OASIS data scanning technology: Is it right for your agency?

A look at scanning technology and what it can offer your agency

While the verdict is still out on when home health agencies must submit OASIS data to the Health Care Financing Administration (HCFA), there are some grim, inescapable realities: The time is coming, and it’s bringing more work with it. No surprise then that agencies are searching for ways to ease this increased burden on their staff without breaking budgets already frayed by the interim payment system (IPS).

One possible source of help: HCFA is offering the data collection software program Home Assessment Validation ENtry (HAVEN). (See box, p. 16.) However, don’t start celebrating yet, cautions Robert W. Anderson, CEO of Windham, NH-based Continuum Care Technologies Inc., a firm specializing in automated database collection for the health industry.

"It’s a major fallacy to think that HAVEN will give you data reports and clean them up. It’s just for data entry," he says. Whether it will ease any burdens is debatable.

One of the more obvious — and, at first glance, easier — means of collecting and submitting OASIS data is using scanning software and technology. Anderson notes at least one benefit is the perceived cost savings for agencies using scanning software.

"With less handwritten information to be entered, you can use a less-skilled person than you need for data entry. So once the clinician becomes accustomed to the forms, within three to four months a system could have paid for itself and then start pouring money back into the agency over time," he explains.

Scanning at work

Certainly the idea of running your aides’ forms through a scanner and having the data magically appear in your computer, ready to be submitted, is appealing. But if you think that with a flick of a switch your problems will be solved, think again. In reality, getting the most out of scanning technology involves careful planning, training, and money. So before you rush to the nearest software vendor with an order in hand, take the time to investigate all your options, scanning and otherwise, before making what amounts to a costly decision. (See list of vendors, p. 15.)

Scanning software does what the name suggests. It scans information, then interprets and translates it before dumping it into a computer file ready for further use. There are two basic varieties: image scanning and data scanning (with data, in this case, referring to written information that will need to be manipulated).

Image scanning has eliminated the need for publications to paste in photographs where needed. Just run the slide or picture through a flat-bed scanner or its equivalent, save the image as a file, and insert where needed. From there, if the graphic designer wishes, the image may undergo myriad changes to where the original image is no longer recognizable.

While the number of actions that can be performed on the image are countless, the one constant is that the image is considered a single entity. Portions of the picture may be lightened to make the background appear sunnier or a stray bit of lint removed from a lapel, but in either case the image is considered as one unit.

Points to consider

This one-for-all system is hardly useful when it comes to entering written data sets, portions of which may be needed in other programs or files. In such cases, scanning a form in the above-mentioned manner would prove a dismal utilitarian failure — you could see the form, lighten it, change its colors, and even cause it to appear as if it were melting, but you couldn’t access the individual bits of written information and link it to other programs or files.

Instead, scanning written information requires an interactive system that allows the user to access certain portions of the data without interfering with or disrupting the original data set.

In this method of scanning, information can be collected in one of two ways, explains Joe Cortese, director of management information systems at Montefiore Medical Center Home Health in New York City.

"The first is an optical mark sense, like the SATs you took to get into college. You fill in a circle, and [the software] can sense if a mark is there or not and where it is. It doesn’t require too much interpretation. The second is optical character recognition, where you have a box and the person is required to fill in a number or letter," he says.

Typically, explains Cortese, these scanners will "look like a little Photostat machine, where forms are self-fed into a data base via a built-in feeding mechanism."

When deciding upon a scanning system, several factors come into play: Price is one, and service is another. Cortese says that in his search for a scanning system he has come across prices ranging from $6,000 to $8,000 for just the software. Add in the cost of a scanner, which can run anywhere from $800 to twice that amount (Cortese suggests buying two to ensure a backup), and the cost of an up-to-date PC, which can run upward of $2,500.

"The whole package, just to get you started, can easily be a $12,000 investment, depending on the bells and whistles," says Cortese. "We’re not even talking about having personnel to deal with errors and run reports or about clinicians’ time."

Anderson suggests companies follow a few basic guidelines when deciding how much to invest.

"The cost of the software will be the same regardless of agency size," he says, "but the hardware is totally a function of agency size. For a small agency it makes no sense to spend a lot on a scanner. If you have about 250 patients and are using single-sided forms, you can get away with a $600 scanner, which scans about 10 pages a minute and can hold 30 sheets of paper in the document feed. But if you have between 500 and 1,000 patients and are using two-sided forms, you’ll need a $4,000 scanner."

With more patients, Anderson suggests investing in a $6,000 or $8,000 scanner. The first is capable of scanning 100 images a minute and can hold up to 300 sheets of paper in the document feeder, he says.

Error handling is another important consideration when selecting a scanning system, notes Cortese, because it’s the nature of the beast for errors to crop up. Referring to the optical character recognition system, he says, "It has to think about it and make a judgment call: Is the number three a three or an eight? Here you’ll have an error rate."

What the exact rate is depends on the method, he continues. "The success rate with the mark sense’ is 99.5%, but when you start introducing character recognition with digits from zero to nine, you drop to a 95% success rate," he says. "If you add in the alphabet, it’s down to an 85% success rate."

What happens when mistakes are found?

