Technology and Life Care Planning
Integrating emerging technology with professional skills provides a powerful tool for a successful life care planning practice (Thomas, 1992, 1994; Weed, 1995, 1996a, 1996b, 1996c). Today, the life care planner can access a wider scope of available resources and information to ascertain the most appropriate recommendations for the client. Previously, the professional did not have access to all possible resources, and existing data usually required considerable time and effort to obtain. With today’s technology and access via the Internet, the professional can maximize efficiency and organization to produce a quality life care plan that best benefits the client’s needs. This post presents guidelines for integrating today’s emerging technology into a life care planning practice and provides practical information every life care planner should know.
As the Internet expands and more and more resources are made available to the general public via the Internet, the resources available to people with disabilities and those who work with them have also grown tremendously (Barros & Boyd, 1997). Because of rapid changes in technology, especially computer processors, hard drive capacity, and the Internet, integration of technology can be confusing and problematic to the life care planner. For example, determining which computer system to purchase, selecting the appropriate software and network capability, training staff, and knowing how to maintain the integrity of the data on the computer system are only a few of the critical decisions in this often difficult process. Therefore, integrating computer technology into a life care planning practice is not easy, and the temptation to avoid the transition may exist. Fortunately, emerging technology offers much more capability, convenience, and stronger computer hardware configurations that should remain functional and productive for the next 2 to 5 years. The professional can limit confusion regarding technology and take advantage of this increased ability by identifying needs within the practice and obtaining a better understanding of today’s technology.
The life care planner must first determine the professional and business goals in the practice before purchasing computer equipment. If the goal is to complete a maximum of two or three life care plans a year, including narrative and tabular printing of recommendations with associated charges, many of the commercially available word-processing, spreadsheet, and database programs will suffice. The life care planner can construct simple databases to track information and resources. Commercial databases such as Microsoft Access and FileMaker Pro are readily adapted to provide simple, flat-file databases for resources and contacts. With professional programming, the databases can be customized to provide comprehensive relational databases for the life care planner.
On the other hand, if life care planning is to comprise a significant part of the practice, existing computer system and software may require upgrading. Computer hardware and software are now available that are reliable and cost-efficient. Access to this technology is essential because it allows production of a quality product that reflects current clinical knowledge and superior organization of information. This technology also enables the life care planner to create a summary table for costs during the client’s lifetime, or on a year-by-year basis, while making the most productive use of staff time.
In short, technology impacts the life care planner in the following ways:
■ Enhances the ability to organize professional contacts and resources in a logical, easy-to-find method
■ Enhances the ability to organize client data to reference deposition dates, trial dates, referral source, and search for conflicts of interest before accepting a new referral
■ Diminishes staff time for specialized reports or printouts
■ Allows greater control over data integrity with less dependence on external computer experts and resources
■ Increases ability to customize reporting formats and invoicing to referral sources
■ Simplifies access to the Internet for research (provides capability to search the Internet from within a dedicated LCP program)
■ Enables access to state and national databases via the Internet (e.g., Health Care Utilization Project data for inpatient hospital charges)
■ Send and receive large electronic files of medical records (i.e., > 100 MBs)
■ Accesses and distributes information via personalized web pages on the Internet
The successful life care planner should be prepared to incorporate the previous changes in a proactive manner to reach optimal efficiency (Thomas, 1994, 2004). Following are useful concepts that will enable the professional to begin these proactive responses and take charge of integrating technology into the life care planning process.
Use of Computers in a Life Care Planning Practice
Computers have become an essential tool for the life care planner. The recent generation of computers with very fast processors gives significant computing power to the small- or medium-size business. Current computers with their speed and improved operating systems allow the small company or solo practitioner to execute very sophisticated programs that were beyond consideration a few years ago.
Now it is possible to use software programs to accumulate all case management information resources and easily identify specific vendors, recommendations, and costs for items in a life care plan. Once resources and vendors are identified in an informational database, faxes can be quickly generated that allow the professional to contact potential vendors for current charges. Upon obtaining the specific descriptions with charges and other pertinent information, these items can be easily translated into the traditional life care plan tables or into a customized life care plan report, depending upon the professional’s preference. Retyping redundant information such as the recommendation and vendor is minimized (Thomas, 1994, 2004).
Because there are a variety of report requests, the life care planner is able to provide a report that meets the standards of life care planning as well as the requests of the referral source. For example, a referral source may wish to have a summary of the items and, in some cases, a summary of charges over the lifetime of the client. In the past, the life care plan narrative may have been completed in a word-processing program. If a cost summary involving mathematical calculations were required, it would likely be completed in a spreadsheet such as Excel, or calculations would have been completed manually using a calculator. Now, all of this information can be completed at the same time in one software program.
