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According to Brian, PDAs also trump previous efforts to use laptop computers to automate nursing paperwork. "Nurses who used laptops hated lugging them around," she said. "They would get through with their visits, and then they'd see the welcome screen. The software was complex, and it required a $3,000 IBM ThinkPad to handle it."

The Palm OS PDAs also have been extraordinarily reliable, Brian said. "I've had nurses' kids drop devices into the bathtub," she said. "That messes them up pretty bad. We've had the Internet connection go out. But as far as the Palm OS crashing and failing, that has never once happened."

Protecting patient privacy

The Health Insurance Portability and Accountability Act of 1996 regulates the use of electronic medical records in the United States. HIPAA requirements include the need for "dual factor" authentication when accessing sensitive patient information. This means that PDA users with patient records must use two of three different approaches to identify themselves to a computer:

• Something you know-like a password;
• Something you are-like a fingerprint; or
• Something you have-like a Smartcard or SecurID card that has a special key separate from the computer
  

"We password protect and do 128-bit encryption and decryption behind the password," Brian said. "In my view, it's much more protected than the typical paper records left on the front seat of a car while someone goes in a store. People have kept copies of paper records to verify their timesheets. I've seen years of physical records left under the bed of health care workers. You have to look at the technology compared to the previous system."

As another precaution, Brian's software does not allow anyone to print or save data from the PDA outside of the authorized synchronization processes.

VNA Home Health Systems' technology was the only one uncovered in researching this story that handles what is still on others' wish lists: it generates the billing right from the PDA. "Our visits are our unit of service," Brian said. "That's what we generate our bills from. Those are all uploaded into our financial system. Say we do 300 visits one day. Those are 'synched' over, appended, someone makes sure there aren't two of the same thing, then they're into the billing and into payroll."

Even at VNA Home Health Systems, the next goal beckons. Brian's next objective is to fully automate quality assurance and process improvement. "For instance, if I give a class to 30 nurses on how to give cardiovascular physical assessments, it would be possible for me to compare their assessments a week before class vs. a week after, to see if their assessments are more sophisticated," Brian said.

Telemonitoring is another strategy to cope with the nursing shortage. If a home care patient can take vital signs, not only can each visit be shortened 20 minutes by doing the test before the nurse arrives, the technology also could replace needless weekly visits, with visits prompted only when telemonitoring equipment readings detect a problem. All these results can be pushed out into the same PDA data system now in use, Brian said.

"If I can do that, I can save another 20 percent on our staffing," she said.

Contact Scott Mace at scottmace@wiredmuse.com

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