Before handing over a check, Cortese cautions shoppers to ask how a particular system will cope with mistakes. Consider this, he suggests: "If you were only supposed to mark one answer, but two are marked, then what happens? Will the software allow you to proceed with the batch and deal with errors later, or will it stop you dead in your tracks and ask the question then?"

Myra DiBlasio, BSN, RN, Rx clinical manager of Home Care Information Systems, in Bloomfield, NJ, explains that her company’s system deals with errors as they arise. "Our software will ask questions about what needs to be verified to make the data clean. If someone has crossed out an answer and written in a new one, the software will stop and ask which is the correct answer. The clerical person, then, can fill in the correct, final answer."

When questions concerning handwriting occur, the system uses a handwriting recognition program. If there’s a doubt as to a numeral or letter, such as is it a seven or a one, DiBlasio says "the computer will stop and ask for verification. The person then can look [on the original form] and tell and verify it in the computer."

As for forms, Anderson says agencies should insist upon software vendors providing updated forms, free of charge and within the timeliness that HCFA requires. Moreover, he says "agencies should always have control of the forms. They should always be yours, and even if you take the standard set, you should be able to make changes either internally [by the vendor] at no cost or send them and have the changes made cheaply and quickly."

Beware of systems that seem too good to be true. Mark DeLauro, RN, applications and case manager for Guthrie Home Health, of Towanda, PA, came across a seemingly great deal that only required his nurses to fill in the OASIS data forms by hand. "For $995 a year, they would send you a master copy of each OASIS form and your printing shop prints them up," he says. "Then you fax the completed forms back to them and they submit the data for you. The only problem was that whenever I called for more information I couldn’t even pin them down on their fax number."

Trained and true

Don’t forget to look into training programs, notes DiBlasio, when considering a software package. Her company offers education on ORYX and OASIS compliance, as well as use of the scanning software. "We offer more education about performance measures . . . and how to use them as something valuable to the agency, so it goes beyond just the technical aspect," says DiBlasio.

Anderson says his firm spends more time training users in the basics of Windows and the OASIS process since often someone in billing does the scanning. "If we have an administrative person who understands word processing, then the training needed is minimal to run the software," he adds.

Duluth, MN-based ScanHealth doesn’t expect training will be necessary, says Michelle Wiklund, vice president of marketing. "Users will receive a complete user guide, and because our system is so intuitive, we don’t anticipate the need for training."

System integration should also be considered. DiBlasio’s firm only sells its scanning solution to pre-existing clients.

"If you’re buying an add-on system that doesn’t interface, you’ll be adding a lot of extra data that you don’t need," she says. On the other hand, an integrated system incorporates data from different files so when printed, the first few pages of a client’s chart are already filled with the demographics.

ScanHealth’s Home-Solutions system doesn’t require agencies to use its other systems to be integrated. "We can be the front end to a back-end system," says Wiklund, "so if the file structures are matched, you can readily import and export data."

Error rates, to be sure, are part of the drawbacks of scanning technology as is its relative newness to the health care scene, she notes. "With scanning solutions, you need to be aware that it’s relatively new on the playing field, so there’s no track record. It’s not an automatic win-win deal."

DiBlasio agrees, up to a point, adding that scanning technology is "fairly new to home care but not to the general public. There are a lot of other places where scanning has been used for years, but we’re just now taking the technology to home care where it’s needed."

She agrees that scanning technology may not be right for everyone, with agency size being a key factor in determining whether the investment will pay off. "The regulations are going to say that information needs to be in the computer system and locked within seven days. It sounds easy to get the information in, but remember that also includes follow-ups and discharges.

"Since you can’t predict how many you will have in a given day, to do manual entry is a little risky. Moreover, state training specifies that this is one of the big things they will be looking at: Did [the agency] get data in within seven days? With scanning solutions, you can get it in a day because it’s a matter of sticking [the form] into a scanner, and it’s in. It can be verified in the system, and once verified, it’s locked and no one can touch that information," DiBlasio adds.

The purchase of scanning software and the related equipment is not something an agency should rush into, if at all. What is right for the large, urban, hospital-affiliated home health agency may not be right for the smaller agency linked to a small, rural hospital. Whether to take the scanning route is a decision only you can make. (See related story, p. 16.)

"It’s not such a mature technology that it’s always right enough to make it worth the while," Cortese says. "There are the costs of technology, technical supervisors, and maintenance. They all must be weighed against the cost of not using it to see if it will be worth it."

Sources

Robert W. Anderson, CEO, Continuum Care Technologies, 63 Range Road, Suite 202, Windham, NH 03087. Telephone: (800) 568-0351.

Joe Cortese, Director of Management Information Services, Montefiore Medical Center Home Health, 1 Fordham Place, Suite 100, New York, NY 10458. Telephone: (718) 405-4401.

Myra DiBlasio, BSN, RN, Rx Clinical Manager, Home Care Information Systems, 300 Broadacres Drive, Bloomfield, NJ 07003-3153. Telephone: (973) 338-2020.

Mark DeLauro, RN, Applications Manager/Case Manager, Guthrie Home Health, RD1 Box 154, Towanda, PA 18848. Telephone: (800) 327-8039.

Michelle Wiklund, Vice President of Marketing, ScanHealth, 4313 Haines Road, Duluth, MN 55811. Telephone: (800) 871-7310.