Working Wonders - Company Business and Marketing

Health Management Technology, June, 2001

Home health agency saves 500 nursing hours per month and gets paid twice as fast by working electronically.

The drive for efficiency extends beyond the boundaries of metropolitan and urban areas. In rural Belzoni, MS, we have found the need for efficiency through technology to be more pressing than in many urban locations--and the results to be equally significant.

PROBLEM

At Mid Delta Home Health (MDHH), we have always strived for efficiency. That's why in 1994 we adopted the use of scanning and optical character recognition with a variety of forms our home nurses use.

But within a couple of years, we realized we wanted to eliminate paper-based data collection altogether, along with the cost of supporting it. We wanted to eliminate data transcription, which is where up to 95 percent of errors occur. Finally, we wanted to electronically validate data and automate time capture.

MDHH's reach extends 120 miles north of our home office and 40 miles to the south. We have 11 branch offices serving 22 counties, and our nurses service a largely rural community.

Before we went to mobile computing, our nurses had to drive to the branch office to collect forms for patient visits, often more than once a day. They had to complete OASIS and all other patient care forms manually while at patients' homes, return the forms to the branch office, pick up more paperwork or wait for faxes with information about upcoming patient visits. After all that, patient data still had to be manually entered into the system from paper forms. We knew our reliance on paper and manual data collection was slowing us down, but we didn't know how much.

SOLUTION

In the late 1990s, I purchased a handheld device and began contacting vendors listed in its user manual about developing applications for mobile home health computing. At the time, none met my many requirements. One of the vendors I contacted was Jim Connolly of Joey Technologies in St. Petersburg, FL. (Editor's note: Joey Technologies was purchased by JetForm Corporation in November 2000.) For about 10 years, Joey had developed apps for mobile and wireless computing with a focus on collecting data that could be uploaded.

Coincidentally, Jim Connolly's wife was a home health nurse, so he was familiar with the field and the barrage of paperwork home health nurses must manage. He felt MDHH's needs were do-able. Joey Technologies had the software and the development tools to produce the computerized forms we wanted.

Initially, MDHH tried laptop computers but we found them expensive, bulky and heavy. They took a long time to boot and battery life was short. In addition, they housed more applications than our nurses would need.

Eventually we decided upon the cost-effective Clio CE handheld devices. In fact, we actually had to wait for the hardware to mature to run our robust forms applications on their bigger color screens with built-in modems and sufficient memory.

Today we have 20 home health nurses using Clio handhelds for data capture. This represents about 20 percent of our workforce. Following our successful pilot, I anticipate the remaining 80 nurses will be mobile by late third quarter.

TRAINING AND IMPLEMENTATION

Our JetForm forms were so well developed, they looked on screen exactly like the paper forms. That was a big training advantage, since our nurses' computer knowledge varied from power users to those who had literally never touched a computer.

We held a number of in-services at the home office, pairing power users with novice users to promote a teaching/learning environment. We let those most unfamiliar with computing take the devices out of the boxes and taught them how to configure them. We showed the nurses how to personalize a device, acquainted them with basic features, let them play solitaire and use the calligrapher feature to gain a comfort level.

When it came to forms training, our strategy worked. The one factor that power users and novice users had in common was forms--they all had to complete the same forms. We let those with the biggest learning curves practice forms completion using their paper forms right alongside the handheld, so they could see how closely their electronic forms mirrored paper. We conducted all training and testing in December 2000, and put the units out into the field one month later.

Now when a nurse visits a patient, he or she collects data needed for Medicaid or Medicare using the JetForm electronic version of standard OASIS forms. To admit a new patient or add diagnostic assessments, the nurse uses a patient assessment form; to transfer or discharge, she uses forms for those purposes; to report hours, she uses an electronic timesheet form.

At the beginning of each day, the MDHH nurse uses her electronic mailbox to download forms for the patients she will see that day. The application syncs the information for each patient to the nurse's Clio. When a nurse visits a patient for whom an OASIS assessment has been completed, he or she gets only the forms needed for a follow-up visit.