Customer Solution Case Study
/ / Home Healthcare Organization Streamlines Processes and Improves Patient Care
Overview
Country or Region:United States
Industry:Healthcare
Customer Profile
The Visiting Nurse Service of New York has 2,500 clinicians who provide nursing, rehabilitation therapy, mental health services, and home health aide supportive care to 24,000 patients each day.
Business Situation
The organization wanted to increase its efficiency and improve patient care by streamlining workflow processes and reducing paperwork.
Solution
The Visiting Nurse Service of New York deployed 2,500 Tablet PCs running Microsoft® Windows® XP Tablet PC Edition to its field clinicians, who use the PCstorecord and share patient information.
Benefits
Better information access for better patient care
Increased productivity and flexibility
Ability to analyzeinformation
Cost savings through integration
Foundation for program expansion / “VNSNY has always taken the Microsoft approach…. With Windows XP Tablet PC Edition, we have it all built into a single operating system that was designed to work with the device. Tablet PCs are so easy to use and Microsoft technology so reliable that we have a lot fewer headaches.”
Rick Stazesky, Director of Information Systems, Visiting Nurse Service of New York
The 2,500 clinicians of the Visiting Nurse Service of New York (VNSNY) visit patients’ homes to provide nursing and other physical and mental healthcare. The organization needed a way to record and share patient information quickly, reducing the time between a patient visit and the updating of that patient’s record in the organization’s record-keeping system. Additionally, VNSNY wanted to shorten clinicians’ long days and reduce their paperwork loads. An early adopter of pen-based technology, VNSNY recently implemented a solution using 2,500 Tablet PCs that run Microsoft® Windows® XP Tablet PC Edition. Tablet PCs enable field clinicians to quickly and accurately complete their work on-site. With consistent formats for its patient records and integration between applications, VNSNY now can manipulate and analyze information to make improvements in the way in which it delivers care.
Situation
Since 1893, the Visiting Nurse Service of New York (VNSNY) has been providing home healthcare to patients in New York City. Today, the organization’s 2,500 clinicians deliver home healthcare services ranging from pediatric to elder care, psychiatric assessments to AIDS treatment, and short–term interventions to long-term management. VNSNY clinicians visit patients throughout New York City’s five boroughs, WestchesterCounty, and NassauCounty on Long Island. VNSNY is the largest home healthcare organization in the United States; in a typical year, its clinicians make more than 2 million visits to more than 100,000 patients.
One of the organization’s strengths is its drive to develop innovative ways of using technology to improve patient outcomes. VNSNY leads the way when it comes to testing and implementing new methods of delivering patient care, enhancing communications with its physician and hospital partners, and promoting operational efficiency.
Regulatory agencies require healthcare organizations to complete a substantial amount of documentation for each home visit; the paperwork is intended to capture clinical data as well as information related to billing and insurance.
Clinicians used to record notes by hand during their daily patient rounds and also attempt to fill out forms while attending to patients. At the end of the workday, clinicians would then call or visit one of five regional VNSNY offices to update each patient’s file in the main VNSNY system. The company wanted to give its clinicians a way to record information electronically while still at a patient’s home to reduce the number of hours in a typical clinician’s workday. Being able to enter data while on-site would also increase the information’s accuracy because clinicians would not skip the data entry whilewith the patient and try to record it later from memory.
Additionally, there used to be a delay of up to five days between a patient visit and when information from that visit was accessible in VNSNY’s computer system. The delays meant that the medical information available was frequently outdated, so subsequent clinicians were visiting patients without the most recent, relevant information about a patient’s treatment. “Our clinicians were basically operating in isolation, which just didn’t make sense because one patient often is served by several of our clinicians, who all share responsibility for the patient’s well-being,” says Rick Stazesky, Director of Information Systems for the Visiting Nurse Service of NewYork. “Our organization strives to have each visit build on the last, promoting better patient care, but we had no systematic wayfor our clinicians to pass on information regarding patients unless they left handwritten notes for one another at the patients’ homes.”
Delays in the availability of information also hindered VNSNY’s ability to promptly send invoices. “Healthcare is a low-margin industry, so we also were looking for a way to have our invoices follow treatment as closely as possible,” says Stazesky.
Another significant deficiency of the paper–based system was that it did not allow VNSNY to gather information consistently from its 2,500 clinicians. Most patient information was written down in narrative form, rendering it useless for any sort of analysis. One of VNSNY’s goals was to compile an electronic medical patient record. “We had this wealth of patient documentation that we couldn’t take advantage of because it was in narrative form, some of it largely illegible,” says Stazesky. “We wanted to use that information as a strategic tool for developing best practices for treatment and directing the course of our organization.”
