The problems plaguing Health Care Information Systems are also found in home care companies that are not automated. With the current strategic plan of acquiring smaller agencies to increase market share, it will become harder and harder to manage and produce the required paper work, scheduling, and being able to bill for procedures performed (6).
There is also an increased burden placed on home care agencies to document all procedures accurately and to get doctors orders completed and signed before any visit can be billed (9). With growing pressure from Medicare and insurance companies to start tracking, and reporting outcomes, it is becoming very apparent that the system of paper files, and the recording of data in triplicate, will ultimately cause Health Care Information Systems administrative costs to grow and keep companies from operating at a profit.
Although, we are not allowed to gather and publish any financial information, it will become very apparent in the proposal (in the problem section of the report), that the problems faced by Home Care Services (in their current process) are affecting its growth which could ultimately jeopardize their ability to remain a leader in their field.
The full intention of this proposal is the recommendation of automation for Integrated Health Service's current operation, and for information collection/retrieval to be accomplished in a more centralized manner resulting in a much more cost efficient and standardized method of care.
Home Care Services is a national home care company which provides comprehensive health services to individuals. Home Care Services currently has 93 branch locations in 17 areas and employs re than 5,700 professional and para-professional personnel who deliver care to their patients/clients.
Services Provided:
Specialty Services:
Home Care Service's Mission Statement:
First and foremost, we strive to serve our patients/clients with the same high standards of inpatient care in a personalized, compassionate, and supportive manner within the setting of their own homes. Secondly, our service meets the demands of today's health care reform by providing quality care while minimizing costs.
The local company's name is Orchestra Home Care which had merged with several regional home care service companies: Partners Home Health, CareTeam, Central Health Services, ProCare, Senior Life Care, Hometown Nurses Registry and Fidelity Health Care. Orchestra Medical Equipment is responsible for providing medical equipment to their clients.
Orchestra is a newly formed division of Home Care Services (NYSE:HCS), a publicly-held, highly diversified health service provider, offering a broad spectrum of sub-acute and post-acute medical rehabilitative services through its post-acute health care system.
Home Care Services currently provides services in the following states: Arizona, Colorado, North Carolina, Texas, Florida, Illinois, Ohio, Indiana, Kansas, Pennsylvania, Kentucky, New Mexico and Tennessee.
Home Care Services issues:
Billing:Managed care has put more demands on the home care environment for cost containment, goal management, and outcome management (5). On top of these are pressures from Health and Human Services to follow OASIS practices, and from the Joint Commission on Accredited Healthcare Organizations (JCAHO) regarding standards that need to be followed in order to become an accredited home care agency. If JCAHO standards are not followed the home care agency can not bill for procedures performed and may with enough violations lose their accreditation.
JCAHO ORYX requirements are as follows:
Attribute one Performance Measures
Attribute two Database (Measurement System technical capabilities):
The measurement system must be able to electronically transmit, from a centralized source aggregated health care organization specific performance measurement data and comparative performance measurement data directly to JCAHO.
Also, a regulation announced by Health and Human Services, would require home health agencies to use a standardized system called OASIS - the Outcomes and Assessment Information Set - to monitor patients' conditions and satisfaction. Under OASIS, home health agencies must perform a standardized assessment of new patients within 48 hours to determine immediate care and support needs. Home health care agencies are then required to update this initial assessment continuously until a patient is discharged to reflect changes in the patient's condition and to measure patient and family satisfaction.
Agencies must also evaluate the results of OASIS assessments and apply this information to agency practices as part of their continuous quality improvement programs. This standardized measurement system helps both inspectors and agencies to identify opportunities to improve performance and patient satisfaction.
Definitive Homecare Solutions
Definitive Homecare Solutions was formed in the fall of 1991 as a partnership between Stuart Crane and Jeff Johnston. The company's original and enduring mission is to meet a market need for cost-effective, easy-to-use software designed expressly for the alternate site infusion industry. After extensively researching the homecare software market, there appeared to be a lack of acceptable products available that met the needs of Infusion Therapy companies. Definitive Homecare Solutions has a current customer base of 250 Registered Customers in 39 states.
Headquarters: Columbus, OhioPatient Care Technologies
1991 Mark Braunstein and Steve Miller open the first PtCT office at Georgia Tech's Advanced Technology Development Center. A program designed to jump-start
small technology oriented companies. In 1992, they introduced their first product--The Home Health Care Documentation and Support System-was developed with their strategic partners, MEDITECH and Data General. In 1993, PtCT won the Health Innovations in Technology Systems (HITS) award given annually by the Henry Ford Health System for the most innovative new health care information system. During 1994, the Physical Therapy Documentation and Support System was released. In 1995 Clinical concepts for Hospice, IV Therapy and Occupational Therapy were released. During 1996, Braunstein and Miller were named finalists in Ernst & Young's Entrepreneur of the Year program. In 1997, their newest product, the Home Care Manager was released.
