Plug in and sign on: Are you ready to automate?

Higher productivity follows careful purchase

People in all types of industries use the term "mountains of paperwork," but people who work in home health agencies contend they are the only ones who truly have to climb those mountains, make sense of them, and use the information within them to bill accurately.

Rather than let this mountain of paperwork crush them, the staff at Haywood Regional Medical Center Home Care Services in Clyde, NC, automated all of its activities and saved more than $326,000 in one year.

With the introduction of programs such as the Outcome and Assessment Information Set, ORYX, and the prospective payment system, as well as all of the expanded forms required for each, Shannon Clark, RN, BSN, MBA, assistant vice president of Haywood Regional Medical Center, told the board of directors that it needed to automate all areas of the home health agency or get out of the business.

"Financially, we could not handle the required paperwork manually and still make money on the reimbursements that were originally published," Clark explains. "My nurses would have to see fewer patients each day to allow enough time to complete the paperwork."

The board of directors approved her plan to automate all functions of the agency from admissions to charting to billing, Clark says.

Starting from scratch

"We had used an automated billing system for several years, but that system was not compatible with anything else on the market that allowed us to automate other systems, so we started looking for vendors that could provide everything from the ground up," she explains.

A team composed of staff members representing different areas of the home health agency, as well as representatives from the hospital’s management information systems department, worked together to develop a request for proposal (RFP) to send to vendors, Clark says.

"The RFP was very detailed and very specific about what we wanted," she explains. Her goal was to work with one vendor who could provide everything the agency needed to automate its functions and to integrate with the hospital’s system, she adds.

The team not only was an important part of choosing the vendor, but it also helped communicate to other staff what was happening, Clark says. 

Laptop not always convenient

In addition to choosing software that met their needs, the team members also evaluated different hardware choices, Clark says. The choice of consumer electronic (CE) devices for the field clinicians rather than laptop computers was made for several reasons, she says.

"They are less expensive and more durable than laptops, and their touch-screen controls rather than a keypad make it easier for clinicians to use," she explains.

The staff at Montefiore Medical Center Home Health Agency in Bronx, NY, also are looking at devices other than laptops as a result of a failed attempt to use laptops in the field several years ago, says Joseph T. Cortese, director of health information management and information technology for the home health agency.

"Four years ago, we provided laptops to our field nurses only to run into unplanned costs, higher than expected expenses to maintain the equipment, and technical problems," he says. "We cancelled the project and spent the last three years being deluged by paper."

The agency is in the process of purchasing a system that will automate all functions but is looking at devices such as pen tablet units rather than laptops, Cortese explains. "Laptop computers are not designed to be turned on and off a dozen times a day or be thrown into the car after each visit," he says.

"We also have field staff visiting buildings with no elevators, and having to carry supplies, briefcase, and a laptop computer up multiple sets of stairs," he points out. This wear and tear meant that Cortese had to maintain a supply of backup laptops, which required storage space and extra expense, as well as technical support available at all times.

He suggests that anyone who is evaluating vendors to provide any type of automation should remember to ask about hidden costs such as those he discovered in the laptop project.

"Find out if you will need to add extra telephone lines, including a toll-free line, to enable your field nurses to check in at night or from home. Also, if you do need to add a toll-free number, remember that the calls are free to the caller but you have to pay for each call. These calls add up," he adds.

"Also, make sure that the software you purchase will coordinate the information needs of all federal, state, local, or accreditation programs in which you participate," Cortese suggests.

More importantly, be realistic about the amount of information you’ll be gathering and make sure the system can not only handle what you have today but will allow you to expand, he adds.

Because field clinicians no longer need desks at which to complete their paperwork, Clark’s organization no longer needed 1,200 square feet of space formerly used for the nurse’s desks.

"We added an ambulatory infusion service in the area that had been used for paperwork and added a new stream of revenue," Clark points out.

Relationship changes

Nurses now complete their patient visits and connect their CE to the telephone line in their own homes to send everything back to the agency, Clark says.

If you do plan to give your field clinicians access by modem to enable them to transmit their data or check in for the next day’s schedule, realize that you are changing your agency’s traditional employer-employee relationship, Cortese explains.

"If you tell a clinician to check in between certain hours to transmit data or receive messages, you also have to be ready for your employees to bring up logistical issues that you’ve never handled," he says.

For example, if an employee lives in an area in which the telephone lines have too much static to transmit data, who works with the telephone company to solve the problem — the agency or the employee? Or if an employee’s son regularly is on line during the same time frame, does the agency pay for the second telephone line?

"These are issues that need to be addressed or considered upfront because as employers, we are moving into the personal or home life of the employee," Cortese says.

How an organization deals with these issues will differ from agency to agency, but he suggests that you know ahead of time how you will deal with different situations.

Even with the problems and glitches encountered during the automation, Clark says she has no regrets about going through the process. "It has been a successful project in terms of productivity, employee morale, and financial success. If we had not automated when we did, we would be bankrupt."

[For more information, contact:

  • Shannon Clark, RN, BSN, MBA, Assistant Vice President, Haywood Regional Medical Center, 262 Leroy George Drive, Clyde, NC 28721. Telephone: (828) 456-7311. E-mail:
  • Joseph T. Cortese, Director of Health Information Management and Information Technology, Montefiore Home Health Agency, One Fordham Plaza, Suite 1100, Bronx, NY 10458. Telephone: (718) 405-4403. E-mail:]