Improving Outcomes in Utilization Management. Module C. Electron
This module explores how utilization management can improve electronic tools—namely, electronic health records (EHR) and other information technology (IT). The module first looks at the relevant data accessed through such tools, such as medical necessity information and discharge plans, and the vital role that EHRs play in preventing unnecessary errors, such as wrong medications or even wrong surgeries. Next, the module looks at the realm of medical necessity—the decision that a patient’s treatment, test or procedure is necessary for the member’s health—which can be measured by both intensity of service (IS) and severity of illness (SI), and tracked by using software that compiles such data. Then, the module looks at software to track and monitor readmissions, adverse events and avoidable delays; it also offers some guidance on how to find the right program for one’s healthcare organization, and how certain federal and state databases can complement the data that CMs and patients need.