Once appropriate software is installed, the professional will also become more familiar with multiple life care planning resources available on the Internet. E-mail communication has increased the sharing of information and the development of listservs has become an instantaneous help desk for the life care planner. By using the appropriate computer hardware and software, the life care planner will have a significant professional advantage. However, before the next hardware and software purchase, review the following guidelines in order to make wise decisions.
Computer Purchase Guidelines
- Purchase a computer with a duo-processor speed of at least 2.4 gigahertz (GHz).
- Purchase a minimum hard drive capacity of 500 gigabytes (GB).
- Purchase a minimum RAM (random access memory) of 4 gigabytes (GB) and 6 MB L2Cache.
- Purchase, at a minimum, a 19-inch flat panel monitor. A “square” monitor as opposed to a “landscape” model is recommended. For more efficient use of computer software, consider using two “side by side” monitors. Be sure to have an adequate video card installed.
- Purchase a laser printer with capability for networking. Most laser printers have this feature at the present time. If color photos or text is included, inkjet printers have excellent quality and are relatively cheap. Because of the cost per page, it may be reasonable to have two printers: one laser for prints and speed, and the other for color needs. Also, some all-in-one machines might be useful for color copies, color printing, scanning to .pdf files or photo files, and faxes.
- Utilize a DSL line or cable modem for access to the Internet.
- Network your computers at the office or home with an Ethernet network. Consider using the wireless networking referred to as Wi-Fi. But remember to have encryption on your Wi-Fi system.
- The most popular operating system is Windows 7, for now. There has been much discussion regarding the windows 8 system, and many people have chosen to stay with 7 “until the next OS come out.” Have your staff trained on the Windows 7 operating system.
- Purchase an uninterruptible power source (UPS), which usually costs between $100 and $200. The UPS prevents sudden power outages on the computer and network equipment. Sudden power outages can result in loss or corruption of data. The UPS also serves as a surge protector.
10. Select a quality company from which to purchase computer and software products. Choose either (1) a reputable company, preferably one that will offer a 30-day, no-questions-asked, money- back guarantee; or (2) mail order through a national company. Mail order companies such as Dell (800-424-1370) and Gateway (800-846-2059) offer a wide variety of products. Consider a 3-year support contract that includes toll-free 24-hour technical support. The cost of this additional service is approximately $200 and, in this author’s opinion, is a very good investment.
11. Select a good data backup system and have a thorough understanding of its use. Some users install the data backup system with the hope it will never be used. Unfortunately, the user may not test the backup system until the dreaded hard drive crash occurs. One important quality of a backup system is that it is convenient and easy to use for both storing and restoring data. Utilizing a DVD burner is one method to archive data on your computer. Another is to purchase a USB portable hard drive, which could easily have the capacity to be a complete duplication of the main desktop computer. This option also offers the opportunity to take your “computer” with you by attaching it to a laptop. And don’t forget to have an offsite copy of your data.
12. Also, have a regular backup schedule for your data files and place the data in an offsite location, such as a safety deposit box, on a periodic basis. This may seem excessive, but I strongly recommend this consideration.
13. In choosing your backup medium, use caution if you purchase a dedicated backup external hard drive with a proprietary compression or encryption system. Such systems work well today, but in 5 years the proprietary encryption system may no longer be supported.
A DVD burner holds approximately 4.6 GB (or 8.5 GB) of information (approximately 6 to 12 regular CDs). One of its advantages is that the DVD can easily be read by other computers. This allows the user to save large files and then place the DVD in a safe location. Also, the professional can use a DVD or CD to mail data to other locations when it would not be practical to e-mail a 60- or 80-MB file. Another advantage of the DVD is that it allows instant access to archived files. A DVD reader/burner is typically a part of the computer system. Successful life care planners recognize the ongoing need to protect their investments with appropriate staff training and data backup technologies.
Software used to assist professionals is abundant in today’s technology. Word-processing programs such as Microsoft Word are a necessity for any office. Database programs that allow the user to design templates are also becoming popular. Such database programs include Microsoft Access and FileMaker Pro. The professional may also explore spreadsheet capability and presentation software such as PowerPoint if the practice needs these. In addition, software programs incorporating the CPT codes (copyright by American Medical Association) are available on CD from many publishers. A simple “CPT code software” Google search quickly yielded thousands of hits referencing companies with products for sale.
While much of the software currently available is designed for home health agencies, specific software for case management and life care planning is now available.
