CASE STUDY: Tender Care Home Health

When Ann Rodriguez-McConnell, RN, started her own home care agency in 2006, she was ready to do things right. As such, she knew that she could not rely on paper to run the organization but instead would need to leverage advanced technology.

“Before starting Tender Care Home Health, I had been working in home health for 15 years. I had worked with many agencies that were run on paper and it really was very inefficient. Some of the biggest problems stemmed from the fact that it often took a long time for the nurses to turn documentation in. With a paper system, it was also difficult to keep tabs on the quality of care being delivered,” Rodriguez-McConnell said. “I decided that my new agency would need to be run with an electronic medical records system.”

So, Rodriguez-McConnell  went down the EMR path from the get-go. The problem: Things initially didn’t pan out as expected.

Home Health software case study

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“We implemented an EMR and got everybody trained but it was a nightmare. Just to open a nurse’s note took about 20 minutes. The nurses had to go through about 20 ‘stoplights’ just to get to their notes,” Rodriguez-McConnell said. “We started losing our nurses because they didn’t want to work with the cumbersome EMR. So, I decided I would just have to go back to paper.”

Finding the right system

McConnell realized, however, that running on paper was just a stop-gap measure. To truly build the agency of her dreams, she would have to bring in another EMR system. So, she decided to meticulously reviewed her options in order to find a system that would be whole-heartedly embraced by the clinicians.

After assessing several systems from various vendors, in 2011 she chose to implement an EMR from DeVero because of the following features:

Easy documentation. The DeVero system mimics paper documentation.  As such, caregivers can move around the system “at will” instead of being forced to traverse through pages of documentation in a pre-determined manner. For example, they can enter a blood pressure reading at any time. In other decision-tree based systems, clinicians might have to fill out pages of demographic information and check off various items before being allowed to enter the reading.

“The nurse’s documentation section is just two pages long versus 20 stoplights,” Rodriguez-McConnell said. “So, our nurses want to use the system.  They don’t view it as a burden.”

Easy implementation.  With DeVero, users can be trained to use the system quickly. “Some software systems are really difficult to understand.  But, with DeVero, the clinicians just put in their password, click on a patient and start documenting in a two-page form,” Rodriguez-McConnell said.

  Easy customization. The DeVero system can easily meet any organization’s changing needs. For example, when Tender Heart entered into a contract with a local hospital to provide care services to the area’s homeless population, DeVero was able to quickly accommodate this new service line.

“DeVero created documentation that makes it possible for the nurses to treat patients in clinical settings at the Salvation Army and the Rescue Mission for the Homeless,” Rodriguez-McConnell said. “So, they are able to see these patients and follow protocols that are presented in the DeVero system while also documenting at the point of care.”

Patient care benefits

With the DeVero EMR in place, Tender Care is now reaping the benefits associated with doing things right. Perhaps most importantly, the electronic access to clinical information is helping to improve care.

“The system helps our clinicians do the job that they need to do – and that’s patient care. Having access to the patient record electronically at the bedside makes it possible to deliver the best care,” Rodriguez-McConnell said. “I remember the days when we were working with a paper system and nurses would have to recertify a patient.  They would have to go to the office, pull the chart, look at the previous notes, see what the vital signs were, see if there were any changes, check for new medication. Now, it’s just a matter of opening the chart in your lap. You can do it right before you go into a patient’s home.”

Point-of-care access to the patient’s history helps caregivers work with their patients to better manage chronic conditions. For example, if home health nurses notice that a congestive heart failure patient has gained five pounds or experienced an increase in blood sugars, they could then make sure that the patient sees the doctor, who could initiate an intervention.

In addition, because McConnell and other supervisors have immediate access to the EMR, they can ensure that nurses are taking appropriate actions as patient conditions change.

“We can open the note and see that the patient’s blood pressure is high.  The next thing we do is make sure the nurse has done something about it. We are only as good as our follow-up and we can identify until we’re blue in the face, but if we don’t call the doctor to do something about it, then we are not improving care,” Rodriguez-McConnell said.

By ensuring that patients receive these needed care interventions, re-admissions are avoided.

The EMR also has enabled Tender Care to implement improvements that have a positive effect on entire patient populations. For example, a review of the EMR documentation showed that many of the home health care agency patients were experiencing falls at night. So, Tender Care offered urinals to male patients and bedside commodes to female patients to eliminate the need to walk to the bathroom at night. As a result, the number of falls decreased significantly.

In addition to these clinical benefits, the system also helps the agency improve its revenue cycle. When the agency was operating on paper, nurses would have to travel many miles to deliver all of the clinical documentation to the home office before claims could be submitted. Then, a staff members would have to enter the information into the system.  If documentation corrections were warranted, the nurse would need to come back to the office and make revisions.  With the EMR, however, central office staff members can open up the EMR and submit claims instantly.  As such, the office is now submitting claims about one day after care occurs, instead of two to three weeks after the series had been delivered.

Indeed, with the EMR in place, Tender Care is realizing McConnell’s initial visions and is experiencing all of the improved clinical and financial benefits that go along with doing things right.

Tender Care Home Health: At a Glance

Established in 2006, Tender Care Home Health, El Paso, Texas, provide physical, occupational, and speech therapy to patients.  The home health agency also provides chronic disease management and healthcare throughout the states of Texas and New Mexico.

Challenges

  • User adoption
  • Care management
  • Revenue cycle efficiency

Solution
DeVero’s Electronic Medical Record Implemented at:

  • 2 Health Home Health Sites
  • 2 Clinics serving the homeless

Results

  • Improved quality of care
  • Reduced readmissions
  • Streamlined billing, improved cash flow