to something. Difficult to train however. CCA is sufficient for documentation.

  Screeners, Medicaid: It is easy to learn and it makes it easy to complete daily tasks when working properly. It’s a
  good system, user friendly, not sure if it is the product or Health Plan (B) but it is too slow. The address book
  should auto populate, they have to add a “doctor” and sometimes it is the same as in the address book grayed out
  but they can just copy and add that one, they have to add each piece of information by hand. The state is the
  system of authority and does not have accurate or up to date info.

  Diesease Manager, Medicaid: Don’t like it – not the layout but it’s slow, hangs – she works fast. Case is
  challenging – creating a Care Plan - time consuming
  Screener & Clinician, Medicare: Delays. Training, it was difficult to learn. 2 day training ½ days for 4 days a
  week.
  Case Manager: Has a lot of system glitches. Freezes a lot. At times can’t get it to take conditions etc. Slow at
  times. Do not care for the poc and having to go back in and change goals from short term goal to long term goal
  and vice versa. It has a lot of glitches and the interaction between it and other programs leaves a lot to be desired.
  Case Manager Screener: Too generic, unable to personalize to members specific needs. Not consistent with
  speed, too much down time. Time consuming. Have to constantly look back to make sure it actually saved what I
  have assigned correctly.

  Clinicians, Commercial: Easier to learn vs. product (F) – progress notes, screener notes MEDai. At a glance.
  History. Cumbersome. It’s measurable.

  Transition of Care, RN: It’s good it has various ways to get into areas of the program. It offers resources within
  the program to help do the job. It is user friendly. It does run slow at times.

  Triage Nurses: One user’s view is mixed on this product. She likes that the assessments are built into system
  and you can view the assignments and their history quickly. The Case Overview feature is a quick way for Triage
  to look at a case and see why it was referred or closed. The “More Information” button is another very good tool
  that allows information to be reviewed quickly.
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  What Our Users Like About Our Product
  Care Manager Supervisors:
  When working properly it’s quick and efficient. User friendly in places. It is designed as a case management
  application. I believe everything case manager’s need is available to them in CCA. Ease of navigation, training is
  a 2 week program.

  Screeners, Disease, Clinician, Triage Nurse, Case & Care Managers:
  They can see and read everything. History is excellent. Easy to learn and use for some. The navigation
  throughout the product is very simple. Easy to read, easy and get information. All info they need is in Case
  Overview and Member Overview. Copy and paste into product (F) - Progress Notes. Screener notes MEDai. Like
  checkmarks, tasks, to be able to focus by using tasks. Covers some of the medical needs of these members.
  Templates the way it’s set up from product (F). Provides good info when working correctly. The templates and letters
  are easy to use. Tasking is an excellent tool and conditions as well, but they are only as good as the user (would
  be nice to pull significant conditions from claims billed automatically, such as diabetes, CHF, HTN…not
  necessarily routine office visits for colds, flu, ect.).



  What They Don’t Like About Our Product – (Most of all performance.)
  Care Manager Supervisors:
  Case lock feature. Need to simplify UI and filters, too much information and too many ways to do stuff. Not
  holding information already entered. Access to Care Plan, care plans collapse while working on them. Letters tree
  defaults to open, short term goals and long term goals being set by the system based on time since creation of
  goal. Good product but ongoing issues. Navigation confusing. Member in focus has to be bigger. (I ran the idea of
  having the member in the center top of the page which she liked. Covers only some of the medical needs of these
  members. One user couldn’t understand why we cannot make the 3 programs that they use the most talk to each
  other. There is too much duplication. Also, the page with the library for Care Plans should not pop up each time.
  It should be there as a reference tool, but you should be able to go straight to the care plan. Down time, speed, in
  the case properties screen having a description field and a notes field (they only need one or the other – not both)
  and the limit of characters in the description field, when closing cases having a note field, not necessary and if
  anything is entered their causes product (F) not to reflect the case closed, this user has never used that field but
  for some reason some of my coworkers fill the need.


  Additional:
      a. Queues- only take 100, its all or nothing, if you say 100 all queues will give back 100.
      b. Can’t flag h-m-low acuity, they want to hit the ones they can impact the most.
      c.   Training takes a long time there are too many ways to do one thing.
      d. They want floating windows like HRA and Care Plan they have to keep getting out of what they are
         working on to go somewhere else to get information or work. Can’t multitask in the product.
      e. Can’t change dates on milestones. They need to capture date opened this date changed or updated.
      f.   They can date but time? Unusual to need a time. It’s recorded everywhere.
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      g. Updating a Care Plan is too time consuming, when you finish a milestone and save it does not take you
         back where you were. It collapses the Care Plan.
      h. Letters no filters.
      i.   Care Plans (gds)-no filters, have to scroll and choose one at a time.
      j.   Hard to delete triage reason without going through many screens to assign it to someone first.
      k.   Progress note filter, always reverts back to original sort and it is not descending.
      l.   No alphabetical order in drop downs.
      m. Can’t cancel an assessment.
      n. Condition list no way to sort by alpha.
      o. Adding conditions painful.
      p. Medication list- no way to sort drug by alpha.
      q. The med profile is not workable-have to make manual note.
      r.   Should have some different contacts listed in address book.
      s.   Don’t really like functional aspects of poc.
      t.   Having to delete goals not wanted, should had to check ones you do want instead.



