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Automation accommodates flow of information
The four technological devices described here represent a smattering of the products that hit the market every month. We selected them because they represent innovations that expedite information flow across the continuum of care.
These products are also good examples of how automatic data collection will improve the ability to monitor and care for patients.
Cyber-SIGN electronic signatures and biometric signature verification. Founded in 1996.
Description: By signing their name on a "digitizing tablet," clinicians may sign off on medical records and orders from an off-site computer. A digitizing tablet (approximately $35 each) beside a computer keyboard can transmit signatures to medical documents and replace the mouse to drive the computer, according to Cyber-SIGN spokesman Dennis Quiggle.
How does it work? For biometric signature verification, the user provides three sample signatures at sign-up. Since people never sign their names in exactly the same way twice, three signatures capture variations. A secured Cyber-SIGN server creates and stores a template of composite data from the original signatures. Each time a user signs an electronic document, the server compares the shape, speed, stroke, pen pressure, and timing of the motion to the data stored on the secured biometric template. Once authenticated, the sign-off is complete.
A physician may write and sign orders from a computer terminal at home, in the office, or on another floor of the hospital. The system also handles faxed orders. For example, if the pharmacy faxes a suggested meds adjustment for a patient, the doctor scans the fax into his or her computer. The image of the order change comes up on the screen. The doctor signs it and sends it on its way. For health care organizations with electronic records, the biometrically verified signature is an added layer of automation and security.
Key benefits: Biometric signature authentication replaces passwords and personal identification numbers which can be forgotten, shared, or stolen. Remote log-on can shorten order-to-patient care cycles and speed the billing process.
Who uses Cyber-SIGN? Several health care systems are currently exploring the application, however, it is not yet on-line in this industry. "The application is keyed to the smaller hospital," Quiggle notes. The system is in use in the banking community.
Cost: A one-time fee of $2,750 covers development of the platform to integrate Cyber-SIGN with the user’s existing application. The turnkey system works with software setups based on Word, WordPerfect, Lotus, and, for a slight extra cost, Adobe Acrobat. After platform installment, the per-user cost for a two-year license covering maintenance and upgrades starts at $35 each for up to 10 authorized signatures. As the number of authorized signatures increases, the per-signature costs decrease.
For information: Cyber-SIGN, 2635 N. First St., Suite 103, San Jose, CA 95134. Telephone: (800) 876-4605 or (408) 324-1001. E-mail: info@csign. com. Web site: www.cybersign.com.
NEON Physician Access, by New Era of Networks Inc.: Patient information via secure Internet site. Founded in 1994.
Description: The system, driven by a Web browser, provides physicians with a consolidated view of patient data on a familiar-looking screen. Users may update patient files as well as place orders through the program. (See NEON Physician Access screen, below.)
How does it work? The Physician Access browser pulls information, which health care enterprises often store in multiple applications, onto a Web page. Web pages are created for each authorized user. Test results, order status, medication profiles, and other data are available on easy-to-use screens. Each user sets up criteria for filtering information delivery, such as all abnormal lab results or status changes within the last 24 hours.
Doctors may enter the system through their health care organization’s network or through the Internet. Entry requires a password and log-in name. Access is secured through two types of encryption which have satisfied the criteria of clinicians in organizations currently using the program. Confidentiality protections meet the Joint Commission on Accreditation of Healthcare Organizations’ security requirements.
Key benefits include point of entry to data stored in multiple software formats and elimination of changes in existing departmental software programs. Product delivers real-time information to users’ Web pages, thus reducing the occurrence of redundant tests and treatment delays. The system requires little or no training because it displays information through a browser.
Who uses NEON Physician Access? Baptist Healthcare System, Information Services Department, Louisville, KY.
Cost: Base price, $50,000.
For information: New Era of Networks, 7400 E. Orchard Road, Englewood, CO 80111. Telephone: (800) 815-6366. Web site: www.neon soft.com.
SmartRack Systems for ambulatory care. Founded in 1992.
Description: The wall-mounted devices, resembling ordinary chart racks, automate and collect data on each hand-off in the patient flow process.
