Home Healthcare Organization Streamlines Processes and Improves Patient Care

Microsoft Office Customer Solution Case Study

(...) 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 the end 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–up line transfers or by going to a VNSNY regional office and using an 802.11b 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 "The fact that Microsoft was making a major strategic commitment to mobile devices convinced us that Tablet PCs were a good choice for us." Rick Stazesky, Director of Information Systems, Visiting Nurse Service of New York 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 (...)