Headquarters: Atlanta, Georgia
Data Counsel, Inc.
Since 1986, Data Counsel, Inc. has been developing and continuously improving software systems designed specifically for home health and hospice. The combination of advanced technology and years of nursing and administrative experience in the field has resulted in the standard of excellence and reliability that Data Counsel's products represent. Easy to use, intuitive, and with fully integrated functions, these PC-based systems are ideal for homecare agencies of every size. Onsite training is provided by staff members with experience in the homecare field and is followed up by support staff committed to assuring that clients get full use of the software's exceptionally extensive benefits.
Headquarters: Montclair, New Jersey
Definitive Homecare Solutions
CPR+ -- Complete Patient Records
Product Description:
CPR+ streamlines the prescription-filling process with easy-to-generate IV labels, pharmacy work orders, compounding sheets, prescription forms, and delivery tickets (with templates). CPR+ automatically calculates refill dates and schedules upcoming prescriptions to compound and dispense. CPR+ interfaces with the Medi-Span Solution Database enabling users to screen for drug-drug, drug-allergy, and drug-disease contraindications, and to print patient drug monographs (3).
CPR+'s complete inventory-management module allows you to track, dispense, and bill for all supplies, rentals, drugs, and noninventory items. AWP, acquisition cost, and HCPCs codes are available by item. Full inventory reporting and a purchase-order module is included. Rental-item tracking by serial number and preventive-maintenance-schedule monitoring make it easy to manage your rental equipment (3). All dispensed inventory is automatically deducted from your on-hand inventory when delivery tickets are confirmed.
CPR+ includes full patient demographics/intake, med profiles, POTs, nursing, pharmacy, and multidisciplinary careplans (with templates), visit reports, assessment forms, progress notes, discharge summaries, CMNs, verbal orders, 485/487s, outcomes analysis, and much more.
The DMERC-Approved Electronic Claims Module and new interface to ENVOY/NEIC make it a snap to submit Medicare and Medicaid claims electronically, improving cash flow and slashing client DSO. CPR+ also enables clients to generate HCFA 1500s, UB-92s, generic invoices, and patient statements. All transactions are logged to the AR module (3). The Special Price Matrix maintains accurate contract pricing for each payor, and allowables can be loaded for each payor, providing an accurate A/R picture.
Other Special Features:
Patient Care Technologies
Home Care Manager for Windows
Product Description:
The Home Care Manager for Windows system has color pop-up windows and graphics. It can be used on a number of field devices (handhelds, notebooks, pen computers, CE computers, etc.). It also allows the clinicians to see progress notes and finished reports right on the screen before printing them.
The special needs of multi-office home care companies are also satisfied by the Home Care Manager. The PtRemote module lets clinicians at satellite offices produce reports and download charts without visiting the main office. Administrators can use PtRemote to manage information from various sites (1). The PtAccess Doctor module lets physicians review their patient's charts and send messages back to the agency. PtAccess Insurance gives third-party payors this same capability. Home Care Manager includes the following home care disciplines: Skilled Nursing, Medical Social Services, Occupational Therapy, Physical Therapy, Home Health Aides, Respiratory Therapy, Hospice, Maternal/Child, and IV Therapy (1).
The PtPathways module is provided to the clinician through the patient chart itself. The clinicians know precisely what assessments, interventions, questions, observations, and care are required for each visit.
The PtAide module enables home health care aides to record patient visits on the handheld using the aide planning subjects set up by the clinician.
Also, with Home Care Manager, clinicians can use the field device to record mileage and activities (like home visits, inservices, personal time, etc.).
Other Special Features
Data Counsel, Inc.