How does it work? The SmartRack System activates when an employee puts a "patient token" into one of its slots. A patient token might be a chart, a super bill, or a form. The slot has sensors programmed to read and record the insertion and removal of patient tokens.
The sensors trip communication devices to notify the appropriate person that a patient is waiting. For example, if a receptionist puts a patient token in the slot at the front desk, the system alerts the nurse that the patient is waiting. This eliminates trips to the waiting room by nurses to check on patients’ arrivals or wait times. (See SmartRack Systems, p. 130.)
The notification method is the customer’s choice. Options include light signals, pagers, or messages on computer monitors. Once the nurse completes the first step of the visit, the patient token goes into the SmartRack outside the exam room to signal the doctor that the patient is waiting. When the doctor finishes, instead of spending several minutes looking for the nurse to come and complete the visit, notification occurs automatically when the doctor drops the patient token into the slot.
Hugh Deaner, president of Queue Corp., manufacturer of SmartRack, says, "The most important function of this system is to communicate that a patient is waiting. Best practices in hand-offs have not changed in 85 years from the manual system of the red flag at the exam room door. This system manages every hand-off by putting the token into the slot."
In addition to managing hand-offs, the system collects data on the movement of patient tokens through the slots. The user chooses what type of data to collect. Information can include wait times in the reception area, intervals between the time a physician finishes with a patient and a nurse arrives to finish the visit, as well as the volume of patients per provider.
Key benefits: Automatic data collection facilitates identification of improvement opportunities. Users manage and change each component of the system to meet evolving needs.
Cost: Varies depending on the size of user’s system and complexity of data collection capabilities. Each system is custom-built, pre-tested, and installed ready for immediate use.
Who uses Smart-Rack? Regional Medical Center, Dover, OH; Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, NC.
For information: Queue Corp., P.O. Box 350, Chapel Hill, NC 27514. Telephone: (919) 929-0222. Fax: (919) 929-0905. E-mail: queuecorp@mind spring.com. Web site: www.queuecorp.com.
TeleHealth Systems: Automated telephony patient follow-up and disease management. Founded in 1993.
Description: Safekeeping TeleHealth — Women’s Health packages monitor high-risk obstetrics patients and provide post-partum and breast-feeding follow-up. Cardio-TeleHealth packages monitor congestive heart failure, anticoagulation management, and chronic obstructive pulmonary disease. Systems work for home care organizations, hospitals, and ambulatory practices.
How does it work? The PC-based TeleHealth system uses recorded voice files. It asks condition-specific questions and records responses as numbers are punched in on the telephone keypad.
Each two- to four-minute call offers the nurse page option, enabling the patient to talk with a nurse on the same connected call. (See "TeleHealth Systems - Outbound Call Flow Chart," p. 131.)
The system includes triggers for nurse intervention should patient responses indicate problems. The process also works on inbound calls, for which the patient enters customer identification and personal identification numbers. Those codes connect the patient to appropriate question sets for his or her condition.
Users may customize patient interview questions and educational components as well as administrative options. The basic telephone set-up is four lines with expansion capability up to 64 lines.
Key benefits: Monitoring is convenient for patients and cost-effective for health care organizations. Health outcomes improve due to close, regular observation by clinicians. The files are available in multilingual formats.
Who uses TeleHealth Systems? St. Vincent Hospitals & Health Services’ Family Life Center (mother-baby unit), Indianapolis; Memorial Home Health and Hospice, part of Memorial Hospital of Salem County in Salem, NJ.
Cost: One-time fee of approximately $37,500 covers configuration, assembly, installation, and on-site training. The annual license fee for unlimited use is $6,000.
For information: G.H. "Gerry" Roesener, President, TeleHealth Systems Inc., 520 N. State Road 135, Suite M78, Greenwood, IN 46142. Telephone: (317) 535-6161. Fax: (317) 535-6166. Pager: (800) 830-5808. E-mail: groesener-tele firstname.lastname@example.org. Web site: www.telehlth sys.com.