VNSNY adopts advanced information technology to improve patient care

Oct 12 2010

Computer Application Provides Agency Feedback on Effectiveness and Identifies Patients at Risk for Hospitalization

Unlike most home healthcare agencies, which have restricted the use of computer programs to such non-patient-care items as billing, the Visiting Nurse Service of New York has adopted advanced information technology in order to improve patient care. One of the results, documented in a new publication, is a significant 10% reduction in patient episodes ending in hospitalization, from 37% to 27% over the years 2001-2009.

"This shows that you shouldn't reserve computer technology for just patient financials when you can use it to enhance patient care," emphasizes Dr. Robert Rosati, Vice President of Clinical Informatics, Center for Home Care Policy and Research, VNSNY.

That is what VNSNY does, following the Government's push for wider use of computers in what's known as Health Information Technology, which allows better coordination of care.  It began with VNSNY's intranet website, initiated in 2002, which includes more than 250 customized patient reports that can be searched for widely differing patient information.

Three of the most important impacts of the technology are: 1) identify patients at risk of hospitalization in order to intervene clinically before the critical stage is reached; 2) discover patients who are eligible for and in need of physical therapy; and 3) assess the performance of clinical staff and programs.

One example, known as the Quality Scorecard, answers a question the agency asks itself: 'how'm I doin?' This report monitors goals and actual performance of VNSNY on such measures as staff oversight, scheduling of patients, discharge planning, treatment outcomes, and patient satisfaction. The Scorecard updates itself monthly to show how well targets are being reached.

"Unless you have a feedback mechanism in place, you have no idea whether your ambitious programs are really working," says Dr. Rosati. "It's no accident," he adds, "that the Quality Scorecard is the most frequently consulted report on our intranet, generating 22,000 hits over a one-year period."

Another popular application of the technology was devised to take advantage of information in the medical literature suggesting that certain groups of patients – those with chronic obstructive pulmonary disease, recent stroke, or hip fracture – are candidates for home-based rehab services.

"Our staff recognized that patients scattered among a variety of VNSNY programs could benefit from home rehab. Therefore, we developed an algorithm to identify such patients and get them into the rehab program," explains Dr. Rosati.

Last but not least is the ability to help prevent hospitalizations. "That is, after all, one of the major goals of home health care – to identify the patient at risk and take steps to interrupt the cycle before hospitalization becomes necessary," Dr. Rosati emphasizes.

Analysis of the VNSNY database revealed several factors that put home-care patients at increased risk of hospitalization: unhealed pressure or stasis ulcers, urinary incontinence, the presence of a catheter, respiratory symptoms, shortness of breath, and congestive heart failure. A computer model was devised to find the patients and place them in one of seven risk categories, ranging from very low to very high, so that appropriate clinical steps could be taken.

"The 10% reduction in hospitalizations is a direct effect of keeping up with the literature and using advanced computer technology to help our nurses provide the best possible care to VNSNY patients," says Dr. Rosati.

"An agency that serves more than 30,000 patients a day in more than a dozen different programs must constantly utilize the latest research from all sources for the benefit of patients. Our development of new computer initiatives within the Health Information Technology framework continues to help us achieve that goal," Dr. Rosati concludes.