Health Management Technology

Technology Triumphs

Technology Triumphs – Technology Information

Linda Long

Home care agency goes from paper records to full automation and saves more than $326,000 in one year.

Shannon Clark, R.N., B.S.N., saw the writing on the wall. As director of Haywood Regional Medical Center Home Care Services in Clyde, NC, she realized that with burgeoning regulations, many home care agencies were literally choking to death from paperwork and in danger of going bankrupt.

Clark decided to take action and automate her system beginning at the point of care. Not only did her small agency survive by automating, it reaped rewards beyond her wildest dreams.

The Key to Survival

Haywood’s Home Care Services serves 17 Western North Carolina counties and provides home health, hospice, home infusion and personal care services in North Carolina and hospice services in Georgia. Annually, Haywood’s clinicians make 18,000 home health visits and provide 60,000 hours of personal care services. Haywood has an average total census of 42 hospice patients.

Until 1997, Haywood used only an automated billing system. In light of OASIS (Outcome and Assessment Information Set), ORYX[TM] (an initiative introduced by the Joint Commission to integrate outcomes and other performance measurement data into the accreditation process) and the newly introduced prospective payment system (PPS), Haywood decided automated patient care management was necessary to keep up with legislation and to remain competitive.

“Our home care staff was seeing an average of five patients a day,” said Clark. “With OASIS we expected to reduce the number of patients we could see. By automating, half of our clinicians have kept their visits to at least five a day, and the other half are seeing six, sometimes seven.”

Thorough Selection Process

Clark looked for a comprehensive, clinical point-of-care system that could be integrated with the hospital’s financial and accounting system. She developed an extensive and thorough system for finding the right software.

First, Clark developed a search team of six comprised of Clark, the hospital’s MIS director, a home health nurse, a billing representative, a pharmacist and an nurse supervisor.

Through industry magazines and websites, they identified 20 potential vendors and sent out RFPs with a set timeline for response. Each of the 17 responses was graded based on questions weighted in areas of importance to Haywood’s specific needs including a hospice package, multiple location functionality, clinical point-of-care documentation, and the ability to integrate with Haywood’s hospital system.

The three top companies were invited to Haywood to give a sales presentation, a live demonstration without the sales representative there, and a cost analysis.

Haywood ultimately chose inSync, a clinical-based point-of-care system co-developed by Patient Care Technologies, Inc., (PtCT) of Atlanta, GA, and MEDITECH. Mark Hanna, PtCT vice president of sales and marketing, says, “inSync is the result of the clinical process and patient outcome management being the center of our world.” Hanna notes that while inSync integrated smoothly with Haywood’s hospital MEDITECH system, inSync will integrate with any hospital system and is not limited to MEDITECH.

The inSync program contains a structured charting system that is used at the point of care by visiting clinicians and nurses. Consumer Electronic (CE) hardware (smaller than laptops and a fraction of the cost) allows for data input in a patient’s home. Prior to using inSync, Haywood’s nurses would carry 10-page-long admission statements, clipboards, notebooks, grids and guides to each visit.

“Each nurse had a full desk in the office because of the paperwork. Nurses would visit patients for three to four hours and spend the rest of the day doing paperwork,” says Clark. “Now they go directly home after their visits, connect the CE to the telephone and send everything back to the agency.”

Staff Acceptance

InSync was still somewhat under development when Haywood decided to purchase the system, so Haywood agreed to be a beta test site and went live Oct. 1, 1998.

Clark says although implementation was steady, it was difficult because it involved completely changing the way they were used to doing business. “It’s a matter of totally rethinking your entire business,” she says. “It required us to think about every step, every process, and to change the mindset of people used to doing things manually.”

Clark also attributes Haywood’s success to communication. “We communicated about every stage of the process,” she says. “We would put signs up that said: `RFPs are back. Here’s the winner.’ Another would say, `We’ve done onsite demonstrations. Here’s the winner.’ “She says that consistent communication built a feeling of excitement and kept everyone in the loop during the entire process.

Although there was still some resistance by the clinical staff, the transition happened steadily because Clark set guidelines and gave employees time to change. During the transition to an automated system, Haywood doubled up on record keeping, and continued to use the paper charts until the specified live date.

“We would provide training and then give them an out, saying, `if you get frustrated with this, put it down and go back to using your paper.’ At the same time, we would say, `By the 10th of the month, we want to see notes from the computer.’ They had deadlines but with leeway, giving them some control over the situation.”

Clark also allowed clinicians to decrease visits during implementation. She suggests that agency proposals to higher management include time and money for supplemental staffing during training so “staff are not rushed and can be successful.”

Impressive Savings

Haywood’s financial results were remarkable. Through complete automation, the number of days that accounts lingered in accounts receivable decreased 37 percent, from 89 days to 56 days, freeing up $200,000 in cash. They decreased support staff from 17 to eight full-time employees, saving $123,000 per year. Haywood reaped a total savings of $326,598 in one year, and the system paid for itself in just 14 months.

In addition, 1,200 square feet of office space was completely freed up and is now used for ambulatory infusion, adding another revenue stream.

And there were unanticipated, morale-boosting results, such as improved attitudes about computers. That, Clark says, has been the icing on the cake. “In the beginning, when we first talked about the need for automation, most people responded with, `I don’t want to.’ Now, if they bring their device in for periodic checking or cleaning, they pace the floor waiting for their CE. They are reliant on them and don’t want to go back to paper,” she says.

Booming Success

Haywood employs a performance improvement coordinator who analyzes the data received from the system. One area is PPS. Clark notes that since PPS went into effect Oct. 1, 2000, OASIS has been used to determine dollar reimbursement. “Different agencies are struggling with how to manage that money,” she said.

Clark says that inSync calculates how much a person’s care is going to cost based on the clinician’s assessment. That cost is then compared to reimbursement and outcomes are tracked, helping agencies assess what treatment and therapy mixes will work best for a given patient. “If we see that a patient is going to be costly, we can look at a different mix, for example, perhaps getting a social worker in there right away. We could not monitor that without a clinical information system. We are very excited about being able to see which patients did better under which scenarios.”

Clark summarizes, “I cannot imagine how this agency would look without this system. It’s amazing to me that we are actually successful in a time when we would have gone bankrupt had we refused to automate.”

Linda Long provides public relations services from Sellersburg, IN. Contact her at

COPYRIGHT 2001 Nelson Publishing

COPYRIGHT 2002 Gale Group