  Screeners, Disease, Clinician, Triage Nurse, Case & Care Managers:
  Performance is slow. Physician practice is not there. Recent doctor, address book, so they have to go back to
  product (F). They toggle all day long. DM workflow I have to copy and paste from product (F) the recent
  information into a progress note. Another thing disliked about the product is the way it freezes up and just spins.
  Users would like to see a feature that will let you filter the member phone logs or provider contact logs. If there is
  a filter that will perform this task, they are not familiar with it. Triage reviews member phone and provider contact
  logs to help determine how to Triage some of the cases reviewed but in this process, they have to go through
  each page to find this information. That can be time consuming when the member has had several cases in past
  or if a case has been opened for quite some time-example PDN. Care Plans. Build own. Takes to much time that
  they don’t have. Canned care plans would save so much time. One user said they can never find what they need.
  Advance options, not sure how to use. Contact detail phone ext not enough room. Its cumbersome, takes time,
  things are scattered all over. They are double documenting and double documents in the system. Example goals
  in Care Plan then they have to document in progress notes so the auditors can see it better. To many clicks
  required and often freezes up. Would be great to have drop down boxes that they could see. They don’t like that
  they have to tab through the all the entries after opening one to view it and when they close it they have to start
  over again. Ideally they would want to go to the end of all the entries instead of tabbing through the entire
  documentation trail. It would be easier for history gathering if the medication, diagnosis info etc. under the
  member information tab was included in the HRA. The Plan of Care process as far as changing the dates is very
  cumbersome and takes a very long time to complete.


  Additional:
      a. Medications! 3 pages of meds. Then I have to go back to the beginning of the list and it scrambles the
         drugs and members to! It just takes forever.
      b. Can’t do 2 things at once.
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      c.   Medications, they may have 25 meds, when you touch a medication and save it does not go back to
           where you were in list and the list may be scrambled from the original list you have, so they have to open
           every med and now they don’t know which ones they opened and which they did not.
      d. Diagnosis codes: They can’t search terms like breast cancer, it brings up nothing. So they go to
         ENCODER to find the real name and enter that like neoplasm of breast.
      e. The short and long term goals won’t stay, after 61 days they are all long term. So they have to write in the
         description if they are short or long term at least gives them option if it is a short or long term goal every
         30 days when addressed. They change.
      f.   User friendly when the fixes were made.
      g. Lots of clicks and back and forth




  How Our Users Get Work Assignments
  Care Manager Supervisors:
  The Care Managers get their cases from the screeners who check for eligibility, benefits and they set up the case.
  The screeners have no direct contact with the member so get the referrals from a UM nurses. Care Managers are
  notified via a task. If they need to have someone cover their case while they are out, the supervisor can manage
  the workload and assign to another CM. Others get them through referrals from product (F) (a manual bucket that is
  worked) they look in bucket, do some research then manually load a case in CAE and Task. Campaigns send lists of members
  to a queue.
  Different lines of business and users work differently, users on a time restraint. They need to have easy access to
  everything and to see data. Some may look at patient list, some at tasks, some cases, no matter which one they
  look at they need to be able to sort easily. They have 15-30 days to get in 3 attempts and open case. So they
  need to know where they are in process by looking at these lists. We don’t understand the fancy filters. Case load
  122 for Medicare 60-70 Behavioral Health.
  My work assignments they are not using at all. Get case assigned. They print this out. Problems, Reason code
  freezes, They can not change the reason code. Auto Triage has speed issues.
  Medicaid CMS get their work from state reports. At a high level: how many did you touch, what was the
  engagement rate, productivity, stratification (workload). There is a hole in CAE cannot get reporting needs met or
  financials- on how they saved money.
  Medicare is pursuing to be member centric – they need the ability to work on more than one member at a time.
  There are not many working on the same cases.

  Non Supervisory Roles:
  Screeners: They assign cases to the case managers. They get list of potential members from an internal
  database, screen them for case management needs, build the case and assign to a CM.

  Another Screener: In product (F), reports from within the company, triage in CCA, and tasks in CCA for 60 day
  rescreens. There are times that they have to assign a case or refer to an outside vendor while another case is
  open. If they have to build another case while one is open, they have to start by building the case from case
  properties screen, set the case they just built as default, then make the appropriate assignment.
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  Clinician Disease Manager, Medicaid: My Tasks. Shares a case with a screener role. A work habit is she filters
  back to the beginning of the year to see all tasks. In Disease Management there is usually a non-clinical
  employee on the case along with a nurse. The nurse is primary on the case.
  Disease Manager Specialist: From DM Screeners and workflow tasks. Only her working her assignments.
  However if for some reason she is out sick her supervisor can set up working sharing. They help each other and
  may just email coworker the member numbers to assist with the work.
  Screener, Medicaid: CTI Dialer, Letter Report, Incoming Line, and Supervisor.
  Clinician, Medicaid: Report and email. CAE My tasks icon in the left navigation. The report may have two people
  working with the case.
  Case Manager Medicaid: My Work Assignments tab. The only one working with the case. She loves how they
  are bolded. Not touched. Screener sends same task which is same task.
  Case Manager: Supervisor e-mails them to let me know when they have one assigned. Only one assigned to the case.
  Another Case Manager: Tasked to her via triage unit for new member assigned, otherwise, the plan of care or workflow
  tasks her and she make tasks for her self – Likes the self tasking ability.
  Clinician & Screener, Medicare: Task List. Social Worker – Email is sent to them to unlock the case many of us
  don’t work on the same case at the same time. Dual Cases.
  Clinicians, Commercial: My Task list from the screener. Is the only one working on the case unless she is away
  on vacation. My work Assignment – only to see brand new members.

  Transition of Care, RN: My Tasks. From triage. BHO can also be working with the member.
  Triage Nurses: Triage assigns the case to the Case Managers and TOC.



  What Our Users Think of the Online Help
  The majority of users asked say it’s useless. Cheat sheets are made up for users. In training they don’t refer to it.



  How Our Users Search Mostly
  Some reported glitches with search were noted from the user such as with certain names the users have to hit
  search twice.

