Using AI in Case Management
October 1, 2023 3 minutes read
By Jeni Miller
As the use of artificial intelligence (AI) wends its way through various industries and advances in its technology, case managers will have to contend with its usefulness in their settings, too.
Touted as a way to save money and time, enable more accurate diagnoses, and streamline processes, AI can be a helpful tool in hospitals. The accessibility of high volumes of information can help with decision-making and care coordination.
Holly Worsham, DNP, MSN, RN, vice president of Kaufman Hall, says the use of AI has been increasing more rapidly since about 2015, and that COVID-19 accelerated it, especially as nurses have left hospitals in droves.
“In case management, [AI] is being used around the UR [utilization review] world quite a bit, and I see it the most in use for natural language processing,” Worsham explains. “It quickly takes information from the electronic medical record and can put it in to make for a more robust process. It does encourage case managers and others to figure out how to do more with less, and how to do better in general.”
Hospitals already use AI for analyzing data, managing administrative tasks, prioritizing cases, and communicating with patients in their preferred language. Conversational AI is used to support patients during post-acute care for managing chronic conditions, making follow-up appointments, and navigate the care continuum. Some hospital systems are putting AI to work in dozens of other ways, too.
While there are other serious issues plaguing hospitals right now, AI offers help for issues that can be easily addressed without compromising the human element of bedside care. Still, some providers and hospitals are hesitant to adopt even the most benign AI programming.
“I’ve had exposure to virtual nursing, and this AI is predictive, especially for fall risk,” Worsham says. “The algorithms run based on movements in and out of the bed. But surprisingly, this just hasn’t taken off. Are people just not ready? Perhaps. But whether we like it or not, we’ll have to at some point.”
Benefits and Risks of AI
Using AI can be an expensive up-front cost, but it can help with rework and labor costs in the future, especially when it comes to denials. Case managers could take the lead on these benefits, learning how to navigate the technology and harness it for use in their role.
The author of an article on this topic detailed how using AI could help “expedite the discharge process, reducing unnecessarily extended patient stays and avoidable inpatient days.” The case study carried out in the hospitals using predictive AI software also revealed the hospitals “eliminated 517 avoidable days monthly over two years, decreased length of stay by an average of six hours per patient, and reduced data collection by 200 hours per week.” Finally, the author reported a savings of more than “an hour per person per shift, prioritized patient discharges, and … up to two additional discharges daily.”1
Still, there are risks to using AI in case management. Sometimes, there are elements of case management that are difficult to measure or capture with AI.
“Since we are working with human beings, it’s just not possible to capture everything in AI that’s in a handwritten note, or how, as a nurse, you just have that gut feeling. You can’t capture it,” Worsham notes. “We still need human beings in that clinical experience to problem-solve and get a true outcome sometimes. There are going to be times when we say, ‘Well, the score says this, but when we do the chart review, we don’t see that.’ AI doesn’t always give the full picture.”
Worsham also mentions the need for cybersecurity when using AI to keep hospitals and patients safe when using these new and developing technologies.
Case managers are encouraged to find ways AI can streamline the functions of their role, especially in places like patient flow, ensuring patients are admitted to the most appropriate unit, and tracking which patients are ready for discharge at a given time. They also might use it to track discharge barriers that can hold up the process and cause dissatisfaction for patients and their families.
Worsham suggests case managers explore all their options when it comes to AI.
“Due diligence is important to find the AI product that best suits your needs, because sometimes what you see is not always what you get,” Worsham explains. “It’s really best to do a deep dive. Case managers may also need to have checks and balances in place, as well as leadership committed to ensuring that the AI program really gives them what they want and need.”
REFERENCE
- Carroll WM. Artificial intelligence: Optimizing patient care in acute and postacute settings. Nurs Manage 2021;52:29-32.
Touted as a way to save money and time, enable more accurate diagnoses, and streamline processes, AI can be a helpful tool in hospitals. The accessibility of high volumes of information can help with decision-making and care coordination.
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