Lean, mean data machine: large New York home health agency transforms itself for success with point-of-care devices and its own internally developed documentation system - Home Care

Health Management Technology, Sept, 2003 by Rick Stazesky

Home healthcare has become an increasingly competitive, low-margin business. According to the National Association of Home Care, Medicare cuts have resulted in a reduced number of home healthcare agencies nationwide. Agencies that have survived have seen their budgets cut up to 50 percent. This has created a competitive environment requiring agencies to adapt or go out of business.

Visiting Nurse Service of New York (VNSNY) has not been immune to these cutbacks. Working to expand our service provisions with a limited budget, we have had to utilize our human and IT resources more efficiently and the information we gather more strategically, all while providing the highest quality of care.

Homegrown System

VNSNY delivers skilled care, including rehabilitation therapy, mental health services and supportive care to a daily census of 24,000 patients in their homes. Ten years ago, we began looking for ways to streamline our operations. As part of this initiative, we began to investigate ways to automate all aspects of caregivers' jobs and reallocate back-office support.

At that time, VNSNY caregivers made their daily visits toting various paper-based files and forms; some medical conditions often required documentation as diverse as their treatments. The caregivers ended up carrying multiple forms and recording most visit information in a narrative format. Once the visits were over, caregivers had to return to their local office to drop off patients' visit notes and receive new information. Business staff at the office then entered the billing information and filed a hard copy of the notes, which were documented with clinical information. This antiquated method of collecting data was terribly inefficient and made reporting and statistical analyses difficult.

We searched for a suitable mobile home healthcare system to automate the entire process. There were prepackaged systems available, but they were limited to handling patient registration and billing. We wanted a system that would integrate the entire clinical documentation process with these functions. We did identify one company that had built a customized mobile home healthcare system, but its solutions were proprietary and would require a long-term dependence, so we decided to build our own.

Point-of-Care Documentation

The homegrown system consisted of a point of-care device from Fujitsu and an application that not only handled patient registration and billing, but also provided a recommended care plan based on physicians' orders and the patient's case history. But we didn't stop there.

We continued to add functionality as more robust technology became available. Today, the process is 95 percent automated. Using the latest generation of Fujitsu Tablet PCs, VNSNY caregivers enter clinical information in a highly structured, electronic format at the point of care. They have on-demand access to patients' records and care plans, drug interaction information and visit notes completed by other clinicians servicing the same patients. They can also use Microsoft Office Suite for e-mail, scheduling and word processing.

By virtually eliminating all paperwork, we have been able to reduce the risk of human error and the need for back-office support. Before initial deployment, the organization needed three business staff for every 20 caregivers. Now, we need one person for every 40 caregivers. The remaining business staff can be used in a more productive customer relationship management role.

Coordinated Care

Unquestionably, the most important benefit of our mobile home healthcare system has been improved patient care. With 95 percent of the patient's case history being meticulously documented and available with just a tap of a stylus, the organization has become a more centralized, cohesive unit. Caregivers can communicate more easily with one another and can use the information gathered to make more informed decisions.

For instance, take Lisa Felszer, a coordinator of care nurse for VNSNY and a member of Adult Care Team 77. On her way to visit one of her patients, Lisa pulls up the patient's recommended care plan on her Fujitsu Tablet PC. The patient is recovering from right hip replacement surgery and is being cared for in his home by Lisa, a physical therapist and an occupational therapist. Lisa is monitoring the wound from the surgery for signs and symptoms of infection and will soon remove the staples. The two therapists work with the patient on muscle re-education and remaining use of his leg's fine motor skills.

When Lisa arrives at the patient's home, she performs a complete examination, updates the patient's case history and completes the visit note, which documents the care she provided. All this patient and clinical data is captured electronically through the system and will later be uploaded to the central database, where it will be shared with the entire care team, including the two therapists.

Although members of Adult Care Team 77 are on different schedules, the mobile home healthcare system keeps everyone on the same page. Each team member has access to the latest patient information, letting him or her know what exactly has been done up to that point and what should be done next.