New Jersey Agency Reports Waves of Advantages from POC System

Ask Debbie Roe what technology has done for the Ocean County (New Jersey) Board of Health and she responds with a double-digit list. After considerable time for thought, the Public Health Nursing Supervisor may narrow it down to the top nine. She will not, however, tone down her enthusiasm for her point-of-care automation system from Thornberry Ltd., in nearby Lancaster, Pennsylvania.

Located in the town of Toms River, the Board of Health is a not-for-profit public agency that offers home health care as well as an outpatient clinic. They use the point-of-care system for both services. Over 60 visiting nurses and therapists carry laptop computers running the NDoc application and the clinic also uses it to register patients.

"Our number-one gain has to be our greatly improved access to information," Roe says. "Everybody has access first thing in the morning to all of yesterday's visit information, including other nurses in the field." Previously, Ocean County nurses had to drive to the office every day to deliver paperwork, which had a tendency to occasionally be misplaced, Roe remembers. Now, nurses always have the most recent visit information at hand when they go out on the next visit, and they can go days at a time without driving to the office. Chart review has become many times easier.

"Another advantage," Roe continues, "is charting consistency. Our QI person is thrilled with the latest NDoc version because it does not permit inconsistencies within an assessment. Before, reviewing a single chart for accuracy was a laborious process. Now, the software eliminates common mistakes." Roe gives the example of opposite "ambulation help" responses between OASIS and 485. "NDoc stops you right there," she says, "and forces you to pick one answer or the other in both locations before you can close out the visit." Most errors are caught at the software level and corrected by the originating nurse before QI ever sees the assessment.

Communication between field nurses and office staff was one of Ocean County's perennial problems. In a typical scenario, a nurse drives to the office to turn in a day's paperwork. Sometime in the next few days, a supervisor reviews visit notes and forwards them on to a data entry clerk or medical secretary for entry into HAVEN or some other clinical application. If the software detects an error, the secretary certainly cannot correct it and the supervisory nurse typically prefers to consult with the original nurse before making a decision. So the communication process begins. A page is sent, hours later a call comes back and the supervisor or secretary is tracked down. If one or the other can be found, the issue is explained. If the field nurse has an accurate recollection of the patient's situation, the question is answered on the spot; if not, the process starts over again. By this time, the OASIS lock date has come and gone and the problem compounds. "All of that leg work and communication delay have been compressed into one simple step," Roe exults. "On the rare occasions when an issue does get by the originating nurse, the office sends her a question by email and gets the answer the next day. We don't miss lock dates anymore."

Roe's list of luxuries afforded by point-of-care software goes on to include automatically generated confirmation forms documenting medication changes, start-of-care notes immediately available to therapy coordinators, clearly identified outstanding physician orders that appear in bright red on the screen when late, and an interesting new feature unique to Thornberry. "On the laptop, the software operates within a browser," Roe explains. "But it lets you open multiple copies of the browser at the same time. If a nurse gets a phone call in the middle of entering an assessment, she can look up another patient's record, answer the question on the spot, and return to the assessment right where she left off."

Finding quick answers has streamlined Ocean County nurse's days in a number of ways, in Roe's estimation. The latest version of NDoc has a summary page for every patient. Her nurses have come to use it with such frequency, she describes it as a "Frequently Asked Questions" function. "With a couple of clicks, a nurse can bring up a page that shows at a glance all the information we usually need when someone asks about a patient. It displays all visits for the current episode, color coded by 'authorized' and 'completed,' the status of any documents, a summary of the last visit, when the next visit is projected, when the patient's next doctor visit is scheduled, a summary of the care plan and any DME products ordered." Roe says the summary page also includes patient demographics such as birth date, address, doctor and pharmacy name and important ID numbers. Just behind the page, available with one more click, is the entire note from any completed visit. Roe and her office staff are especially fond of NDoc's to-do list for nurses, which has reduced phone calls. "The list shows every outstanding task," Roe says, "485s, recertifications coming due, OASIS assessment window dates, everything. They see the list every day and rarely miss a deadline."

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