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Mastering Disability at Internet Speed.
Author/s: Peter Rousmaniere
Use of the Internet as a learning resource for disability management
has been slow. More tools are needed to tame the Internet for the needs
of the average, time-pressured disability professional.
The Internet has been promoted as a learning tool for disability
professionals, insurers, and risk managers since the mid 1990s. The
track record to date appears to be equivocal. On the one hand, the
success rate in using the Internet for learning purposes is uneven. On
the other hand, the disability community is learning how to adapt the
Internet into an effective learning resource for time-pressured
professionals.
These findings arose from an investigation we at Delphi Technology
Inc., of New Brunswick, N.J., conducted in spring 2001. The research was
part of a forecast of trends in information technology for the risk and
insurance industries.
Physical access to the Internet is no longer an issue. According to
informal estimates, more than 90 percent of claims executives, care
managers, and occupational health clinics routinely use the Internet, at
least for e-mail. Among employers, those with less than 50 employees are
well below that penetration rate but are expected to catch up in the
next year or two.
Not much more than 1 percent of policy issuances and claims are
primarily processed on the Internet. So what evidence is there that
using the Internet as a learning tool has become more successful?
The sheer mass of disability-related content on the Internet is
indeed high. This content can be sourced through search engines,
listservs, and portals such as Medline, NCCI, The Reed Group, and Work
Loss Data Institute.
But only a very small share has been custom designed for the
Internet. A relatively rare example is provided by The Disability
Management Employers Coalition, headquartered in San Diego. The DMEC
scripted an Internet version of its Certified Professional Disability
Management course. Currently about 20 percent of all registrants take
the 120-hour course through the Internet. Sharon Kaleta, chairman of the
DMEC, expects that the Internet share will increase to 40 percent
because of the advantages of Internet-based learning, such as
flexibility and a more diverse class population.
Moreover, it is questionable how much of the Internet content is
truly helpful, or even able to be located. Disability professionals
usually learn under intense time pressure. They seek practical knowledge
about a specific topic at the time they need it. Does the Internet
deliver under these conditions?
We set up a test to find out. We chose a medical topic to be
researched. We selected a relatively new surgical procedure, IDET, or
intradiscal electro therapy. Surgeons perform it primarily to relieve
pain symptoms. They insert into a vertebral disk a probe to apply heat.
We asked Suzy Conway, the director of reference at the Harvard
Medical School Library, to perform a for mal literature search to not
take more than 20 minutes. Conway used one search engine, Medline. She
located 10 scholarly articles. Anyone can access Medline. But Ms. Conway
doubts that a disability professional with just average experience in
literature search would have found half of these articles. Access to
research resources on the Internet does not ensure success.
We also asked Corey Fox, Ph.D., a West Hartford, Conn. psychologist
with a full-time consulting practice in pain management, how he would
perform a quick search. Fox said that he would look for treatment guide
lines and pertinent position papers by leading associations. He would
try to locate national experts. He estimated time on the Internet at
about an hour, followed by about 10 phone calls to contact a couple of
experts. Fox believes that success of the search will vary by the skill
of the inquirer in medical investigation.
Dr. Neil Smithline is an occupational health specialist in Sausalito,
Calif., who uses the Internet for re search fairly often. We asked him
to spend 15 minutes searching the Internet. He reported afterwards that
the medical Web sites he frequently visits contained mostly testimonials
about the procedure and little objective information.
Anne Llewelyn is a Miramar, Fla. based independent catastrophic case
manager. She uses the Internet al most daily to research medical topics.
When given the assignment, Llewelyn conducted a search that within 15
minutes gave her enough information to talk confidently with a patient
and physician about the procedure. She finds the Internet a rich
resource of information, but notes that persons with less experience
would not obtain equal results.
Finally, we put ourselves to the test. The results, after 15 minutes,
were poor. We accessed much material but had little confidence in its
reliability or what to do next (on- or offline) to improve the search.
The vastness of content on the Internet is of little value to the
student who does not, and may likely never, accumulate the requisite
learning skills and experience. That is the predicament of many, if not
most, disability professionals.
Standards Needed
We tried to get to the bottom of how outcomes in using the Internet
under real life conditions could be improved. How does the typical
professional have a chance of achieving satisfactory results, perhaps
even the results achieved by experts?
We concluded that to do so, three standards must be met. The term
"PIE" captures these standards. The disability professional
must start the learning process Proximal to her or his normal work
environment. It must occur Immediately, on demand. Finally, the
professional should enjoy the Expectation that the inquiry will be
successful, i.e. effective. For the "E" to be achieved, the
first session has to deliver a big learning gain.
Learning the PIE way can be very productive. Professional tasks can
be completed faster, and learning costs should go down. A brief review
of three very different professional groups reveals how the online
learning experience varies today.
First, consider claims adjusters and telephonic case managers. They
manage many claims simultaneously. They must be informed about a wide
range of legal, medical and vocational issues. They sit at workstations
with a claims or care management software system turned on. With an old
system, the user must research using books, the phone, and an instructed
Internet search. With recently designed systems, much of the learning
takes place on the screen. Some have workflow management tools to alert,
schedule and route inquiries. Users can access large electronic document
libraries, and hyperlink to an Internet destination.
