Getting the Right Medicine

Medecision brings speed, efficiency to medical management.

For managed health care pro-viders, making sure patients take the correct dosage of the correct drugs is a vital step in the effort to maximize the welfare of their customers while minimizing costs. Software developers such as Medecision Inc. are incorporating new features into their care management applications that recognize the increasing complexity of this task.

Medecision last week added enterprise-class data warehousing and reporting to its Integrated Medical Management software—which automates transactions among insurers, physicians and pharmacists—to lower costs and improve outcomes.

Medecision Integrated Data Repository, or MIDR, is a data warehousing facility that uses an Oracle Corp. database. The companys CarePlanner Reporting and Information System, known as CRIS, organizes data into a business presentation format, offering standard report templates that can be customized.

Together, MIDR and CRIS establish a single point where patient and provider care can be linked to help identify patients at risk for inappropriate medicine use or for any other problems.

Blue Care Network, the HMO subsidiary of Blue Cross Blue Shield of Michigan, has been using the new data warehouse and reporting system from Medecision since May. The software helps generate reports quickly and easily so that nurses and other non-IT professionals can use them, said Jan Jennings, director of Medical Informatics at Blue Care Network, in Southfield, Mich.

When nurses record initial patient information to set up care plans, the system assesses whether the patient is a candidate for case management. From the outset, Blue Care Network can use recorded data to better identify each patients needs, Jennings said. For example, it can identify whether a patient has been prescribed multiple medications and assess the patients understanding of the drugs and how they should be used, she said.

"We want to make sure the patient understands what medications should be taken, what they are taken for and what to do if there are complications," Jennings said.

The Medecision system identifies patients who might need quarterly updates and helps determine whether a nurse should call more often or whether additional support from a pharmacist or physician is needed.

"We have a real close relationship with our pharmacy department," Jennings said. "A lot of this is about providing education. If youre a diabetic, are you sure youre taking your blood glucose level every day?"

To be sure, integrated medical management software helps insurers as well as patients. Medecisions CRIS links case management data with outcome data and aggregates results to provide population-level statistics. For Blue Care Network, the system has created improved patient profiles early on and helped identify cases in which members did not need to be referred to case management, Jennings said.

"We can now determine what interventions are really working," Jennings said. "This allows us to get down to the member level and also up to the population level."

Blue Care Network has used Medecisions software for about seven years, but it was not able to efficiently generate decision-reporting documents with earlier versions, Jennings said. Previously, creating a monthly report of hospital admissions would take as long as 5 hours, but now it can be generated in 11 minutes, she said.

Medecision faces competition. Landacorp Inc., based in Atlanta, offers medical management software called MaxMC, which helps managed care providers track cases. With multiple clinical protocols, the system assesses the right levels of care, flagging cases that require special management or intervention.

For managed care providers, the ability to consolidate and analyze information in myriad ways is a means of improving the bottom line while promoting better care, according to Medecision President John Capobianco, in Wayne, Pa.

"If you look at the health care industry, it is on the cusp of the next generation of health care provisioning throughout this country," Capobianco said. "It is consolidating around this continuum of care. This is a brand-new push in this particular sector."