Quality care at hand

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Quality care at hand
Quality care at hand
As if providing high quality, hands-on resident care weren't a big enough job, today's busy caregivers also must juggle diligent charting and documentation duties to meet regulatory requirements. That also will ensure that the organization is properly reimbursed for the care provided.

Long-term care operators are increasingly tapping the power of handheld computing devices that allow staff to quickly and accurately capture critical data at the point-of-care and stay mobile.

“Caregivers are not sitting at a desk in front of their PCs. They are on the floor providing care, running programs, coordinating with other staff and working in and out of different rooms,” said Mark Woodka, CEO of OnShift. “Being able to input and access critical data at the point of care boosts productivity and outcomes  and drives efficiencies.”

An added benefit: Tablet and other handheld computing devices cost far less today than they did just a couple years ago, while delivering far more applications, user flexibility and inherent value. These marked improvements, coupled with the long-term care sector's more focused efforts to improve resident care and satisfaction, have helped place mobile IT devices in the hands (or at least on the wish lists) of many long-term care providers.

Touch — and go
Simplified documentation remains operators' primary reason for adopting handheld devices. Many are seeing these technologies as a logical next step in augmenting electronic medical records and creating a more comprehensive, up-to-date snapshot of resident treatment, care and conditions.

Connecting wirelessly to EMR allows caregivers to review, input, document and chart critical information, such as resident history, medication passes, care plans, and progress notes. It also allows them to capture MDS data and resident interviews as they happen — at the bedside or anywhere a caregiver engages with the resident.

“It isn't good enough to just collect data. Providers must now also interact with the data by gaining immediate access to a resident's care plan, care requirements, most recent vitals, safety precautions, and so on, while communicating with colleagues to facilitate quick decision-making and collaboration,” said Teresa Chase, president and CEO of American HealthTech. “Mobile devices make all of this possible and can also provide the best opportunities for early detection, intervention and the avoidance of hospital readmissions.”

Beyond that, improved accessibility and portability gained through mobile technology adoption can prevent EMR gaps due to delays between care delivery that are often caused by a caregiver's need to reach a fixed work station. That, in turn, leads to more complete and accurate data on activities of daily living, which translates to higher resource utilization group scores and reimbursement, according to Keane Care Inc.'s Director of Sales Jim Ingalls.

Today, mobile devices are more user-friendly, thanks to larger screens that enhance readability, and touch screens that simplify data entry. Some devices also are voice-assisted, allowing staff to stay with residents instead of leaving them to summon help or retrieve equipment or supplies.

“This means there is no break in the cycle of care,” stressed Amy Harvey, vice president of product development for Vocollect Healthcare Systems Inc.

Help at the fingertips

Multi-use capabilities of today's handheld devices are also making it easier than ever for staff to complete their many daily tasks — from making calls and accessing email on the Internet or an intranet to uploading and downloading images and other content — all from their handheld.

At Edgewater Pointe Estates, an ACTS Retirement community in Boca Raton, FL, the community's rehabilitation services provider — Genesis Rehab Services — issues handheld devices such as iPads that allow staff to easily document care, take notes, manage email and billing, and communicate with the interdisciplinary care team.

“For us, it's important to [leverage] technology that allows us to do our jobs more accurately and efficiently.

Handheld devices have allowed us to stay on top of our [day-to-day responsibilities], while keeping resident care our number one priority,” said Edgewater Director of Nursing Angela Holman.

Encouraging staff to use their mobile devices to access the latest evidence-based, peer-reviewed clinical information is another way providers can boost the value of their investment.

“This type of immediate access can help facilities provide a higher level of care for residents, as well as help them maintain compliance,” said Steven Littlehale, chief clinical officer for PointRight.

Expanding the reach
Long-term care providers that haven't yet adopted handheld technologies — or are using them in more limited applications — may be surprised by the extent of the value they can bring to their organization.

Increasingly, providers are using smartphones or tablet PCs to gain control of employee scheduling. According to Woodka, if a caregiver calls off an hour before a shift and the scheduler is out of the office, that scheduler can simply log the call-off from a smart phone or tablet and automatically alert all qualified and available staff of the available shift.

“As replies come in, the scheduler can make the appropriate assignment and fill the shift without ever having to be in their office,” he noted.

Handhelds can make better use of staffing resources in other ways, too, such as allowing off-site physicians and specialists to communicate remotely with long-term care staff to improve diagnosis and treatment response.

Recognizing that physicians and wound care specialists are not always easily accessible to those in long-term care, Lee Rogers, DPM, associate medical director of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles, started a pilot program to allow wound-related video communication via iPhones and iPads.

“Hands-on assessments are valuable, but that isn't always possible,” said Lee, who also chairs the American Diabetes Association's foot care council. “Video communication lets you examine a two-dimensional image of a wound, without having to move the patient from the nursing home to a hospital or clinic. Having the ability to evaluate a wound or suspected skin breakdown earlier is very helpful and allows proper care to happen sooner rather than later.”

Even if a facility isn't currently using video conferencing capabilities, staff can still use their smart phone or tablet PC's integrated camera to document wound status and other clinical issues as they arise. It's a function that's especially useful for temporary or contract nurses, according to Ingalls.

Business office help
Handheld devices can be powerful operational tools that measure — in real time — key performance indicators, such as census, labor, collections, risk management data and more.

“Senior management can view consolidated KPIs at a corporate level and drill down to a region or facility level,” explained Rand Johnson, marketing manager for Prime Care Technologies Inc. He pointed out that PCT's
primeView dashboard incorporates real-time alerts when certain key performance indicators exceed predetermined thresholds.

Data security also has improved, with solutions increasingly allowing users to remotely access and input pertinent data without worry of it making its way into the wrong hands. As Doc DeVore, director of clinical informatics and industry relations for AOD Software, explained, most handheld devices allow providers to take advantage of “cloud computing,” whereby tablets serve as “thin clients” that interact with centralized servers but don't actually store data.

Further, IT solutions vendors are making significant improvements to handheld devices' durability and cleanability — two key issues for budget-conscious providers. Today, devices are being sealed to prevent water damage and can be sterilized throughout the shift to comply with facility infection prevention protocols, added Steve Pacicco, CEO of SigmaCare/eHealth Solutions Inc.

Capturing compliance
In addition to engaging all users in targeted training — much of which can be provided free of charge from software and solutions vendors — experts stressed that long-term care providers must also invest wisely in accessories and maintenance programs to keep their devices running optimally, longer.

Keeping batteries charged (and back-ups ready nearby) is prudent, as is encouraging staff to be cautious when they are using or storing their handheld devices, especially when they are handling confidential data from patients.

Swapping batteries at the end of each shift is another wise move, according to Pacicco. He suggests using holsters to carry the devices and help prevent them from being lost, misplaced or damaged.

Supplying affordable after-market accessories, such as small Bluetooth keyboards that simplify note taking, also can boost user compliance, according to DeVore. Making computer carts accessible in resident each resident room and other care areas also has its benefits, added Greg Goodale, marketing manager for HealthMEDX Inc.

“In long-term care, we will always have to find a way to put down our chart, phone, laptop or whatever other items we carry to properly care for and interact with residents,” he said.

Whether a long-term care provider is already engaging in mobile computing or is just beginning to explore its possibilities, experts largely agree that the use of handheld technology in long-term care is the wave of the future.

“There will be some seismic shifts in how care is provided, coordinated and paid for,” predicted Woodka. “There will come a point when handheld devices are embedded into the mainstream of long-term care.”
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