Second are clinicians at occupational health clinics. These workers
must stay informed of developments in medicine and treatment guide
lines. We interviewed Dr. William Newkirk, director of research at
Occupational Health Research, of Skowhegan, Maine. OHR's clinical and
medical management software is installed in about 500 sites throughout
the United States. Newkirk says that improvements in technology have
made it feasible to build into the clinical workstation a multimedia
medical library. This includes not only documents but also videos and
other educational content residing either locally or at a remote site
accessed via the Internet.
For claims, case management and health clinic professionals,
workstations are becoming learning portals. The boundary between content
located on the Internet and on a local storage drive becomes
transparent. Content can be made more relevant to the students, both in
the first hit and for follow-up inquiries.
This is in contrast to the predicament of small- and medium-sized
employers. Safety, human resource and line managers are often under
trained in prevention and disability management. Jon Coppelman, who runs
Coppelman Associates in Holliston, Mass., has supervised safety and
injury management training delivered to more than 10,000 small to
midsized employers in his career. "Training," Coppelman says,
"is usually off-site, removing the student from her or his familiar
surroundings. Training on disabilities has all too often been a matter
of one place, one time, and one course fits all."
"An ideal time for disability training is the hour of
injury," he continues. "We need just-in-time training at these
events. The ideal technological vehicle is an Internet-based first
report system. It would have a workflow-driven debriefing session
attached to it. I have searched the Internet and cannot find disability
training modules that are appropriate. What's out there is old
book-driven pedagogy dressed up in new technology. That is why I am
writing new scripts myself."
A Model Program?
Dr. Barton Margoshes believes he and his colleagues at Liberty Mutual
have found a comprehensive Internet-based learning solution for the
firm's disability professionals.
He runs the medical director services within the Liberty Mutual
Insurance Group. His unit advises adjusters, nurses, doctors, and
in-house attorneys on medical and return-to-work matters. In 1999, the
unit introduced iCase Manager on a corporate intranet. Current in-house
subscribers number 4,500.
The service started by first offering documents online, such as
disability guidelines. As users asked for more text, it was provided.
Then the unit introduced a service to provide an e-mail help desk, which
answers all inquiries by a clinician usually on the same day. As of
early 2001, iCase Manager was handling about 8,500 discreet sessions a
month, and more than 2,000 help desk inquiries have been answered,
coded, archived, and made accessible by direct search. A
soon-to-be-added service will be Internet-based conferences.
The way the service handled IDET reveals its responsiveness. Through
the e-mail help desk service, Margoshes' staff began receiving questions
from claims adjustors regarding this procedure in 1998. After an online
literature search, the service contacted a manufacturer, spoke to
physicians familiar with this procedure, sent a regional medical
director to a training course, and within two months published a claim
management guideline. The guideline included recommendations for peer
review, representative price and coding information, and inclusion and
exclusion criteria.
According to Margoshes, the service has prospered because the content
has been driven mostly by user demand. The archived e-mail questions are
entirely the result of user inquiries. There is no FAQ scripted from on
high. The combination of documents (about 50,000 pages are accessed each
month) and help desk provides the right balance of self-help, fast
response, customization, and knowledge accumulation.
The Liberty Mutual program underscores the importance of helping the
disability professional meet her or his immediate learning goal. But
from what perspective? Books, articles, conferences, Web sites, and
Internet listservs are usually tilted toward one stakeholder group or
another.
With the Internet, it is easier to deliver multiple views of a shared
situation, using a common script. Dr. Jennifer Christian of Webility.md,
located in Wayland, Mass., proposes that training content for disability
prevention and management should be based on common scripts. As one
active in occupational health, insurer, and employer circles, Dr.
Christian finds that in view of the integrity of the overall training
program, as well as for efficiency, common training scripts should be
prepared, and thereafter versions for each stakeholder group.
Assessment and Forecast
Our research has consistently shown that it takes several years to
learn how to master new information technologies. Adaptation of the
Internet as a learning resource has been slow, but so has use of the
Internet for other insurance, risk management and care management tasks.
The Internet needs to be tamed with the needs of the average,
time-pressured disability professional in mind.
It is important to note that claims and care management systems are
the initial learning portal for many disability professionals. The
Internet and these systems should be viewed together as a resource. Our
research findings point to gradual growth in learning through the
Internet. The key trend to track is the emergence learning tools tied to
claims and care management systems. The content in cludes just-in-time
mini courses, reference material, and user-driven
Q and A services.
The payoff from these trends will be internal efficiencies, better
out comes, and greater reach of professionals beyond their disciplines
and organizations and into the broad, complex world of disability
prevention and management.
Rose Hickey is business analyst at Delphi Technology Inc. Peter
Rousmaniere is director of business development at Delphi Technology
Inc.
COPYRIGHT 2001 Axon Group
in association with The Gale Group and LookSmart. COPYRIGHT 2001 Gale
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