Since the mid-1990s, VNSNY has been working to eliminate its clinicians’ use of paper forms. The organization wanted to help its clinicians spend their days more efficiently, with a greater proportion of time devoted to patient care, rather than paperwork.
Solution
VNSNY decided to investigate mobile technology to meet its clinical and administrative needs. “Mobile technology is useful for the Visiting Nurse Service of New York because we are a field-based organization, with large numbers of clinicians, including nurses and physical, speech, and occupational therapists,” says Stazesky. “Giving our field staff tools that travel with them seemed like a good way to cut down on paperwork while providing us with consistent information at an enterprise level.”
In 1995, VNSNY first decided to try out portable computers for its clinicians, but after some initial testing, the organization instead turned to early pen-based technology from Fujitsu. Pen-based technology not only was more comfortable for the clinicians to use, but also less intrusive during a patient visit. With traditional portable computers, clinicians had difficulty keying in information while administering hands-on care. Because patients were already used to clinicians using clipboards and pens, they perceived pen-based technology for information entry as much more familiar and less threatening.
“We often serve people who aren’t necessarily comfortable with technology, so we want to create the most unobtrusive, comfortable atmosphere for our patients as possible,” explains Stazesky. “Finding a flat surface for setting up a portable computer and then typing away just wasn’t conducive to a positive patient experience.”
Moving to the Tablet PC
VNSNY took a phased approach to establishing its pen-based, remote-computing environment: It added one significant piece of functionality each year to take advantage of hardware or software advancements. “We didn’t want to follow the ‘big bang’ strategy of upgrading our technology because we felt it would be both easier on our patients and better for our clinicians if we eased them into it,” says Stazesky.
In late 2001, the organization began a large development phase that involved the release of VNSNY’s Visit Documentation Module, an application that was scheduled to be completed around 2002. The timing happened to coincide with the end of the useful life cycle of the organization’s pen machines. Fujitsu had provided VNSNY with the pen machines, and it was at this time that Fujitsu introduced the organization to Tablet PCs, which were new to the market.
Tablet PCs are fully functional computers that support mobility with built-in wireless capabilities and a long battery life. Mobile workers can use Tablet PCs as they would conventional portable PCs with standard keyboards, or they can use the computers as a slate with “pens” that have writing and drawing (“ink”) capabilities. The Tablet PCs run the Microsoft® Windows® XP Tablet PC Edition operating system, which is built on top of Windows XP Professional and offers advanced handwriting and speech recognition capabilities for creating, storing, and transmitting handwritten notes and voice input.
VNSNY took an immediate interest in the new technology, especially after learning that Microsoft had developed a version of the Windows XP operating system that was embedded into each Tablet PC. “The fact that Microsoft was making a major strategic commitment to mobile devices convinced us that Tablet PCs were a good choice for us,” says Stazesky. “We soon saw that Tablet PCs were great next-generation devices that would allow us to do things we never could do with our remote-computing system before.”
The functionalities that were most important to VNSNY included speech recognition, significantly improved handwriting recognition, and the ability to run the full feature set of Microsoft Office XP Professional on the remote device. Because the organization’s previous pen-based system could not run any version of the Office programs, translating information into other formats had been difficult. “The Tablet PC represented the last piece of the puzzle. With it, we could reach our goal of effectively building an electronic patient medical record,” says Stazesky.
Putting the Pieces in Place
To take advantage of economies of scale, VNSNY purchased 2,000 Tablet PCs from Fujitsu at once and turned to PanurgyOEM, a managed services provider, for computer storage and distribution. PanurgyOEM put the VNSNY standard image on each computer and shipped groups of them in installments to VNSNY’s regional offices. The organization deployed the Tablet PCs over the course of a year, adding another 500 computers near theend of the project and wrapping up the deployment in May 2004.
To meet the information collection needs specific to its industry, VNSNY developed its own remote-computing applications, using the Microsoft Visual Basic® development system version 6.0 and a Microsoft Access 2002 database. The remote-computing applications work with VNSNY’s internally built medication database, which has more than 200,000 entries. The database enables clinicians to check a patient’s medications for duplicate therapy and drug-to-drug interactions, without having to carry around medical reference books and researching possible drug interactions each time a medication is added.
VNSNY has configured its Tablet PCs as remote, stand-alone systems. Clinicians upload and download patient information to and from the main database over standard dial-upline transfers or by going to a VNSNY regional office and using an802.11b wireless connection to the VNSNY intranet. The organization is considering the implementation of a wireless wide area network to further improve the speed and convenience of information transfer.