HomeCare Management Systems (HMS+)
Field HomeCare System (FHS)
HomeCare Scheduling System (HSS)
Product Description:
HomeCare Management System:
HomeCare Scheduling System:
Field HomeCare System:
Site Consolidation Software (SCS):
Criteria |
Definitive Home Care Solutions |
PtCT |
Data Counsel, Inc. |
Security & Privacy |
High |
Medium |
High |
Standards Protocol |
High |
High |
Medium |
System Availability |
High |
Medium |
High |
Graphical User Interface (GUI) |
Medium |
High |
High |
Integration |
Low |
High |
Medium |
Costly |
Low |
Medium |
High |
Installation & Training |
High |
High |
Low |
Support |
High |
High |
High |
Outcome Measurement/DSS |
Low |
High |
Medium |
Remote Information Gathering |
Low |
High |
Medium |
Scalability |
Low |
Medium |
Low |
Scheduling |
High |
High |
High |
Doctor Order Management |
Low |
High |
Medium |
MediSpan Drug Information |
High |
Low |
Low |
Follows JCAHO Standards |
|
|
|
JCAHO business rules built in: Drug Management Fax Management |
Low |
High |
Low |
Electronic Claims |
Low |
High |
Medium |
Infusion Therapy Tracking |
High |
High |
High |
Overall, the three systems analyzed are easy to use and meet many home care operation requirements. Through analysis of the home care activities, we have decided the best fit for Integrated Health System's Pittsburgh operation is Patient Care Technologies Home Care Manager System. A number of criteria have been met to reach this recommendation. With Home Care Manager, data is entered one time, allowing clinicians to spend more time caring for patients instead of filling out forms. Access to data-no matter who recorded it, means clinicians don't waste time searching for information. With Home Care Manager, charts can be loaded via modem at the clinicians home or via a direct connection to a workstation at the office. Clinicians can also use the field device to record mileage and activities such as (home visits, inservices, and personal time). PtCT unlike the vendors endorses and implements HL7-the standard for data interchange in the healthcare industry. HL7 not only assures standardization of data, but also virtually eliminates manual processes in moving data between systems. Even though costs are higher than the other two vendors examined, storage, retrieval, and access capabilities to information are worth the investment up front for cost efficient savings and a qualitative method of care over the long term. Also, PtCT unlike the other two vendors investigated, has met the initial criteria for inclusion in the future accreditation process and is included on the Joint Commission's list of acceptable systems (5).
In conclusion, with managed care pushing for more cost effective methods of care, and JCAHO requiring outcomes tracking as a part of the accreditation process, home care information system will have to integrate clinical and administrative functions into one system in order to meet the demand now and in the future for home care services (8).
|
Coding/Design |
Purchase |
Initial Training |
1 year support and maintenance |
Definitive Homecare Solutions - CPR+ (2-6 user network version) |
n/a |
$6,995.00 |
Free* |
Free - first year customers $1319.20 - 2nd & 3rd year customers (Updates/enhancements are provided every 6 months) |
*Free 8 hours of telephone training
Recommended hardware for single-user CPR+:
Recommended hardware for multi-user CPR+:
It is strongly recommended that a dedicated server be implemented in a multi-user environment.
|
Coding Design |
Purchase |
Initial Training |
1 year support and maintenance |
Data Counsel, Inc. - HMS+ Homecare Management System (6 user network version) HMS+/Btrieve HSS Homecare Scheduling System FHS Field Homecare System Communications Manager Field Software (each) 1-5 SCS Site Consolidation Software |
n/a |
$22,500.00 $2,000.00 $6,000.00 $5,000.00 $1,200.00 $1,200.00 |
Consulting, custom programming, or additional training (per day charge $640.00) |
Payable and renewable annually at 15% of purchase price. ie. For HMS+ Homecare only: $3375.00 Unlimited telephone support, all product enhancements, error correction, modem support) |
Computers and Network Requirements for Data Counsel Software:
Minimum Computer Recommendations for Current Purchases:
Server:
Workstations:
Network Hardware and PC Software Recommendations:
|
Coding Design |
Purchase | Initial Training | 1 year support and maintenance |
Patient Care Technologies - Home Care Manager for Windows |
|
Price dependent upon customization | Price dependent upon customization | Price dependent upon customization |
Description and Goals | What Actually Happens |
Planning Phase (1 Month) System Implementation requires hours of preparation...careful planning maximizes the payoff! |
Agency Planning Seminar (2 days in Atlanta) Agency Project leaders come to Atlanta to:
|
Installation Phase (1 month) Setting up and testing the hardware and software prior to training. |
Configuration Testing (1.5 days on-site) Through pre and post-visit conference calls and an on-site visit, a PtCT Systems Services Rep will ensure that:
|
Reengineering Phase (3 months) Realizing the benefits of the Home Care Manager not only requires learning the technology, you also need to redesign your business processes for Maximum performance. |
Core Group Training Program (3 on-site training visits) Along with the 3 on-site training visits, the PtCT Educations Services Rep also conducts weekly phone conferences to ensure that:
|
Staff Training Phase (6 months) The ultimate success of the project depends largely on how well your staff uses the Home Care Manager. Commitment to training the remaining members of your staff is key to success. |
Staff Training Preparation (1.5 days on-site) Pre and post-visit phone conferences enable the PtCT Educational Services rep to ensure that:
|
Conversion Phase (2 months) Once clinicians learn how to use the software, they can begin using the Home Care Manager for all of the clinical documentation needs. After a couple of months, all of your charts will be converted to the system and brought up-to-date. |
Performance and Quality Visit (1.5 days on-site) During this visit, plus pre & post-visit phone conferences a PtCT Performance and Quality Consultant provides:
|
Recommended hardware for Patient Care Technology:
Server:
Workstation:
Also supports:
A notebook computer
Go back to the Project Page
Rema Padman, rpadman@andrew.cmu.edu