FIGURE A

Jeneane Brian, CEO of VNAHHS, looks up patient data on her Palm IIIxe handheld. Click picture for a larger image.

By March, the solution was being tested by clinicians in VNAHHS' high-risk infant homecare program. Four months later, Brian began to use the Internet version of Pendragon Forms to support multiple users. VNAHHS now has over 100 visiting nurses using Palm Powered handhelds with the remaining clinicians to be phased in over the next 6 months.

Clinicians use their home PCs or wireless modems to synchronize their handhelds with the VNAHHS' central database each morning. This provides up-to-date information about each patient that can be referenced on the handheld throughout the day.

SSL (Secure Sockets Layer) is used to protect data transmissions, and each clinician has password access that determines the areas and features she can use when accessing the central database. The transmissions are encrypted, and Medicare has approved the electronic signatures used.

During a patient visit, clinicians can use their handhelds to access patient information, shown in Figure B, and medical resources like the drug reference and interaction application LexiDrugs, giving them valuable decision support right in the field.

FIGURE B

Patient information can be easily and clearly examined on the Palm handheld.

They also collect patient information using the handheld. Figure C shows Tena Bowish, a VNAHHS clinician, looking up patient information on her Palm Powered handheld.

FIGURE C

Tena Bowish, a VNAHHS clinician, looks up patient information on her Palm Powered handheld. Click picture for a larger image.

Following a patient visit, clinicians can complete the electronic nursing forms, shown in Figure D, from their handhelds, and upload the information to VNAHHS' servers using a modem. Over the next 24 hours, they can access that form from their home PCs or handhelds to edit and complete unfinished forms. This new process saves the nurses time and simplifies information collection and management for VNA. It also enables up-to-date communications with the care team and home office.

FIGURE D

Practitioners can choose from a variety of different forms.

Forms are also used to guide questions and answers, as shown in Figure E.

FIGURE E

Each answer leads to a new question.

Field staff has permission to view and edit only their own data, while managers can view all data transmitted by their staff in addition to their own data. Managers use a Microsoft Access-based interface that's different than the clinicians use, which allows for queries of data for analysis. Visual Basic is also used to create reports and display information.

Handhelds produce many health returns
Thanks to Brian's innovative use of handhelds, VNAHHS has improved documentation accuracy, clinician satisfaction, and point-of-service decision support. The solution is largely credited with a 37% increase in employment applications by clinicians between January 2001 and June 2001. The company has also recorded a five-fold decrease in reporting turnaround time, and a 50% reduction in paperwork.