      1. Case#
      2. Subscriber ID#
      3. Member ID#
      4. DOB
      5. Member Last Name, First three characters or whole First Name ( But it takes to long )
      6. Group#
      7. SS#
      8. My Tasks filter
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      9. OCC name
      10. Health Plan (B) ID#



  The Back Button(s)
  “We tell everyone that they are forbidden to use the back button in the product.” – CM & Content Manager

  Occasionally they will use the CA back button. Some use the back button only when CCA locks up and they need
  to move away from the screen they are in. Not a normal way to do things they said. They are trained to navigate without
  using the CCA back. The CCA back doesn’t take them always back one step. This is why this has forced them to train using
  neither of the two.

  Some were told years ago not to ever use the browser back button. In observation some users use the right click
  browser back function. Also observed, on many screens there was no browser bar at the top at all so this
  eliminated the browser button being clicked but not the right click functionality for the browsers back.



  CAE Mail
  All users interviewed said they don’t use the mail in CAE on the homepage.



  CAE Today Section
  All users interviewed said they don’t look at the message in the today section on the homepage. In fact many said
  the message was there from the beginning of the install. So messages have been there longer than 6 months.
  This section holds no value to our users.



  CAE Statistics
  All users interviewed said they don’t look or use the statistics section on the home page. This section also holds
  no value to our users.



  Date in the Top Navigation
  Many users did not know the date was up there. This holds no value to them as well. Many are in their calendars
  in outlook before they get to CCA.


  Greetings User
  They could careless that they are greeted on the homepage or anywhere else in the product. Date of last login
  and time they do not look at either next to the greeting.

  Alerts in the Top Navigation
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  Health Plan B didn’t have this feature turned on. Health Plan A ignores it.

  Member in Focus
  Users got use to after a while. When they first started off some kept forgetting to look up in the left corner to see
  which member was in focus. They would enter in notes for the wrong member. The biggest issue is the size. It’s
  hard to see for many users.

  Case Lock
  This feature is cumbersome to users. They don’t forget to release cases until the end of the day or until someone
  sends them an email or comes to their desk. This feature no one uses that we observed. The workflow has
  conformed to a worked around for this problem. I question the feature and how many of our customers use it.
  Nurses do all the time (95%) – have to have supervisor unlock the case 3 or more times a week because nurses don’t unlock



  Icons
  What we found out was that the icons do not help aid the meaning of the controls. The label is sufficient. The
  icons add unwanted visual clutter. Users often would what the icon is or what it means. Another concern is just
  having the icon with no label. The alt tag is the label in some situations such as the quick links at the top of the left
  navigation. However many users have the alt tag turned off in the browser. This is dangerous.

  Aids
  All the users interviewed and observed had aids for helping them during task completion. They vary from, post-its,
  binders, intranets, work documents to diagrams. Discovering that the help is not used at all and if ever used did
  not provide the user with the answers they needed.


  Creating a CM Care Plan
  Building the CCA Care Plan with the member
  Screeners start to build a care plan when a case needs to be opened on the member. No consent is needed. So
  many care managers start on the phone with the care plan already constructed.
  Consent is needed from the members in all line of businesses except for Medicare and parts of Medicaid. With
  Medicare they just need to be a willing participant. DM for Medicaid is mandatory – don’t need consent also. The
  member is not on the phone in most cases when in CCA constructing the care plan because often times they only
  have the members on the phone for a short period of time. The user interface in CCA also takes time to navigate
  through so they don’t want to waste the member’s time. They tell the member what they want to do and get
  consent verbal and written.



  Care Plan & Policy Drivers
  They build care plans based on the issues/conditions/gaps identified during the assessment which is completed
  with the member. Regulations, URAC, NCQA, 36 HEDIS, Medicare. Care Plan ability to report off all info for the
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  line of business. QIP patient safety 97% bench mark 100%. Condition List. They have one screener that is a
  nurse. They create the care plan and address ALL pertinent needs, so there is a strong correlation.



  Quality Assurance check on Care Plans
  Question asked: When you are doing a QA check on your Care Plans, what are you looking for?


  Responses: We look to make sure that all gaps, issues, conditions are address in the care plan. Especially
  safety issues. We have an audit tool, look at that tool and you will know exactly what we look for. Individualized,
  specific and comprehensive. That the plan of care addresses all areas of need identified in the HRA/progress
  note. If we follow URAC guidelines.


  Disease Manager Specialist: To assure that my care plan address’ members needs and deficits

  Screeners, Medicaid: Audit tools – case properties/description “update case phase.” For the Disease
  Management Associates we mainly use the CTI DMA Workflow, CaringStart Workflow, or the Adult Direct
  Assignment Workflow depending on the case. The Intro Letter and Brochures need to be sent out to each
  member with an open case.

  Care Manager, Medicaid: Compliance with the audit tool. Nurse workflow. Gaps in care. Quality. Improve
  products, living will. Individualize – no boilerplate.

  Disease Manager, Medicaid: Checks everything – timing, late on tasks/timeliness/Documentation up to date

  Triage Nurse: I would think they look for individualized Care Plans specific to that member. Things have
  changed since I was a Case Manager and TOC Nurse.
  Commercial, Clinician: Met member’s needs. LTG and STG. They put in workflow. They look to see if I added
  the gdls I am supposed to. Read all progress notes – look and see if user has address the issues – filters to see
  her entries then looks at the care plan. Short and long term goals. Do the problems I ID in assessment reflect on
  Care Plan. I have to have safety on the Care Plan.


  Case Manager, Commercial: Stg/ltg and all needs being met or addressed.


  Screener & Clinician, Medicare: Dates span, meeting goals, right diagnosis, addressing issues and they look
  into progress notes. Medication reconciliation on every call, I have to open every medication and close it to get a
  new progress note to prove it. Date spans correct, goals appropriate for diagnosis, make sure we are addressing
  goals, have to open every goal and sometimes interventions to chart on, then I also put it in progress notes.
  Medicare is looking for UM part, QA department. Screening as well. Claims history. UM note review.
  Readmissions.


