Visiting Nurses Association Home Health Systems (VNAHHS) in Santa Ana, California, joined the club this year, becoming one of the first home healthcare organizations in the nation to develop and utilize Palm Powered handheld technology to give nurses more time to nurse.

A non-profit community-based organization established in 1947, VNAHHS provides home health for patients from newborns to the elderly living in Orange County California and the East San Gabriel Valley, part of LA county. The company's staff includes 250 full time clinicians as well as many part time and contracted therapists and social workers.

Home Health Services offers intermittent home health care including pediatrics, high-risk newborn, maternal-child, psychiatric, and adult home health. The company also provides hospice care for terminally ill patients.

Diagnosis: nurse burnout
VNAHHS receives funding from the United Way as well as numerous state and federal grants that are program specific. It is self-supporting from patient revenues for its main programs, making it a cost-conscious operation that finds it difficult to compete on salary alone to attract clinicians.

During today's nursing shortage, this presents an interesting challenge for the company--how to attract qualified clinicians and prevent them from leaving the profession due to too much time filling out forms and not enough time spent with patients.

Compare your paperwork to these clinicians and you'll understand their pain. On average, a routine visit generates at least 3 forms: one to document nursing care; one to document time and attendance; and another that could have to do with physician order changes, supplies orders, managed care visit authorizations, or interdisciplinary communiqués.

With up to seven patient visits per day, the task of completing these forms and getting them quickly to the central office for transcription is a daunting one.

In addition to addressing these issues, VNAHHS wanted a way to improve the resources available to nurses caring for patients at home, and cut the amount of time clinicians spent traveling to and from their home offices to drop off paperwork. They also wanted a faster way to gather information and make it available to clinicians in the field and management, both for patient care and for trend analysis.

The treatment: Palm mobile field service solution
In January 2001, Jeneane Brian, nurse and CEO of VNAHHS, used Pendragon Forms to create iForms, a custom software solution running on PalmIIIc and PalmIIIxe handheld computers as well as Handspring Visor handhelds running the Palm OS. Figure A shows Jeneane looking up patient data on her Palm computer.