Securing the Mobile Environment
Ensuring that it is doing all that it can to protect its patient information is imperative for VNSNY. The Tablet PCs have multitiered security levels, which help the organization adhere to the regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). VNSNY has configured the Tablet PCs so that clinicians need a name and password just to get the Windows XP Tablet PC Edition operating system to start; clinicians then need to supply another name and password to access the applications that run on the Tablet PC. For certain components of the applications, users have to enter a personal identification number (PIN), which acts as an electronic signature. VNSNY also is considering the use of biometrics as a potential security measure that would further protect sensitive patient information. Additionally, VNSNY uses the encryption features in Windows XP to safeguard sensitive information in the event that a Tablet PC is stolen or lost.
Using Tablet PCs in the Field
With the Tablet PCs, VNSNY’s clinicians can use the productivity tools in Microsoft Office XP Professional, including programs such as Microsoft Excel, Word, and the PowerPoint® presentation graphics program. With the Tablet PC software’s native ink capabilities, clinicians can use the pen to control the computer and applications, as well as input regular handwriting, which can then be converted into typed text. Also, the organization now relies on Microsoft Outlook® Web Access, which makes it possible for clinicians to send and receive e-mail messages from any remote location in which they have Internet access. Additionally, VNSNY field clinicians can quickly and easily get access to all of the documents and information on the organization’s intranet, which uses Microsoft Windows SharePoint® Services.
Because its clinicians already were fairly familiar with both the Windows environment and pen-based machines, VNSNY did not have to conduct much training on the Tablet PCs. VNSNY provided some basic training on the Windows operating system for those who were unfamiliar with it.The organization also spent three hours orienting users to the physical features of the new devices, followed by three half-day sessions on the new, internally developed applications.
VNSNY clinicians now use their Tablet PCs for activities such as completing visit notes or vouchers for reimbursement. They review caseloads and plan their schedules each week by using information that they pull up on their Tablet PCs. “Anything that used to be done on paper now is handled through the Tablet PC,” says Stazesky.
Benefits
With the introduction of Tablet PCs running Windows XP Tablet PC Edition, VNSNY now has a means of delivering better care to its patients through accurate, up-to-date information. The organization also benefits from a body of clinical information that is highly structured,can be shared easily, and is in a consistent format that facilitates business and clinical analysis.
Better Information Access for BetterCare
By having technology tools at their fingertips, clinicians can check in with VNSNY before patient visits to make sure that they have reviewed the most recent patient information. If, for example, a patient receives care twice a day from two different clinicians, those two caregivers now can easily communicate with each other before making contact with the patient. Clinicians can share test results and concerns about any new health issues, which helps patients receive more consistent care. “This never could have happened before the Tablet PCs,” says Stazesky. “We used to have to leave notes in conspicuous spots in patients’ homes to share information. Using Outlook Web Access means that our clinicians have a single, more discreet source for up-to-date information.”
Beyond day-to-day patient information, clinicians use their Tablet PCs for sending and receiving critical medical information, such as guidelines and training updates. Having an effective e-mail tool also gives them the opportunity to communicate with others in the healthcare field. “The Tablet PC solution allows us to enhance the compatibility between our back office, our field clinicians, and other patient care stakeholders,” says Stazesky.
VNSNY also has found that automating how it collects patient information has been a decided advantage in addressing ongoing regulatory demands and documentation requirements. “For us, Tablet PCs are a long–term strategic investment, with our break–even point spread out over a long period. In the meantime, we’re able to increase the consistency of our care delivery across a diversified work force—clinicians are no longer islands unto themselves but rather areinterconnected,” says Stazesky.
More Time Spent on Patient Care
To streamline their recording processes, VNSNY clinicians use programs such as Excel, Word, and PowerPoint as well as Outlook Web Access, which helps them send and receive e-mail messages remotely. “It’s a huge time-saver for clinicians to be able to send and receive e-mail wherever they connect, and their e-mail is synchronized automatically whenever they log on,” says Stazesky.
Tablet PCs also help ease the complicated, time-consuming Medicare reimbursement process for VNSNY clinicians. Part of the process involves completing the Outcome and Assessment Information Set (OASIS), which is a federally mandated assessment tool for home health agencies. OASIS, a 25-page form, must be filled out early in the treatment period for each patient. OASIS includes instructions that require clinicians to sift back and forth through the document to enter different levels of detail, depending on the patient’s situation. Now, however, the Tablet PC OASIS application guides clinicians through the assessment, helping them deal with the layers of “paperwork” more efficiently. “I don’t have to spend much time writing the documentation because everything is basically in the application and I can click on it like using a mouse,” says Lisa Felszer, Registered Nurse and per diem coordinator of care at VNSNY. Having OASIS in an electronic format also spares clinicians from having to physically carry the large quantity of paper that the previous system required.