  Care Plan > Problems (Conditions )> Goals > Barriers, Interventions & Outcomes
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  Question asked: Do you agree with this association? A Care Plan is made up of Problems, those problems have Goals,
  and those Goals can have Barriers, Interventions and Outcomes?
  “I did not know about barrier milestones.” – Care Manager
  Responses: All agreed but we learned that most users document the barriers in a progress notes or they don’t document
  them at all because they say they don’t know where to do that in CCA. Many also said that there are gaps in care plans.
  Changing all dates on case properties screen w/tabs. Assessment, Problems. Condition – Resources/how to help/what we do
  – Communication/outreach – Solutions. Users should have the ability to update the goal not the intervention.


  Here is how one user sees it:
               a.   Condition of Member.
               b.   Resources (How do we help them).
               c.   Out Reach (Communication).
               d.   Solution.

  Then there was this statement, “Case around care plan.” So again what we are hearing is that the care plan should not be
  attached to a case but the member.

  Interventions are redundant. Update Milestone and include in progress note. Just goal not intervention. Sometimes 40 of those
  things. Every 30 calls. Yes, although the wording can be confusing at times. Milestone is a problem. Mostly Goals MUST have
  interventions and outcomes in order for it to be a Care plan.

  “The whole wording within Care Plans goes straight to hell. Hard to teach the language. The same thing is named three
  different things!” – Care Manager, Medicaid

  Then we also discovered some labeling issues. The word Problem sounded to negative. Diabetes isn’t a problem it’s a
  condition It should be labeled Condition(s). The word milestone means the problem to some users. A labeling exercise would
  be beneficial for Care Plans.



  Care Plan Creation
  Question: How do you create the care plan?
  Responses:
      1.   Library Guidelines.
      2.   Cases, Edit, Add Milestones, Health Plan B Workflow, choose Appropriate Guideline, and then check off the needed
           items.
      3.   Workflow import suggested guidelines. Blow past the stoplight page.
      4.   Some go to the Care Plan tab and pick the guidelines one by one


  Question: Do you use recommended guidelines?
  Responses: Workflows set in place for our Department. I skip the suggested guideline page, too cumbersome. Blank
  template. Goal, Intervention. It would be great if we could drag and drop them over. Unchecking it time consuming.
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  Question: Do you add guidelines from the “Add milestone” page?
  Responses: Yes that is how we Import our Care Plans. Very complicated process. Yes but it is painful. STG & LTG
  workaround in the subject. They change but the date drives this which is not good. It always goes back.


  Question: Do you adjust the due dates?
  Responses: Not usually unless we are working Manual Call Outs.


  Question: How granular would you like the dates?
  Responses: The care plan dates and the short vs. long term goals need to be fully set by the CM. A short term goal that was
  created more than 30 days earlier is not necessarily a long term goal. It may be a short term goal that has not been met. Have
  to – Audit driven – should be in Care Plan. They don’t really go through progress notes in detail. Don’t know what they mean.
  Due dates are necessary, its just a lengthy process. I do not want granular dates. This makes things very time consuming.
  Care plans have to have set dates to achieve goals


  Question: Are due dates on all the care plan items useful?
  Responses: Yes, essential but most case managers send themselves a manual task for follow up and address the
  care plan at that time. They do not rely on the care plans automatic. They adjust the dates. Useful for not getting into
  trouble, remind me task. All goals have to be measurable. They update every 30 days so this triggers me to look at them. They
  are very useful to the users. Constantly resets – as many in bulk as possible – Intervention dates DO differ from goal dates. It
  becomes very repetitious to have to change dates on all the items so it’s consuming the users time. Bulking them is one
  solution. Goals need dates also.


  Question: How many problems do you typically address in a care plan?
  Responses: It varies widely depending on the needs of the patient. I generally they see anywhere from 1 – 6. It snowballs
  after duration.
  NOTE: Interesting side note on the working habit that the system has created. One user said that during Assessment loading
  time – writes out everything - the system froze while on the phone with a member and lost everything. So from that experience
  she always takes paper notes. She has 330 DM cases with a notebook of all those members.



  Task & Intervention
  Question: How would you describe the difference between a task and an intervention? How do you use tasks when
  working with a care plan?


  Responses Tasks: Users see tasks as something they have to do (action) and serves as a reminder to perform their job. A
  task is something that either the CM or the member needs to complete while an intervention is something a CM would do.
  Most send themselves a manual task for their 30 day follow up and do not use the automatic care plan tasks. Disease
  Management Associates only work tasks from the Care Plan or tasks that have been sent to us by the nurses. We send the
  Intro Letter and Brochure to the member, check to make sure a case is loaded in product (F), Inform the Member of the Care
  Plan, and Send a task to the Screener to assign to a nurse using the Care Plan. The task is not associated to Care Plan.




  Responses Intervention:
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  Intervention is what they need to do (action). Intervention could be verbal to member – Care Plan is member specific. Focused
  only on member by member then to task list. I know the intervention task is for the Care Plan so I know what date it is due.
  Intervention is how to or what. An intervention may be what that task is and how it is generated. Intervention is member
  related. An intervention is something you want to have member utilize in order to see changes. An intervention is something I
  do to help the member to improve their quality of life. Interventions are things that I will educate a member on in order for them
  to achieve the desired outcome and eventually the goal. An intervention is like I am educating them or I am calling a doctor.



