Choose the right staff to lead technology march

Those who’ve made the leap to new technology say a key to success is identifying staff who can serve as a liaison between the home health operations and the new computer system.

At the Visting Nurse Association (VNA) of Hudson Valley, in Mount Kisco, NY, one of those people is Joyce Galuppo, RN, MS, the agency’s new director of clinical information systems. Asked what attributes her job requires, she answers expansively.

"You need someone who knows home care, who knows all the pieces, soup to nuts. Someone who has the clinical experience, who’s had supervisory experience, and knows the big picture. But also has the ability to solve problems and do critical thinking. And has a sense of humor and is willing to work long hours."

Sometimes, that person, like Galuppo, is identified by administrators and assigned to the task or is the administrator. Jeneane Brian, BSN, MBA, president and CEO of VNA Home Health Systems in Santa Ana, CA, not only has overseen her agency’s switch to a personal digital assistant (PDA)-based system, she actually wrote the software to create the forms her nurses use.

But neither woman, surprisingly, is your prototypical computer geek. Before taking on these projects, both say they were computer-literate, but had no specific programming or technology training.

"I owned a computer, and I could get on the Internet," Galuppo says. "I’m a pretty good typist, and I knew [Microsoft] Word very well. Did I know a whole lot of anything about computers? No. Did I learn this new system? Yes."

What’s more important than computer-savvy is the clinical mind that a home health manager brings to the task of automating an agency, Brian says. Take the forms she creates. Because her nurses use hand-held devices with small screens, questions must be phrased so that they fit into a small space.

"I believe that does take a clinical content knowledge person," she says. "I think a nurse needs to do that because only a nurse is going to know what that question implies and what the question is going for.

"The programming part to me is the typing part, and that’s almost the fun part," Brian says. "The harder aspect of it is making sure you’re asking the right questions and you’re giving the right prompts for answers without biasing the information."

When VNA of Hudson Valley began the process of switching to a new computer system, it assigned two clinical staffers to help coordinate the change. One was Galuppo, then a clinical manager, with more than 20 years of experience. The other came from the agency’s quality improvement department.

Both were sent to training sessions conducted by the vendor, where they learned about all aspects of the new system, including the software’s financial applications. The breadth of understanding was essential as the team worked to bring each department up on the new system, first the back office and financial staff, then the clinical staff.

Because the new system ties the financial and clinical sides together so closely — it won’t allow the agency to process a request for anticipated payment unless all of the assessment forms are filled out properly — Galuppo acts as a go-between, helping iron out problems as they come up.

"When the finance people run into a glitch — the visit isn’t in, or the assessment hasn’t been locked, or there’s a question about the HHRG [home health-related group] — I’m the person who touches base with the clinical people," she says.

Choosing a project leader

Brian says that whoever is assigned to lead a technology project needs to be experienced enough to understand all of an agency’s operations. "That’s usually not somebody at the entry level of your organization," she says.

At the same time, the person tapped can’t be so vital to day-to-day operations that the agency will fall apart without him or her. Galuppo says that when she first moved to the clinical information services role, she was relieved of all of her other duties for six months. Then, the job became permanent.

Brian says an agency should expect to lose the use of that staffer for at least a year.

"Whoever it is that’s in charge of it needs to wake up in the morning thinking about it, and go to bed at night thinking about it, every single day," she says. "I don’t know how else it can get done."

In her own case, Brian started VNA Home Health System’s upgrade shortly after taking the helm in September. She says she was lucky the agency was so well run when she arrived that she could take on the automation project herself.

"I’ve been able to have the luxury to focus on this very intently for several months now without it meaning the agency faltered in any serious way," she says.

For Galuppo, focusing on the technology project hasn’t distanced her from the home care nursing she loves. Before dispatching nurses with laptops out on visits, Galuppo tested the system herself in the field.

Whenever the agency installs an upgrade, she’s the one who field-tests it.

"I think of myself as a nurse first, and I truly love nursing," Galuppo says. "We have all this equipment, you walk in with this laptop, but when someone’s feet are really dirty and disgusting, you still have to pull the basin out and wash their feet. You still have to do hands-on.

"That’s what I love about this. I don’t see myself ever giving that piece up."