A computer in the hand is worth more to nurses
A computer in the hand is worth more to nurses
System streamlines paperwork, care pathways
(Editor’s note: Beginning with this issue, Hospital Home Health provides readers with a series of features on emerging computer technology for use in the home care industry. We do not endorse one product over another, nor do we attempt to rate products. Rather, we let home health practitioners tell us their experiences with products they have researched and purchased, as in the following story on hand-held computers.)
When Southeast Home Health administrator Barbara Rauh-Powell, MSA, BSN, RN, CNA, went shopping for a computer system, she had one thought: The nurses will have to like it.
Powell knew that no matter how much a system could speed up the agency’s documentation process, if her nurses in the field couldn’t learn it easily, it would be a waste of money.
"If the staff won’t use it, it won’t work," she says.
Her common-sense approach led to a solution the agency’s 17 RNs and two social workers applaud. After researching several other products, Powell decided on the PtCT Home Health Care Documentation and Support System, sold by Patient Care Technologies (PtCT) in Atlanta. The system has virtually eliminated paperwork, giving the staff time to make more patient visits. It also has helped cut costs.
A hand-held computer
At the heart of it all is the PtCT hand-held computer, a portable device about the size of a Game Boy computer game. Specifically designed for point-of-care documentation by home health clinicians, the hand-held computer allows nurses at a remote location to download patient charts, physician orders, and even nurses’ notes via modem.
The product, for which Southeast Home Health served as a beta-testing site, is the result of a collaboration between PtCT, MEDITECH, and Data General.
Weighing just 14 ounces (including two AA batteries), the PtCT computer can be easily stored in a handbag or backpack. Requiring only seven keys for most functions, it can be operated with one hand. The user is guided through a series of preset options that are selected by the press of a button. Neither typing nor computer skills are necessary.
"I looked at about four other systems," Powell recalls, "but they all used laptops. We carry enough junk. This device is very easy to operate, and it interfaces with the hospital’s MEDITECH software."
Before the PtCT system was acquired in early 1994, nurses at the agency, based at Southeast Missouri Hospital in Cape Girardeau, MO, documented everything by hand. "I felt our nursing documentation was not well-done," Powell says, "and was very time-consuming."
Powell elected to try another approach. Nurses began dictating skilled visit notes, and Powell hired secretaries to transcribe the dictation. But this, too, proved time-consuming and costly. "Our documentation did indeed improve in content," she says, "but it still involved a great deal of time and money to produce."
In 1993, Powell’s staff made 9,000 RN visits, costing $47,483 in transcription fees. With the PtCT system estimated to cost $88,262, she realized that it would pay for itself in transcription fees alone in about two years. But there was more.
"Based on information from PtCT and a hospital we visited which was currently on PtCT, we felt we would be able to increase our RN visits by 1,222 using the same number of RNs currently on board."
In 1995, the staff made approximately 16,000 RN visits, says Powell. "And we estimate in 1996 we will do approximately 18,000 RN visits. We did not increase staff RN FTEs during this period. Instead, we were able to add an RN to do quality improvement and risk management."
Nurses have more time to practice nursing
By interfacing with Southeast Missouri Hospital’s computers, Southeast Home Health has streamlined the paperwork and patient tracking processes. "We can generate charges from one system to another; we can download charts from the hospital. Hospital case managers would have access to home health nurses’ notes and documentation. In turn, I can review documentation when the patient is in the hospital. And we can do this as we need to, at our leisure. It saves time."
Because nurses spend less time filling out forms, they have more time to practice nursing, although productivity was never an issue. "Productivity was presented as a by-product of the system that would benefit us in the end," Powell explains.
Powell acknowledges the system isn’t perfect. "It does only a fair job on neonatal," she says.
It won’t print out a graph of a patient’s vital signs, although the graph can be read on the computer screen. PtCT is working on that feature, she says, along with a way to summarize physician progress notes. "They come out in pages, and I hate em."
And an $88,000 price tag might scare off some agencies whose resources are more limited.
But overall, the system gets high ratings from Powell. "The nurse’s aide care plan is excellent. When you print the form it only prints exactly what the aides are supposed to do for the patient. It’s a very specific plan of care," she says.
Mark Braunstein, MD, Patient Care Technology’s CEO, explains: "Her nurses are largely freed from paperwork. Instead of reading and filling out forms, they can begin each day by downloading via modem a patient’s records."
Braunstein says both clinical and financial data are shown in detail, and a nurse simply "toggles up and down [the screen] and picks the right question and answer."
Another advantage, says Braunstein, is the degree of integration made available by putting both the home health agency and the hospital on the same system. "If you are a MEDITECH hospital, administrative and financial discharge data can follow the patient. Visit counts, cost of care, and billing dates can automatically go to the general ledger systems of the hospital. We also send clinical data to a MEDITECH clinical data repository, like lab and X-ray, so it is easily accessible to the doctors in the community."
Braunstein says his organization is working to advance the documentation process even further by creating a seamless system. "As hospitals and home health agencies must coordinate services under managed care organizations, which want to reimburse one time, we think more integration is going to be required."
System avoids duplication of efforts
To Braunstein, seamless delivery of care means doctors, nurses, and home health agencies will use the same clinical vocabulary and pathways for care. "As patients move, everybody reads the same record and plan," he notes. "Not having that duplicates efforts, causing mistakes. We are all trying to drive the cost of care down. It’s no different than any other business: If you have several record systems, you duplicate efforts."
The system at Southeast Home Health includes 20 hand-held computers, one for each staff member, plus four PC workstations for staff, and a workstation for the secretaries. One hand-held computer is used by social services staff, and two are kept in reserve.
The costs break down to $720 for each hand-held device, including software and training. There is a one-time licensing fee of $1,000, Powell notes, as well as an annual maintenance fee of $300. Braunstein points out that the maintenance fee covers not only troubleshooting but also software upgrades.
"Price starts in the mid-twenties [$20,000] and goes up depending on the size of the agency," Braunstein says.
"For continuity of care and safety, it’s excellent," Powell says. "We don’t need double charts any more. When they load the schedule into the hand-held, it can give them the last three to five days of a patient’s chart."
Powell says it takes 20 seconds to access a chart from the telephone at the home. When a patient calls in to the agency, the on-call nurse takes the name and phone number and calls the patient back within five minutes of downloading the record from the hospital computer to the hand-held device. The chart pops up on the screen along with travel directions to the patient’s house. "The nurse can go from wherever she is at the time," says Powell.
Another feature Powell likes is the computer’s ability to automatically change the HCFA 485 when physician orders change. It makes keeping track of medications easier, too.
"If a patient is placed on a new medication, I enter it on the med sheet with the order date, and it automatically prints it on the doctor’s order. The med sheets always correspond with the doctor’s order."
Although the system has been a boon for Southeast Home Health, Powell doesn’t recommend it for everybody. "Don’t buy it if you aren’t going to use it," she advises. "We had one group who came here to look at our system. They bought one and they are thoroughly disgusted with it."
The reason, Powell says, is more the agency’s fault than the system’s. "They wanted it only for a care plan. That’s only a tenth of what it does. Why spend the money? They don’t want to use it. You can’t pick and choose on it. You have to use all of it."
Other agencies might find laptops or tablet computers more suitable, but the PtCT hand-held unit is a comfortable fit for Southeastern Home Health. "After we had used the system for a while, I remember asking my staff what they wanted me to tell the hospital board. And to my surprise, they all said, Thank you. It’s been a tremendous help.’ "
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