  Editing Care Management Care Plan
  Task & Intervention
  Question: Do you make changes to a Care Plan once it is saved?
  Responses: Yes. A care plan is a living document. Case Managers should be revising the care plan as members make
  progress. It is changed on a monthly basis usually, adapted and updated throughout the life of the case. Screener role says
  not usually unless he is working a Manual Call Out task where he is trying to Inform the Member of the Care Plan. Some
  update the Care Plan milestones on every call. Constantly adding more or adjusting dates. Only to mark goals complete, or
  add new ones are the only changes some make. Also if it’s the wrong member or not a real problem so they take it out. Other
  changes are they go back and approve or mark as met/unmet while poc in process and add new goals as needed.


  Question: Do you manually select interventions and outcomes and add them?
  Responses Tasks: No canned only. Barriers mostly are recorded in progress notes. Some do occasionally create manually.
  Manually deselects them……not fond of functional aspects in POC. Some do select interventions and outcomes, but again
  most haven’t added any barriers yet. Some use what is available in the system and edit out what they don’t need before
  saving. Barriers are reflected in the care plans they choose often. Of course those are limited and don’t cover every scenario.


  Question: Do you ever add barriers to the Care Plan?
  Responses Tasks: Supervisors also say they don’t believe that their Care Managers are using the barriers. If it is reportable It
  would be useful. Barriers are not widely used on many teams within Health Plan A and B. Some also add member barriers as
  guidelines. If they need to – Barrier transportation, it’s a guideline. Many users didn’t know they could add them. Another users
  stated, “I do not like to add barriers to my care plans as this implies that it is something that is stopping the member. I believe
  that everything is obtainable.”


  Question: Any other changes?
  Responses Tasks: Adding additional guidelines, problems, interventions, outcomes, marking goals as met, editing the due
  dates.


  Question: What would you like to see improved in the process for updating Care Plans?
  Responses Tasks: Easier access to the Care Plan (a shortcut icon would be great). If the problems/goals did not collapse
  after every edit of the Care Plan that would save the Care Managers a great deal of time. They currently collapse while they
  are working in them and they would like to see that changed. Pick a group of them more than one at a time. Many like canned
  care plans. More choices – uses same one – case specific. Time consuming – change dates. Contact unable to contact. We
  would love an attempted to contact button. Or a button if 3 attempts are made. Then a reminder is automatically generated in a
  few days. Too time consuming too many clicks, too many notes for attempt to contact. Import more than 1 guideline at a time,
  problems do not collapse while updating. Expanding collapse problems with every edit lots of scrolling. For goals to remain as
  you make them-either stg/ltg and not change on their own…this waste time to go back in manually and change them. Keep the
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  add milestones from popping up each time you go to the care plan. A drop down box to choose STG or LTG without those
  choices changing automatically when the dates are changed. Quicker ability to import more than one care plan at a time.


  Question: Are there any restrictions when removing things from Care Plans once they’re created? Example would be
  of mandatory goals or interventions.
  Responses Tasks: Not at this time but it is being discussed. It’s hard to remove once it’s on the Care Plan. Some think it
  counts against them in the audits if they delete goals.


  Question: Is it acceptable or common to remove Problems, Goals, Interventions, etc. If so do those decisions need to
  be justified or documented?
  Responses Tasks: They do not remove but they can mark as unmet or not applicable. Some can’t remove now. If removed a
  reason code – CMS approval comes up. Barriers should be put in place anywhere. Yes it is acceptable and common to
  remove Problems, Goals and Interventions. No restrictions. If picked met or not met. They should only be importing the
  problems/goals etc that are needed. Some users just mark as met/not met and indicate reason-that is what a poc is for to keep
  updated with changes, additions etc. Justification is that each plan of care needs to be individualized to each member based
  on their identified areas of need so they more flexible the better it fits the member’s situation.




  CLOSING REMARKS


  From the collective research done from these three customers we learned some important key take always to
  enhance our product.

  Learn ability of the product can be improved by reducing visual clutter, having consistency with styles and
  functionality and by conforming the product to the users mental model. This would also reduce training costs in
  the long run.

  Workflow enhancements such as allowing the user to work on more than one member at time would increase
  productivity.

  Designing the screens to take every pixel into account. There are a lot of wasted pixels that could be put to use
  displaying more of the content the users have to get at. The liquid layout is a solution along with other methods as
  moving the left navigation to the top. Using right click menus would also increase real-estate for certain controls
  that remain in the content area put are of no use to the users or to the current user at that point in time of the task.

  Eliminating controls that are not used by users. Coming up with a process that deprecates features for good or
  lowers those controls in the UI hierarchy. The frequency test would be helpful data to collect to support such a
  move.

  Asking the users what types of changes, additions, or deletions they’d like to see to the existing technology or
  work process is great feedback. However we need to find the common ground of all of our customers. Express
  that we want to make their jobs easier and will establish an ongoing working relationship to improve the product
  and their experience.

  FRIDAY W ORKGROUP SESSION - NOTES
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  ASSIGNMENTS
  Split the big group up into 4 mixed groups:

  In this exercise, document how you would go about assigning work so these members get to the most
  appropriate case manager. Indicate the steps you would take, and the information and resources you
  need to get the job done.

  #1: A monthly report that lists members who are high risk has been produced and needs to be reviewed for
  possible assignments. This month’s list has 1000 members.

  NOTES: They want to see FaceBook and Twitter Integration. Real-time feeds.




  #2: Inpatient admission >5 days report: John Stroke, a 49 year old male, married

          CM Referral info:
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                 History of CAD and HTN
                 Admitted from ER 6 days ago, with chest pain that started at work
                 Heart attack in progress.
                 History of bipolar disorder
                 Arteriogram showed 3 vessel occlusion
                 CABG performed day of admission
                 Complicated by a stroke 2 days post-op
                 Currently on a medical-surgical floor
              

  NOTES: They want the address book auto stamp.




