There has been a drastic change in how hospitals and ambulatory clinics do business. Utilization management software is a form of healthcare management system used by hospitals to ensure enhanced delivery of services and quality patient care.

The software captures and organizes data, reconciles inconsistencies, and drives efficiency. It helps to reduce costs by monitoring utilization patterns, identifying waste, detecting duplication of treatments, and preventing fraud. Hospitals and ambulatory clinics can optimize and control the use of resources, including labor, equipment, space, and personnel. Here are a few tips on utilization management software to enhance your operational efficiency.

1. Identify Your Goals

What do you intend to achieve by using the software? How are you going to use it? What information do you need to collect and why? The answers will help determine what features you need in the software. Set clear goals and priorities. Write them down and make sure they are realistic. The best utilization management software has capabilities that help you meet and exceed your goals. You may not need all the features offered in one software. Some goals may include reducing hospital patients’ average length of stay, using certain expensive items, or increasing total revenue by driving more profit from each procedure.

2. Implement Automation

Automation is the key to measuring and managing your resources. Some systems can be programmed to automatically track units of measurement, procedures, medical supplies, or diagnostic imaging reports. Complex processes can be automated and simplified so staff can do those tasks that take less time. Automating tasks ensures accurate data collection and manages the number of hours staff spend on repetitive activities. Look for a solution that can be configured to fit your processes and help you reduce manual data entry. Your system should be able to automatically capture data from various sources, including the health information system (HIS), resources management, clinical record, and others in real-time.

3. Enhance Teamwork and Communication

Teamwork will help you achieve your goals. Develop processes with your staff and set goals to achieve them. The different departments in a hospital or ambulatory clinic operate as independent units with their own specific goals and objectives. The various teams manage different clinical categories, such as department management, medical staff, and hospital administration. Encourage teamwork and communication by sharing department information, data, and best practices. Providing staff with a central location for all resources helps them view the bigger picture of their department and the general hospital or clinic. The utilization management software should integrate with these various systems to allow information to be shared.

4. Leverage Technology

Your team requires laptops, PDAs, and smart devices for communication and mobile access to the utilization management system. Make sure there is on-demand access, both in and outside the hospital. Remote access ensures that all team members are connected to the network no matter where they are. Cloud storage capability provides you with control over data storage and easy backup and recovery in case of system failure or damage. Invest in high-end hardware and software such as touchscreen technology, multifunction printers, digital cameras, and smart devices capable of accessing and processing large amounts of data. A secure Web interface is also helpful for team collaboration and communication.

5. Evaluate Performance

You need to track your performance with each measure you input into your utilization management software. Set weekly, monthly, quarterly or yearly benchmarks for your data collection. You should also identify and clearly define your process measures to improve performance. Ask questions such as “How do we know we’re doing a good job?” to encourage best practices and improvement programs. Assess your performance and measure improvements. Compare your data to benchmarks and previous records. Evaluate how you are doing by using the trends in your data. You can use this information to identify areas that need improvement or to help verify significant improvements. After evaluating your performance, create a clear action plan. The plan should include measurable interventions that will be used to achieve the targets you set.


New digital solutions are entering the healthcare industry to help meet the challenges of rising healthcare costs through better standards of patient care. With an eye toward performance, these solutions are being used by hospital systems and Payers to create a competitive edge and ensure they deliver the best possible healthcare value to their patients. By moving beyond paper-based interventions, healthcare organizations can maximize the potential of their data to drive better decisions that improve operations throughout the organization.

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