Case Management with Email Messaging

Many of our customers include Case Management as part of the mix of services provided to clients. Among the seriously mentally ill (SMI) population, Case Management has become an essential service helping individuals gain the most from the services they receive. Helping the client take their medication as prescribed, assessing their current symptom status, intervening to alter treatment rapidly if a crisis is looming are all functions that Case Managers provide. These services are provided both in-person and by telephone.

A new study published in The Journal of General Internal Medicine suggests that email contact with a trained psychiatric nurse can dramatically improve the outcome of medication treatment for depression by internal medicine practices. Reported in Healthcare IT News on March 17, the study was a follow-up to a similar study using telephone contact with patients who had newly been started on antidepressant medication. According to the report, the email messaging was even more effective than a telephone call in improving the benefit of the medication.

The study utilized 208 members of Group Health, a consumer-governed, nonprofit, integrated healthcare organization that coordinates care and coverage for 600,000 individuals in Washington state and Idaho. The Group Health Research Institute (GHRI) was the responsible research organization. GHRI  is a non-proprietary, public-domain research institution within Group Health.

The Group Health plan includes a patient portal that has access into the organization’s electronic health record. According to the abstract of the article, the Intervention consisted of:

 Three online care management contacts with a trained psychiatric nurse. Each contact included a structured assessment (severity of depression, medication adherence, side effects), algorithm-based feedback to the patient and treating physician, and as-needed facilitation of follow-up care. All communication occurred through secure, asynchronous messages within an electronic medical record.

This study was motivated by poor improvement outcomes reported nationally for depressed individuals treated by their primary care providers with antidepressant medication. The goal of the entire research project is to determine if use of an organized plan of treatment including evidence-based follow-up services would result in greater effectiveness of medical therapy.

A significant movement is developing within the U.S. to improve outcomes of our healthcare system by providing services in non-traditional ways. The Connected Healthmovement seeks to improve healthcare services and outcomes by use of technology to remotely monitor and provide services. Partners Healthcare Center for Connected Health has been a pioneer in this effort. Their web site states the goal in this fashion:

Changing Healthcare Delivery

We are engaging patients, providers and the connected health community to deliver quality care outside of traditional medical settings. Telehealth, remote care and disease management initiatives reflect the opportunities for technology-enabled care programs.

What potentials do you see for the use of electronic methodologies like secure email communication with clients within your organization? Are you already engaged in such endeavors? What do you see as the obstacles to such care? What are the potential benefits to your clients? How do we get from here to there?

Please share your experiences, concerns and other comments below.

One thought on “Case Management with Email Messaging

  • I already do a bit of this, however with great caution about confidentiality on the web. I think to be fair to the practitioner, it needs to be a reimbursable service. I am not aware of any insurance company that does so, and I suspect many, maybe not all, patients would have trouble paying an additional fee. What are others doing about this?

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