Christian Lous Lange was a Nobel Peace Prize-winning Norwegian historian, teacher, and political scientist, who died in 1938. What could he have to do with case management today? The answer to that question comes in the form of one simple quote, "Technology is a useful servant but a dangerous master."

I have been an advocate of technology for my entire case management career. To say that I think we should stop using technology would not only fly in the face of my previous support, it would also be a mischaracterization of my intent in writing this column. My purpose is to relate a theme that has arisen during recent engagements and to ask you to consider whether we are leveraging technology or whether it is just getting in our way.

I served as an advisor during the design and implementation of a case management information system (CMIS) upgrade. One of the biggest complaints with the existing system was "too many pop-ups slow down our work." Not an uncommon or unreasonable request; this is something I've heard many times, and not only from case managers.

So, I asked for a list of pop-ups that were baked into the current system and for a real-time demonstration of the workflows to understand the contexts in which they occurred. Without getting too deep in the weeds, the exercise proved interesting. There were a handful of noncase management pop-ups that were handed off to the department manager to sort out internally. But there was one pop-up that staff was asking to be eliminated that had me scratching my head. It was a prompt for the sending care coordinator to have telephone contact with the receiving coordinator. Ostensibly, this was to present the transitioning person's hospital course and address questions just prior to the anticipated transfer.

When I inquired why this was up for debate as an essential pop-up, the response I received was disturbing, "We don't usually connect on the phone directly. If we can't reach the person, we leave a voicemail and our contact information in case there are questions with the paperwork." When pressed to estimate the percentage of time this type of transition took place, the response was between 70% and 85%. When I asked how many callbacks they typically received, the response was 5% to 10%. To generalize these fuzzy estimates, for every 100 discharges (to another inpatient facility), approximately 30% or fewer patients' care was discussed on a person-to-person telephone call. These telephone calls are known as warm handoffs.

The reason I bring this up is not to bash a facility or case managers. Truth be told, this is an example that I've seen repeatedly in acute hospital, rehabilitation, and home care settings over the past few years. Even managed care organization clients relate a low percentage of warm handoffs with staff at in-network facilities. So, I pose these questions to you:

* Should a pop-up window prompting a warm handoff be considered nonessential to care transitions, which is an essential aspect of care coordination?

* Is a voicemail message sufficient to ensure the receiving facility understands the hospital course and subsequent care needs of a person?

* Is this an example of technology getting in our way of our work?

Behind every CMIS is at least one case management expert serving as part of the design/development team. When an organization purchases case management software, there is at least one case management expert serving on the integration/implementation team. We trust that these subject matter experts have the experience and expertise to design and integrate software that aligns with our real-life needs.

Technology is constantly evolving, our workflows don't change at the same pace, perhaps we should consider whether they should. When a workflow (or process) changes, it is greeted with an array of reactions-applause, sighs of resignation, or groans and grumbles. The bell curve of reaction to change inevitably covers a wide gambit. We have early adopters and at the other end of the spectrum, we have those who are dragged along kicking and screaming with every change that is made to their jobs. In today's lexicon, is the objection to a pop-up window the equivalent of a groan? Is a live telephone conversation was really that difficult to pull off? Some might argue it is because of the breakneck pace of the work itself.

Whether technology gets in our way or not is open to debate. When there is a check box or pop-up, it is an indicator that a specific task needs to be completed. A pop-up serves as a reminder. Depending on the facility, in case management, pop-ups may include the manner and/or timeframe in which a task should be completed.

Does technology help us prove our value to our clients and the companies we work for? If so, how? If not, why?

We cannot allow technology to drive case management's future out of the hands of clinical professionals.