  #3: Member with a risk score of 9: Jane Fall, 87 year old retired school teacher, widow



          CM Referral info
              History of HTN, CAD, Type 2 diabetes, COPD-bronchitis, Osteoarthritis, Osteoporosis, and s/p
                total knee replacements.
              3 ER visits the last 3 months for falling in her home
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  NOTES: Auto referrals. Build cases automatically. Tagging the skills of CMs. What strats. CMS enters skill or
  skills entered by CM user by a questionnaire. After entry then it is synced to the right Member/Case. Example:
  Spanish speaking member is tagged on intake. Then it is synced with skills tagged. IH250 downloads
  automatically. Auto brochure triggered from results of the HRA.




  #4: New member transitioning from previous plan’s CM: Manuel Lung, 14 year old male



          CM Referral info
              Severe cerebral palsy
              On a ventilator at home
              Language barrier problems
              Parents having problems understanding the benefit plan
              May have to change providers
              Fear losing the support they currently have
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  NOTES: Knows specialty. Based on diagnosis system knows which case is more important. Different colors –
  referral sources. Different colors Hospital.




  #5: Referral to CM upon discharge from mental health floor: Sally Head, 63 year old female



          CM Referral info
              25 year history of schizophrenia, anxiety disorder and depression
              Came to ER by ambulance, presented with auditory hallucinations
              Medical history includes CAD, Asthma and Parkinson’s disease

  CREATING A CARE PLAN
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  QUOTE: “I have my Blue Sky Now.” – CM, Medicaid



  Split the big group up into 4 different groups:

      1. Commercial folks

      2. Medicare folks

      3. Medicaid folks

      4. Mental health folks




  Stratification
  Scenario: A monthly report that lists members who are high risk has been produced and needs to be reviewed for
  possible assignments. This month’s list has 1000 members.

  In this exercise we are going to create a Care Plan the way you think it should be created.




  Commercial
  Scenario: Report for inpatient admission over 5 days has revealed the following member may need care
  management. John Stroke, a 49 year old male, works full time has POS plan with 1mil lifetime limit. John has
  history of CAD and high blood pressure. 6 days ago, developed chest pain at work, went to ER, found to be heart
  attack in progress. Angio revealed 3 vessel disease with 3 vessel occlusion. CABG was performed same day.
  Post op day 2 had stroke with deficits. He is currently on a medical-surgical floor. Has right sided deficit and some
  confusion and aphasia. Is married but marriage is strained, according to wife, and she does not know if she can
  care for him, she works and he is bipolar and difficult to manage. There may be financial difficulties.



  In this exercise we are going to create a Care Plan the way you think it should be created.
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  Medicare
  Scenario: The HCC Risk management report has come out and there is a member with a risk score of 9 who
  may need care management. 87 year old Jane Fall has a Medicare advantage plan with part D coverage with an
  OOP max of $2400. Her history reveals High blood pressure, CAD, Type 2 diabetes, COPD-bronchitis,
  Osteoarthritis, Osteoporosis, and s/p total knee replacements. Utilization records show 3 er visits the last 3
  months for falling in her home. Jane lives alone in her home of 50 years. Her husband died many years ago and
  her adult children live in other states. Her income is limited and she may not be taking her medications correctly.
  Her adult children are very worried and want to put her in a nursing home and state that their mother is depressed
  and not herself anymore. Jane absolutely refuses to live in one of those homes and insists she is just fine,
  claiming “I just get dizzy” sometimes.



  In this exercise we are going to create a Care Plan the way you think it should be created.
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  Medicaid
  Scenario: The report the state sends monthly to notify the plan of new members has a member named Manuel
  that may need care management. He is 14 year old child on a ventilator at home. He is disabled with the
  managed Medicaid policy. He has severe cerebral palsy. There was a note from the state the family has language
  barrier problems and has problems with understanding the managed Medicaid. The state’s Medicaid program
  recently went to all managed Medicaid. Anyone with Medicaid had to choose a managed plan. They may be
  worried they have to change providers and lose the support they have sending him to school with a nurse.



  In this exercise we are going to create a Care Plan the way you think it should be created.
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  Behavioral Health


  Scenario: A referral was made to CM after a hospital called to pre-cert an admission to the mental health floor.
  Sally Head is 63 years old, came to ER by ambulance, presented with auditory hallucinations. Sally had been
  calling 911 every 5 minutes for several hours prior to admission stating that the aliens were telling her they were
  going to bomb the earth any minute and something needed to be done. Has 25 year history of schizophrenia,
  anxiety disorder and depression. Medical history includes CAD, Asthma and Parkinson’s disease.



  In this exercise we are going to create a Care Plan the way you think it should be created.
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2010 Usability Report                                                                                    60 of 70




  Build your own dashboard


  In this exercise I want to design your home page with you. It would be more like a dashboard of your CM
  world. After you login this is the first screen you will see. So this could be a bigger picture of how you get
  your work. So I’m asking you how you would like to get your work in an ideal user interface.
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2010 Usability Report                                                                                                              63 of 70




  OUTSIDE FIRM – REPORTED IT PROBLEMS




                             Problems identified by UM and CM staff (3/22/10)
                                                                                        A
                                               E