Several software programs are available for the life care planner:
■ Ann Maniha offers a life care planning program designed to work with Microsoft Word or WordPerfect.
■ Computer Methods offers an online program for report writing, See www.LIFECARE WRITER.com.
■ LCPStat software for life care planning was introduced in 1993 by TecSolutions, Inc. and recently released version 7. See www.LCP3 .com.
■ Legal Nurse Consulting Practice, LLC offers the Legal Nurse Systems Suite of Software for life care planners. See www.legal nurse systems .com.
■ SaddlePoint Software, LLC offers PlannerPro! Plus, a program that provides tools for the life care planner. See www.saddlepoint.net.
■ Total Life Care (TLC) software by Compensation Economic Information Systems was made available for purchase in 2003. See www.reh abserv .com/tlc.htm.
These programs should be carefully reviewed by the life care planner considering a specialty software package for life care planning. The program should offer the user the ability to organize data and generate reports in an efficient and reliable manner. Such programs would also be a business advantage to those individuals using technology and life care planning. As with any software used in forensic settings, the user should be aware of any Daubert implications and be prepared to answer questions about the software from a Daubert standpoint (see the post on this website by the plaintiff and defense attorneys).
Another type of software that would be advantageous for the life care professional is a voice recognition technology (VRT) program. VRT is not a new concept; however, it has become popular because tremendous strides have been made in VRT, and computer hardware and software programs are now available at reasonable costs. VRT programs allow the professional to speak into a microphone and the computer will “type” at a rate of 50 to 125 words per minute with approximately 95% accuracy, increasing efficiency and reducing overhead in this high-technology approach to office tasks. Most VRT products are compatible with the major word-processing, spreadsheet, and database programs. Feedback from life care planners reflects the general history of VRT—it is a mixed review. Some life care planners give a favorable report on the use of VRT; others have had a poor experience. One issue is that words are occasionally misspelled. Actually, the word is spelled correctly, but the VRT understood a different word than was intended! Therefore, editing a report is more challenging.
Also, Internet-related software includes a variety of programs such as Real Audio, a software program that allows the user to listen to music or speech from an Internet site. The audio capacity will become more important as continuing educational programs and distance-learning strategies are introduced by professional associations and universities.
Computer Operating Systems
Most life care planners will be using the Windows 7 operating system by Microsoft. Some of the software used by life care planners can be used on either the Macintosh or Windows operating system. However, most life care planners utilize the Microsoft operating system. With any of the new generation of operating systems from Microsoft and Apple, the user can access the Internet, receive e-mail, download files, and research the various databases. Although there has been concern over the future of the Macintosh computer and Apple Corporation, based on relatively recent product announcements, it is probable that the Macintosh operating system will remain a viable operating system for many years to come.
Networking refers to the ability for several computers, in an office or at separate locations, to be electronically connected. The decision to network has become an easier one to make. Prior generations of computers were difficult to network. Windows XP/Vista and Macintosh have significant network capability built into their operating systems. For offices that have four or more people using the Internet or sharing the same life care planning databases, establishing a local area network is essential.
Once the decision to network is made, establishing the network should be relatively straightforward. A cable specialist will run cables, and a software specialist will set up the protocols for the computers to talk to each other. The user should be certain to ask that firewalls be installed to prevent unauthorized access to the computers via the Internet. Your computer consultant can advise on the most appropriate firewalls (protection from computer hackers and viruses). And the user should be careful to save the various passwords associated with the modem and firewalls in a safe and secure location.
There will be a moderate cost for the initial network installation and associated hardware and software. There are also other costs involved such as ongoing maintenance and upgrades. In addition to the costs for the initial technology purchase (i.e., specific hardware or software products), there is also a commitment to staff training and development in the use of the network.
Using the Internet as a Resource
The Internet continues to grow in both volume and quality of information. It has become a useful medium for life care planners to locate medical specialists and resources (Thomas, 1996b, 2004). In addition, most medical centers have home pages that allow users to learn of services offered by specific facilities and to contact persons in these businesses. Data regarding specific medical fees/ charges by CPT code have become easier to obtain over the Internet. Charges by DRG can be obtained but less useful in many cases than would be charges by CPT codes.
For life care planners that have already attempted to find information on charges, there are software programs that provide charge by CPT codes. PMIC offers Medical Fees in the United States 2008, an eBook in .pdf format. See http://pmiconline.stores. yahoo .net/mefeinunst203.html.
