Hospitals Work to Resolve Homecare IT Bottlenecks

Hospitals with electronic medical records often have portals so that affiliated ambulatory care providers can view patient charts from outside the institution, but the interoperability generally only works in one direction. Few current EMRs are set up so that external users actually can send data back to the hospital.

Saint Raphael Healthcare System in New Haven, Conn., is trying to change that with its homecare/hospice subsidiary, VNA Services, which VNA Services, which cares for 600 to 700 patients at any given time. "We haven't solidified the connection yet with the hospital," says VNA's manager of clinical information services, Dottie Bezanson. But they are working on the link now, with the help of a common vendor, Misys Healthcare Systems (Raleigh, N.C.).

Hamden, Conn.-based VNA Services already is essentially paperless, as all 40 or so of the agency's field clinicians have laptop computers they take to the point of care. Before going out, users download patient demographic and medical history information from the homecare organization's server, according to Bezanson.

Information from referrals has to be keyed in, but nurses and physical therapists chart all homecare encounters electronically, right in front of patients, which even elderly patients with multiple conditions generally are not averse to, Bezanson says.

"At this point, a lot of our patients, they're faced with computers all the time," says Bezanson, a registered nurse and part-time practitioner. "It really enhances their comfort that they know I have their information."

Just to make sure Bezanson says that she likes to remind clinicians during IT training that the computer is merely a tool to help them do their jobs better. "You're a nurse first or a physical therapist first," she says. This attitude also has helped lower staff resistance to the EMR from when VNA Services started more than three years ago. Also, potential hires are given a clear message during the interview process, according to Bezanson: "It's not optional."

Right now, users in the field have to sync their laptops to the server when they get back to the office or connect via the Internet from home. One of VNA's two locations is moving soon, so the organization is studying the feasibility of wireless broadband service to offer real-time connectivity in the new facility, Bezanson says.

However, the real goal is to create live connectivity with the health system and its flagship, 511-bed Hospital of Saint Raphael. Ideally, VNA clinicians would be able to pull up information on homecare patients recently discharged from the hospital. "It would help us plan better care," Bezanson says. "It would help alleviate some of our patients' anxieties."
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