                                                                                  A
                            BCBST MD                                  Precertification      Provider’s   Patient
                                               Precert.               Assistant
        PAC DAYS                                                                            Nurse        MD
                                               Nurse                  (BCBST)
        (Clerical skills)                                                                                          Patient
                                               (BCBST)                (Clerical skills)
                                                                                                                   Need:
                           Work:
                                                                                                       Work:       Service that
        Work:              Review claim                               Work:.
                                               Work:                                  Work:            Determine   requires
        Receive approval from Nurse for        Evaluate for Medical   Collect         Request          Need and    pre-
                                                                      Demographic
        Or denial from MD Medical              Necessity And                          Precertification Service     certification
                                                                      information fromand provide
        Notify provider by Necessity           benefit Coverage
                           And                                        Customer (A)    Information to
        Phone and mail
                           Benefit criteria.   1) Collect Clinical     (Data Elements BCBST nurse.
        Of decision.                           information from
                           Approve or Deny                                  (B)
                                               Customer (A)           Process to enter
                                                (Data Elements             data
                                                    (B)                    elements
                                               Process to enter             (C)
                                                    data elements     Use resources
                                                     (C)                    (D)
                                               Use resources (D)      Provide
                                                                      Approval
                                               Pend to MD (E)         If possible (A)
                                               Provide
                                               Approval
                                               Possible (A)


      Precertification of a need before a service is rendered
                and concurrently while in a hospital
                                                                                                                       69



  Problems were identified through observations of the work of each of the workers in the pathway and through a 2
  week compilation of problems identified by staff during the course of their work:



   I. PRECERTIFICATION ASSISTANT:

   2 Precertification assistants help to identify problems in the course of work for 10 work days. In a total of 18
  shifts, they reported 205 total problems (average 11 per shift).
2010 Usability Report                                                                                                                                                                                        64 of 70




                                             Types of Problems Precertification Assistant

                         70                                                                                                                                         65
     Number of problms




                         60   49
                         50                                 42
                         40
                                                                                  23                                                                                                     Types of Problems
                         30
                         20
                                              6                           4                                                                                                      8
                         10                                                                     2        0         0     3          0              3
                          0
                                             LOI Internal
                              LOI External




                                                                                                                         Lack of


                                                                                                                                                   Duplication of


                                                                                                                                                                                 Other
                                                                                                                                   Interruptions
                                                                                                         Printer
                                                                                  PC/Computer
                                                                          Phone




                                                                                                                                                                    Copy/paste
                                                            Misdirected




                                                                                                System


                                                                                                                   Fax




                                                                                  Type of Problem




  Problem Descriptions that may possibly benefit from IT involvement in solving:



  1) When Precertification assistant takes demographics for a prospective UM or UM logging: she must enter
     Code 780 (general diagnosis) in product (F) as diagnosis code. (This must be done every time). This creates
     rework:
         A) If provider has clinical information for the nurse, the person is transferred to the UM nurse. UM nurse
             has to change it to the correct diagnosis. (This is done every time)
         B) If the provider does not have the clinical information to give to the UM nurse at the time, the
             Prospective UM goes into the LOI queue and the following day, the Appeals nurse has to review
             each case and either “obsolete” them, remove from the queue because clinical is in, or send the
             provider a denial letter for Lack of Information. ( The volume is: approximately 224- 284 per week)
  2) Copy and paste was the most frequently identified problem by staff- though they do not necessarily see it as
     a problem- they see it as the best way to do their work in the current condition.



  3) System slow and product (F) Clocking
                                                                                                                                                                                               th
                         Clocking reported as a problem on 4 out of 10 days and on March 5 product (F) down for 45 minutes.



  II. UM Nurse:
2010 Usability Report                                                                                          65 of 70




   2 UM Nurses help to identify problems in the course of work for 9 work days. In a total of 14 shifts, they reported
  2165 total problems (average 142 per shift).


                            Type of problems for UM RN
                             Number of times reported




              600                                      533
                                                    474
              500
              400 276
                     257                         267
              300                                         213            Type of problems
              200
              100        28 12 2 16 9 0 50 13 15
                0
          pl nte so w n

          O Co of ns
                   pr a s .
                 ct ss al
                M te a l




                tio u p ce




                              s
               Ap om one

                          t r

           ck u i F e r




                      ob te
       Du I f Re Do x
          em /C h s
                         C s




               er y/p fo
                       Pr ion
                      ica e




                            m
                    de a
                    ed ue
        st C P all
             ir e gt I rn
        M se I In rn




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                          in




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                        te
        Ca LO Ex
                  I
              LO




        La reg
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      Sy P
          isd




         Ca




                                  Type of problem




  Problem Descriptions that may possibly benefit from IT involvement in solving:



      1) Case Management issues: (identified: 28)
            A) Can see that status is “open” but cannot tell if in process of assessing or accepted.
            B) Unable to find name and number of Case Manager assigned to the case.




      2) Specific details regarding system application issues:
            A) PSI: Not able to navigate through product (F) while in CG (mentioned by both nurses)
            B) Checking procedure codes in Medical policy outside of product (F)
            C) “Save Note”: identified as a problem: 30 times
                        i)      Took 25 minutes to resolve
                        ii)      Took 10 minutes to resolve
            D) System frozen:
                        i)      UM Routing form frozen: identified as a problem : 2 times
                        ii)     Facets frozen: unable to save
                        iii)    System froze when attempting to go to CG
2010 Usability Report                                                                                           66 of 70




                          iv)      CG down x 5
                          v)       All computer programs crashed- had to document



                E) Physician unable to see baby on G-drive- had “re-pend” 3 times
                F) No warning screen or notification of a gold carded doctor:

                     Pended to physician by mistake: 2 times

                G) Letter template errors: Identified by UM RNs 3 times
                               i.       Double clicking address fixes
                               ii.      Letter builder problem
                               iii.     CM: RN- Has to adjust address to fit into envelope window properly
                               iv.      CM- letters are not in alphabetical order
                H) Service screen: Delete diagnosis when trying to add additional diagnoses.
                I) PC problems:
                               i.       screens open and close : identified: 10 times
                               ii.      PC computer: freeze
                               iii.     PC computer: shutdown
                J) ICD search less sensitive to spelling errors
                K) Loaded inpatient but caller wants observation: Multiple changes to screen, overrides, etc.
                L) System application: Problem with CM member referral screen
                M) System Applications: Problem with address x 2.



