Agency-Vendor Collaboration Results in Improved Care, Lowered Costs, Fewer Desks

What is the relationship between software and furniture? The odd question surfaced when a point-of-care software system implemented by Twin Tier Home Health allowed the Vestal, New York agency to dramatically reduce clinician office time. No longer requiring work space for clinicians who rarely drove to the office, the agency sold their desks!

Twin Tier is a division of United Health Services and serves a semi-rural region near the New York/Pennsylvania border. The agency moved to Thornberry's NDoc clinical point-of-care system in 2004. Committed to constantly finding new ways to increase efficiency and effectiveness, Twin Tier was not content to stop at merely streamlining documentation.

Management's style is to develop agency improvement projects in collaboration with vendors and Thornberry was a more than willing partner. Two recent joint efforts resulted in Twin Tier gaining the ability to import lab results and wound photos directly into the NDoc patient record.

Lab Results Integration
Twin Tier previously used a manual and time-consuming process to review, input and track lab results. Faxed results were placed in office mail boxes, where they sat until each clinician personally retrieved them. After responding to immediate patient needs suggested by abnormal results, they entered the lab results into NDoc. This arrangement produced two negative effects. It increased clinician office time and mileage, thereby raising agency costs, and it introduced undesirable delays that countered the prompt response Twin Tier prefers to offer.

Reinventing agency procedures
Upon Twin Tier's suggestion, Thornberry developers ran with the idea of adding automated lab results to NDoc's integrations. The concept came at a time when the vendor's clinical consultants were working with software developers to finalize a true electronic medical record for home care and hospice. The integration of automated lab results took the product one step closer to being a complete, paperless medical record. The new functionality met Twin Tier's twin goals: rapid response to patient needs and increased staff productivity.

Gains and benefits
Lab results received electronically by Twin Tier now automatically update the NDoc patient record. Abnormal results trigger email alerts for case managers, who can then review them from their laptops and take appropriate action as needed. "Our goal is to constantly make our staff more productive, more effective through technology," said Twin Tier CEO Joe Cerra. "Not only does the agency win, but our patients receive better care with improved outcomes. We will continue to improve through technology and are grateful for our partnership with Thornberry."

Patients with abnormal results benefit from prompt action on their behalf as the clinician can now contact physicians from the field. Clinicians have additional time in the field since they are no longer required to return to the office just to review lab results. The agency enjoys increased clinician productivity as lab results no longer need to be entered manually and reduced mileage expense creates additional savings.

Wound Photo Integration
Twin Tier's wound care processes included providing each clinician with a digital camera and memory sticks. During wound care cases, clinicians took pictures and personally delivered the stick to the office. An administrative assistant loaded photos onto a shared drive and printed copies. The clinician verified the printed photo before filing it in the patient chart. Obviously, a cumbersome and time consuming process.

Back to the partner
The challenge to integrate wound photos into the NDoc electronic patient record was intriguing to both Thornberry and Twin Tier. Thornberry president Tom Peth considered the feature an important component to his company's intention to create a true EMR. "Integrated wound photos are another example of the connected care we believe is crucial for home care and hospice organizations to succeed," he told his staff when he accepted the challenge.

Today, the entire process is automated and built into the software, again saving clinician time and company mileage costs. Clinicians take the photo, connect their camera to their laptop and, in essentially one step, upload and attach it to the written wound description in the NDoc patient record. Photos are transmitted to the agency during laptop synchronization. When the patient record is reviewed in the office, a complete photo history of each wound is available to case managers, wound specialists, patient physicians and, when necessary, auditors.

Benefits
Following integration of wound photos, Twin Tier experienced another productivity increase for both administrative assistants and clinicians. Administrative staff is no longer involved in wound care. Clinicians are not required to make unnecessary trips to the office, leaving more time for direct patient care.

"This is truly a win-win-win situation and the only one that makes sense in an age of ubiquitous, high-speed Internet connections," declared Cindy Trait, Twin Tier information systems coordinator. "Patients receive better care, clinicians no longer have to run fool's errands to deliver memory sticks and the agency benefits from improved productivity and reduced mileage."

Conclusion
Today, clinicians are in the office so seldom that Twin Tier sold their desks. Time once spent driving is now available to patients. Clinicians work from home and are empowered to set their own schedules. Staff members appreciate the reduction in redundant, time-consuming processes. Twin Tier realizes a revenue increase and cost reductions due to the success of two collaborative projects with its software vendor. Productivity and staff morale have improved while mileage and paper and copying supply costs have been reduced.

Despite early successes, Cerra and his management team have made it clear there is more innovation to come. Recognizing the need for connected care and ever-increasing efficiency to enable a home care agency to adapt to industry trends, they will continue to collaborate with Thornberry to find new ways to improve efficiency, patient care, staff morale and agency revenue. Thornberry, for its part, will continue to seek collaborative client relationships in its effort to support effective and efficient home care and hospice organizations.

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