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04/01/2002

Departments

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Prescription for Results

Roving healthcare providers customize their own handheld solution.

By Allegra Pollock



Time is sacred for most people and home health providers live by this rule. Between filling out paperwork for their patients and driving to and from the home office to drop their documents for filing, there is scant time left to actually provide care. At Visiting Nurses Association Home Health Systems (VNAHHS) in Santa Ana, Calif., home health providers are reclaiming their days by utilizing handheld solutions. Last January, Jeneane Brian, RN, the CEO of VNAHHS, customized a software solution to run on Palm IIIc and Palm IIIxe PDAs, as well as Handspring Visors. This software has allowed clinicians to speed up the process of gathering information about patients and alleviate the need to spend long hours filling out paperwork. I had the opportunity to speak with Brian about the software solution and how it has impacted VNAHHS. FFA: Tell me about VNAHHS. What services do your nurses provide?
Jeneane Brian: The VNA is a not-for-profit home health agency and hospice. We have a community mandate to take care of people in their homes who have suffered from an illness following hospitalization. We also care for patients who need physical therapy in the privacy of their home. Many of our home-health nurses provide care for patients from infancy through adulthood. The only thing we donít do is perform surgery. We are professional nurses, physical therapists and social workers who visit patients and help them recover from an episode of illness. FFA: How does the solution you employed for your nurses help them do their jobs better?
JB: We decided to employ the Pendragon Internet form, a rapid application development software--you buy the software and create your own applications, but you donít have to program. Clinicians receive information from an over-the-counter handheld device--we use Palms. Using the handheld, clinicians are able to bring a patientís entire chart with them to the house. The nurses are able to document clinical information on the handheld using forms already containing the patientís medical information. Nurses then have critical patient history, allowing them to better assess and treat a problem. After filling out the correct forms on the handheld, nurses synchronize the information across a Hot Synch Manager to the Internet or an intranet on the agencyís Web site, to the server and back. Everyday the patientís information is refreshed from the server to the handhelds, and every time the patientís clinician syncs, we receive and update the information. This provides the clinical staff with the most up-to-date information about a patient. There is no longer a need for paperwork--itís all done electronically. Everyone on the care team shares the most accurate information. FFA: Why did VNAHHS choose this solution?
JB: Wallid Yosafi, our IT director, and I are responsible for this system. Wallid was here before I came aboard. He customized a financial system on an AS 400 platform--thatís an IBM platform that we came to rely on and were able to change to our own needs. It was his belief that we try to grow our own solution so we wouldnít have to rely on an outside vendor to make changes and customize our system over time. Plus, there were absolutely no handheld solutions for home health available. We wanted to automate our clinical documentation but there was no software available. Because handhelds had finally become affordable and the Palm operating system is stable enough, we were willing to take the risk. We experimented with rapid application development software and had a couple of false starts. We finally landed on the Pendragon Internet form, starting out slowly and building up. We have been very pleased with the results. FFA: Do the clinicians modify or customize the software? Is it simple enough for them to do themselves?
JB: I wrote the software and made the changes. The nurses meet with me if they feel they need to make a change, for instance if the descriptions arenít laid out the way they want. If enough nurses agree, we make the change. This is software that was built by clinicians for clinicians. FFA: How long did it take to fully integrate the system at VNAHHS?
JB: We started a year ago and tested it on five nurses--now all of our full-time nurses are using the application. We havenít rolled out all of the possible applications, but our entire staff is using the ones we have implemented. We are sequentially introducing more and more complex applications to them. We have 100 users in the field, synchronizing data, using the handhelds. Our internal staff also uses them for time and attendance documentation. FFA: How have clinicians and patients responded to this product?
JB: One of the primary reasons we decided to do this was to reduce paperwork and documentation time, plus driving time back and forth to the office that was necessary to turn in the paper work. We wanted clinicians to be free to see more patients and have a life outside of work. For every hour of home healthcare, there are 48 minutes of paperwork. It was our goal to reduce the time spent with paper in half. The group that implemented the system last January has achieved that kind of time savings. Patients have been curious--when you open up a laptop it creates a barrier between a nurse and patient because of the screen, and patients havenít liked that. Since the nurses can put the handheld down or do some of the documentation after they leave, itís less intrusive and less of a barrier in communication. FFA: Were there any problems with the implementation of the software?
JB: The average age of nurses in our agency is 47, and one of the biggest factors that we faced was that many nurses werenít technically savvy. Our system requires interaction on the Internet--nurses not only needed to have keyboarding skills, but they had to learn how to download files and be comfortable on the Internet. Plus, they had to learn how to use a small device that has a two-and-a-half-inch screen.The training necessary for successful Internet navigation has quite a long lead time. Many nurses had never even used the Internet. Before we included the Internet in our solution, the nurses would input information on the handheld but couldnít see a printed version. This was a very difficult change for them to overcome. They still donít see that piece of paper with the patientís information on it, but they are satisfied because they have information in their hands that theyíve never had before. FFA: Do you have plans to help other VNAs and non-profit healthcare providers acquire similar technology?
JB: We did not develop the system for sale; we developed it for our internal reasons. Itís created so much of a stir that weíve been asked repeatedly about selling it. Iím not comfortable with selling it yet because I have too much work to do before I could. We have had one hospital in San Diego convince me to help create a solution for them. We are going to be helping them use the system for their paternal child program.

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