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Agency quickly recouped initial expense
No one in home health care will deny how cumbersome it is to rely on paper documentation. For this reason, many agencies have switched to using handheld computers and other types of electronic documentation systems.
However, this can be quite expensive, and it often requires extensive computer training of staff. The Visiting Nurse Service of Rochester & Monroe County Inc. of Webster, NY, has found a third alternative: a telephone documentation system.
The agency, which has more than 600,000 visits a year and is partnered with the University of Rochester Strong Health System in Rochester, NY, first began to look for a solution to the paper-driven system five years ago.
"Every patient seen by a home health aide had a separate sheet, so the amount of paper was astronomical," says Annette L. Mackin, MBA, chief financial officer.
"The document sheet we had in the field was used for billing, payroll, and medical record documentation," Mackin adds. "So the timeliness of getting it and accuracy were paramount because so much depended on that sheet."
At first, the agency had a task force meet to discuss how they could reduce the amount of errors that occurred in documentation. But the task force soon determined that it would be impossible to eliminate all or nearly all errors while the agency continued to rely upon paper documentation. "We began researching various options and decided to develop a telephone-based system," she says.
Defining critical roles is necessary
A committee consisting of representatives from payroll, billing, medical records, clinical care, and managers determined which were the most critical elements for each of their jobs.
For example, the payroll representatives were concerned about obtaining data that they could use to process payroll since the documentation was the basis for determining the number of hours an employee worked. Under the paper documentation system, payroll staff would review mounds of paper each Monday, summarize all the hours, and then send use this to generate checks, Mackin explains.
The new telephone documentation system has a payroll tracking report that collects the hours, the base pay on those data, and interfaces with the computerized payroll system. In that department alone, the telephone documentation system has cut down the necessary medical record filing staff needs by two full-time equivalents (FTEs), Mackin says.
Full-time position, time saved
Another FTE is saved in the data entry and processing department, and it saves managers time in conducting chart audits, she adds.
The home care agency’s information system staff selected the best software to do the job, and the committee developed an outline, plan, and flowchart for how to implement the new system.
"We piloted it with a small group," Mackin says. "We needed to make some modifications to make sure the phone calls were short and that the scripts were accurate and not confusing."
One change that became necessary was in the timing of staff’s calls to the system. Initially, managers wanted staff to call right after they arrived in the patient’s home and again when they left. But that proved unworkable, Mackin says.
"Now staff are instructed to call after the visit or soon after," she says. "They enter the time they arrived, the patient’s number, the employee number, and when they left the home."
Staff call from a regular touch-tone telephone line, dial into the server, and give information via the touch-tone pad. The tasks they performed are coded with numbers that they use when inputting the data. After the employee telephoned in the information, the computer has an automatic validation check that can match the employee and patient with the visits authorized and scheduled to make sure the employee stuck to the care plan.
When the bugs were worked out, the agency added extra telephone lines to handle the documentation calls. The agency’s information systems staff made sure the telephone documentation software was interfaced with the regular computer documentation, Mackin says.
Then the home health aide staff were trained how to use the system over the course of two days. "We individually took people and walked them through the script of how to dial in and how to answer questions," Mackin says. "We did one-on-one training with 650 aides."
Supervisors also received the training and staff receive remedial training whenever necessary.
Electronic data simplify job
All documentation now is saved electronically. Specific charts can be printed out for surveys or audits, and data are much easier to find now that they’re all electronic, Mackin says.
"We back up our systems daily with off-site storage, and now we have a redundant server so that if one goes down the other one goes up immediately," Mackin says.
The entire software and equipment cost was about $25,000. The agency saved some start-up costs by developing its own documentation script and worked with the home care software vendor to interface necessary data, Mackin says.
• Sandy Roberts, RN, BSN, Manager of Home Health, Watertown Memorial Hospital Home Health, 125 Hospital Drive, Watertown, WI 53098. Telephone: (920) 262-4709.
• VHA Southwest Inc., 1490 Quorum Drive, #300, Dallas, TX 75240. Telephone: (972) 866-7400.
• Annette L. Mackin, MBA, Chief Financial Officer, Visiting Nurse Service of Rochester & Monroe County Inc., 2180 Empire Blvd., Webster, NY 14580. Telephone: (716) 787-2233.