Medical charge information is often proprietary, and the publishers charge a premium price for the information in both printed form and access over the Internet. It is probable that databases with medical charges will eventually become available on the Internet. For example, one experienced professional has developed a Web-based site to assist with sharing of life care planning data in partial answer to this problem (www.care planners .net). In addition, TecSolutions, Inc. offers a CPT lookup database that reflects CPT descriptions, Medicare allowable fees, and Medicare allowable payments to ambulatory surgical centers and outpatient hospital surgery departments (see www.LCP3 .com). Note that CPT is a registered trademark of the American Medical Association.
Since the CPT codes and descriptors are copyrighted by the American Medical Association and are not in the public domain, all companies that utilize the CPT codes have to pay a royalty to the AMA.
The Internet will continue to expand access to medical and legal databases. Some of these databases, such as HCUP (www.ahrq .gov/data/hcup), have excellent medical charge information that is free of charge, whereas other databases are proprietary (see www.ahd .com/subscriptiondetails. html) and have an associated fee. A general rule of thumb is that any printed information requiring payment will also require payment when obtained over the Internet.
Two useful websites are
■ Healthcare Cost and Utilization Project (HCUP). (For inpatient hospital charges based on ICD 9 Cm procedure codes or ICD 9 Cm diagnosis codes; http://hcupnet .ahrq .gov.)
■ CPT Code Medicare Fees by location. (From the American Medical Association’s website, https://catalog .ama-assn .org/Catalog/cpt/cpt_search.jsp?locality=XX.)
Internet Access Providers or Internet Service Providers
Internet service providers (ISPs) are prevalent in nearly all areas of the United States. Use of ISP has become easier with the introduction of DSL and cable modem service. DSL and cable modem services provide unlimited access to the Internet, but with limits on how much data the user can upload. DSL providers typically limit the upload speed and allow higher download speeds. In contrast, cable modems typically do not cap the upload speeds; therefore, at times you may have fast download and fast upload speeds. But cable modems are similar to a telephone party line—if several people in your neighborhood log on to their cable modem, the download and upload speeds will diminish. In addition, companies such as Verizon and AT&T offer wide-area wireless broadband service for laptops in most metropolitan areas.
Internet Search Engines
Search engines are proprietary software programs that are accessed via the Internet and allow the user to list and enter keywords for topics to be researched on the Internet. The search engine will review its database of Internet sites and provide the life care planner with domain names and uniform resource locators (URLs) of sites on the Internet that have information related to the keywords. The life care planner can access a particular site by clicking on the site name. There is no charge to use the more popular search engines such as Google.com and Wikipedia.com.
E-mail is another primary use of the Internet and most life care planners are well familiar with this technology. E-mail means sending an electronic message to someone else that has an Internet or other e-mail address. This approach offers many advantages. For example, even though the U.S. Postal Service can deliver the same message, the exchange via e-mail occurs in a matter of seconds. Therefore, sending e-mail is essentially instantaneous, and typically there is no per message charge for e-mail. Also, once an account with the Internet provider is established, the user can send unlimited messages (Thomas, 1996a). Most Internet e-mail programs limit the size of attachments. This can affect sending large documents or high-resolution photos. For documents that exceed your Internet e-mail attachment limits, companies such as YOUSENDIT (see www. yousendit.com) offer the ability to send large documents (up to 2 GB) for a fee of about $10 per month (Pro Account).
Videoconferencing has become readily accessible to most Internet users in the past few years. As life care planners continue to purchase computers with faster processor and Internet access speeds, video compression programs are also becoming more effective. As a result, acceptable- quality videoconferences are available over the Internet. Video quality will not be that of a television, but video on the computer screen will provide acceptable viewing for communication.
Significant commercial value has been placed on videoconference software. Corporations (and life care planners) spend a significant amount of money for staff traveling to face-to-face meetings. The value placed on the face-to-face meeting is so significant that the life care planner and others will pay premium prices for reliable videoconference software and hardware.
In summary, technology has a significant impact on the life care planning process. Technology continues to evolve that will allow more efficient and accurate completion of life care plans for individuals with catastrophic injuries. Computer hardware and software will allow quicker processing of reports and locating of appropriate resources. Use of software such as word processing, specialized programs for life care planning and case management, sources of information, and data on CD-ROM/DVD/Internet will continue to increase.
Implementing the use of computers and software into life care planning is more than simply buying a computer. There must also be an appropriate computer system, including hard drive capacity, processor speed, software, backup system, software/hardware maintenance, and staff training. Since data that are becoming available are more comprehensive, additional computing power will be required to process this data at a speed acceptable to the life care planner. This post contains guidelines and other information to encourage the successful integration of technology and life care planning and to provide the life care planner with necessary information.