        3) Fax issues: ( identified: 50)

            Some specifically identified issues

                A) Faxes upside down: 4 times (identified by CM as well)
                B) Fax screen issues: 37 times




        4) Duplication of Information: identified (identified: 474)
                          i)      CM complexity and in notes
        5) Copy/paste: (identified 533 times)
                          i)      UM inquiry bucket – tedious clerical work.



  Problems identified beyond UM process:



   I.        Appeals Nurse: 470 problems identified in 3 shifts.
2010 Usability Report                                                                                              67 of 70




                                                    Types of problems for Appeals Nurse
                  Number of problems




                                          400                                       341
                                          350
                                          300
                                          250
                                          200                                                  Types of problems
                                          150
                                          100                            47 25 37         20
                                           50   8   0   0   1 11 1   0
                                            0




                                                  Co of s
                                                        ica e r
                                           st C/ Ph al




                                                 er /p .
                                               ica ru ce
                                                  A p mp e
                                                         nt l




                                                                  s
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                                                             Type of problem




  1) Majority of problems: copy/paste (341).

      i) Copy and paste required to be use Milliman guideline wording.

  2) Clocking or slow product (F) (reported 3 times)



  II. Appeals tech: 30 problems reported in 8 shifts .



     1) Majority of problems identified: waiting in line for the copier: 14 times
     2) Product (F) clocking.




   III. Problems identified by Case Management through observations: ( 3 Case managers have identified 386
   problems over 12 total shifts)
2010 Usability Report                                                                                                                       68 of 70




                                                                  Case Management Types of problems
     Number of times reported




                                250
                                                                  202
                                200
                                150
                                                                                                                                  Series1
                                100
                                                                             50                                              42
                                 50                      4   12         10             12       3   12           6   17 12
                                       0             2                             0        0            1   1
                                  0
                                                                             PC/Computer




                                                                                                      Copy/paste
                                                       equipment

                                                         Advance




                                                                                                    Fax clarity (ie




                                                                                                         problems
                                                      Incorrect or




                                                                                    Printer



                                                                                                    upside down)

                                                                                                        Resource
                                                                                    Phone




                                                                                                               Fax
                                                     LOI Internal




                                                                             long distance
                                      LOI External




                                                                               Application
                                                          Facets




                                                                                                     Interruptions
                                                                                                    Duplication of
                                                                              Can't make
                                                       no phone
                                                        System/




                                                                                                          Lack of
                                                                                 System




                                                                                                           Other
                                                          Care




                                                                                                         Info.
                                                                                  Type of problem



  Product (F):



         1)                      If phone number is wrong, can correct in CCA but not in product (F).
         2)                      Can’t pull up out of pocket maximum
         3)                      Got diagnosis code: 584 but invalid number of digits when putting into product (F).
         4)                      Product (F) slow : reported 6 times : descriptions:
                                      a) Product (F) hanging up multiple times
                                      b) Product (F) stalling again
                                      c) Product (F) clocking: 2 minutes
                                      d) Product (F) clocking: 1 minute
                                      e) Product (F) locking up: 4 minutes
                                      f) System clocking 3 minutes: sign out and in.
                                      g) Clocking 1 minute then stopped.



  CCA

  System design:
2010 Usability Report                                                                                               69 of 70




                1) In CCA phone log: cannot tell if previously spoke to person or not, have to click on each individual
                   line to find out in progress notes.
                2) Edit timing for a milestone is time consuming (Reported by 4 RNs)
                          a) “Advanced Options fixed works sometimes but not others have to check
                          b) Cannot punch one button and update all goals
                          c) Extra step with Care plan goals.

                3) Cannot copy with mouse depending on the document

                4) Cannot go from Care Plan to Progress notes. (Back out identified as a problem       110 times)

                5) CM nurses “skip” page that are suggestions for other assessment

                6) “Skip :”gaps in care”

          7) Cases: work assignments only come up 10 at a time
          8) A lot of steps to change short term goal to long term. (Reported 6 times) description: “Milestone
              properties is the only way to change short/ long term goal status”
          9) Member phone number not on main member overview page- extra work looking for it in case
              properties description box.
          10) Phone number listed on personal contacts in Address book.
          11) Savings locks out when case is closed.
  II.       System problems encountered:
            1) “Server application error”.
            2) Lost work in CCA - has to go back to reopen
            3) Clinical doesn’t line up right when copying from product (F) into CCA
            4) Difficulty finding a good fit for a goal.
            5) Kicked out of “conditions”.
            6) Kicked out of CCA twice
            7) CCA slow. Reported 4 times. 1 description:

                     Took 25 minutes to change dates on 1 member.

                8) Found interventions and outcomes were not popping up on task list.
                9) Progress note did not appear. Had to get out and in 3 times before it appeared.
  III.          Assessments:
                1) General assessment is not appropriate for certain patients (URAC and NCQA requirement)
                2) Pediatric assessment is for well child- gaps in care are not appropriate for NICU patient.
                3) Format for DM survey requires information that may not be able to be obtained.



  OTHER

         I.          Has to reset printer every day from “Universal printer”: Got Help desk to fix.
         II.         On a fax, the right scroll button disappeared, had to reopen to fix it.
         III.        Letters are not in alphabetical order.
         IV.         No internal Health Plan B phone book.
         V.          Copy/paste did not work.
         VI.         Second screen monitor not working ( reported 3 times- had to reboot spent
2010 Usability Report                                                                                  70 of 70




               7 minutes rebooting one of the times)

     VII. Product (F) is member ID number driven but CCA is name driven. (The only place in CCA that the
  member ID # can be found is on the member overview screen.)

								
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