Home Health

HEALTHCARE SOLUTIONS
Palm handhelds treat home health ills
By Christine Harland Williams

If the most unappealing part of your workday is devoted to filling out paperwork, join the club--the club of workers in the field using Palm handhelds, that is.

During today's nursing shortage, this presents an interesting challenge for the company--how to attract qualified clinicians and prevent them from leaving the profession due to too much time filling out forms and not enough time spent with patients.

Compare your paperwork to these clinicians and you'll understand their pain. On average, a routine visit generates at least 3 forms: one to document nursing care; one to document time and attendance; and another that could have to do with physician order changes, supplies orders, managed care visit authorizations, or interdisciplinary communiqués.

With up to seven patient visits per day, the task of completing these forms and getting them quickly to the central office for transcription is a daunting one.

In addition to addressing these issues, home health administrators wanted a way to improve the resources available to nurses caring for patients at home, and cut the amount of time clinicians spent traveling to and from their home offices to drop off paperwork. They also wanted a faster way to gather information and make it available to clinicians in the field and management, both for patient care and for trend analysis.

The treatment: Palm mobile field service solution
In January 2001, Jeneane Brian, nurse and CEO of VNAHHS, used Pendragon Forms to create iForms, a custom software solution running on PalmIIIc and PalmIIIxe handheld computers as well as Handspring Visor handhelds running the Palm OS.

By March, the solution was being tested by clinicians in VNAHHS' high-risk infant homecare program. Four months later, Brian began to use the Internet version of Pendragon Forms to support multiple users. VNAHHS now has over 100 visiting nurses using Palm Powered handhelds with the remaining clinicians to be phased in over the next 6 months.

Clinicians use their home PCs or wireless modems to synchronize their handhelds with the VNAHHS' central database each morning. This provides up-to-date information about each patient that can be referenced on the handheld throughout the day.

SSL (Secure Sockets Layer) is used to protect data transmissions, and each clinician has password access that determines the areas and features she can use when accessing the central database. The transmissions are encrypted, and Medicare has approved the electronic signatures used.

During a patient visit, clinicians can use their handhelds to access patient information and medical resources like the drug reference and interaction application LexiDrugs, giving them valuable decision support right in the field.

Following a patient visit, clinicians can complete the electronic nursing forms from their handhelds, and upload the information to VNAHHS' servers using a modem. Over the next 24 hours, they can access that form from their home PCs or handhelds to edit and complete unfinished forms. This new process saves the nurses time and simplifies information collection and management for VNA. It also enables up-to-date communications with the care team and home office. Forms are also used to guide questions and answers.

Field staff has permission to view and edit only their own data, while managers can view all data transmitted by their staff in addition to their own data. Managers use a Microsoft Access-based interface that's different than the clinicians use, which allows for queries of data for analysis. Visual Basic is also used to create reports and display information.

Handhelds produce many health returns
Thanks to Brian's innovative use of handhelds, VNAHHS has improved documentation accuracy, clinician satisfaction, and point-of-service decision support. The solution is largely credited with a 37% increase in employment applications by clinicians between January 2001 and June 2001. The company has also recorded a five-fold decrease in reporting turnaround time, and a 50% reduction in paperwork.