Home Health Care Software Recommendation For Home Care Services Organization

 

Nicholas Callas

Connie Greenwald

I-Ping Li

 

March 9, 1998


Table of Contents

  1. Executive Summary
  2. Background
    1. Organizational Background
    2. Organization History
  1. Existing Operation
    1. Overview of current process
    2. Problem Definition
    3. Requirements
  1. Software Candidates
    1. Software Vendors
    2. Software/Product Information
    3. Vendor Comparison
  1. Recommendations/Conclusion
  2. Appendix - Implementation/Maintenance Costs
  3. Bibliography

 


I. Executive Summary

 

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.


II. Background

 

A. Organizational Background

 

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.

 

B. Organization History

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.

 


III. Existing Operation

 

A. Overview of current process

 

B. Problem Definition

 

Home Care Services issues:

Billing:
Scheduling:
Paper Work:

C. Requirements

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

  1. The measurement system contains measures to address at least one category of clinical performance, health status, patient satisfaction, and administrative/financial.
  2. Individual practitioners are not addressed individually.
  3. The system has a documented procedure for adding, modifying, maintaining, and deleting performance measures.

Attribute two Database (Measurement System technical capabilities):

  1. The measurements system contains one or more automated databases; is operational; is ongoing; and can link individual health care organizations or sites with their own data.
  2. It must receive and store, or has access to, performance measurement data of individuals (patients, enrollee, employee, etc.) for each measure is targeted for use in the accreditation process.

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.


IV. Software Candidates

 

A. Software Vendors

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, Ohio

Patient 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

 

B. Software/Product Summaries

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:

  1. Integrated Outcome Analysis Module with establishment of a National Benchmarking Program Master
  2. Company-Wide "Things to Do Reporting and Scheduling" Automatic AWP Updating via Medi-Span Interface Report Writer - enabling Customers to create their own custom Reports Development of the CPR+ Provider Network - a coalition of over 250 independent home infusion therapy companies.

 

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

  1. All data captured during the patient visit can be reformatted for administrative purposes (i.e., billing, scheduling, payroll, HCFA forms, etc.).
  2. Home Care Manager is the first system to offer OASIS (Outcomes Based Quality Improvement study) as a fully integrated part of the charting process.
  3. Home Care Manager is being considered by the Joint Commission for possible inclusion in the ORYX initiative (which integrates computerized performance measurement into the accreditation process) for purposes of participating in the accreditation process.
  4. PtCT is the first clinical home care software company to endorse and implement HL7-the standard for data interchange in the healthcare industry.

 

Data Counsel, Inc.

HomeCare Management Systems (HMS+)

Field HomeCare System (FHS)

HomeCare Scheduling System (HSS)

Product Description:

HomeCare Management System:

  1. HomeCare Management System accomodates home health, hospice and private duty agencies.
  2. Integrated billing and clinical functions operate without overlapping or conflicting data gathering requirements (2).
  3. Financial, management and regulatory reports available on demand.

HomeCare Scheduling System:

  1. Weekly and Monthly calendars with simultaneous updating of patient and providers
  2. Fully integrated with HMS+
  3. Operates grahically under Windows 3.1+, Windows 95 or Windows NT

Field HomeCare System:

  1. Uses standard laptop, notebook and pen-based, handheld computers under Windows 3.1+, Windows for Pen Computing or Windows 95 (Win 95 strongly recommended).
  2. Sophisticated assessment and variance recording (including OASIS).
  3. Encrypted uploads and downloads
  4. Fully integrated with billing, orders, and reporting functions in HMS+
  5. Increases patient care time by virtually eliminating paper and greatly reducing office visits and travel time (2).

Site Consolidation Software (SCS):

  1. Provides each agency with full HMS+, HSS, and FHS capabilities while consolidating data centrally for billing/collection/AR functions.

 

C. Vendor Comparison

 

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:
Goals Management
Drug Management
Fax Management

Low

High

Low

Electronic Claims

Low

High

Medium

Infusion Therapy Tracking

High

High

High

 


V. Recommendation/Conclusions:

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).

 


VI. Appendix -- Implementation/Maintenance Costs

 

 

Definitive Homecare Solutions:

 

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.

 

Data Counsel, Inc.:

 

 

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:

 

 

 

PtCT's Implementation Process/Home Care Manager for Windows:

 

 

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:
  • Learn the capabilities of the Home Care Manager
  • Learn what is required to implement the system
  • Gain hands-on experience necessary to begin the Implementation Process

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:

  • All PtCT hardware and operating system requirements are met
  • The Home Care Manager is properly configured
  • Any pre-training system problems are resolved
  • Agency personnel understand system maintenance requirements

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:

  • A core group from your agency (6 clinicians and 2 administrative personnel) learn the ins and outs of the Home Care Manager
  • Agency workflow is reengineered
  • New policies and procedures are created to reflect the workflow changes

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:

  • All reengineering objectives are successfully met
  • All training issues are resolved
  • A viable staff-training plan-that includes all disciplines-has been constructed

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:

  • A review of your reengineered workflow process
  • Refresher training in the areas that need it
  • Written suggestions for improvement

 

Patient Care Technologies:

Recommended hardware for Patient Care Technology:

Server:

Workstation:

 

Also supports:

A notebook computer

 

 


 BIBLIOGRAPHY

 

  1. http://www.ptct.com/content - Patient Care Technologies, Inc.
  2. http://www.datacounsel.com - Data Counsel, Inc.
  3. http://www.cprplus.com - Definitive Homecare Solutions
  4. Crowley, Ray. Home-care providers combine resources. Denver Business Journal, Denver, CO, US; v.47, no.24, p.10C; (February 23, 1996).
  5. Healthcare Informatics: NURSING SYSTEMS '97. Case in Point: Home Healthcare Meets Managed Care. February 1997.
  6. Neurath, Peter. Managed Care software firm ready for the market. Puget Sound Business Journal, Seattle, WA, US; v.16, no.43, p.3; (March 8, 1996).
  7. Reed, Vita. Home health care emerges as a "rapidly growing" option. Las Vegas Business Press, Las Vegas, NV, US; v.13, no.1, sec.1, p.1; (January 8, 1996).
  8. Scanlon, Cynthia. Home Health Care among fastest growing fields. Business Journal-Phoenix & the Valley of the Sun, Phoenix, AZ, US; v.16, no. 10, sec. 1, p.23 (January 5, 1996).
  9. Wang, Phyllis A; Spiller, Kate. Home care manages patients cost-effectively. Capital District Business Review, Albany, NY, US; v.22, no.48, p.12A; (March 11, 1996).


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