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If nursing's embrace of computer technology can be compared to a hurricane, the Visiting Nurse Service of New York could be considered its eye.

Nearly 2,300 nurses and therapists are being issued Fujitsu Tablet PCs this year, for a workforce fanning out into the five boroughs of the city, like a paperless tornado.

The organization's point-of-care application, written in-house, replaces 95 percent of the paper it uses with a highly structured set of software that automates almost all nurse recordkeeping. VNS is no stranger to pen computing, but the new Tablet PC allows the nation's largest nonprofit home care organization to automate 100 percent of the point-of-care tasks, instead of the 50 percent achieved in the past round of automation.

"It was very cumbersome to carry around all the paperwork we had," said Lisa Felszer, RN, a per diem coordinator of care at VNS. "I would guess it doesn't really support decision-making the way the Tablet does. Every diagnosis generates certain problem areas. Each of these problem areas gives us a critical pathway that has a lot to do with what we're taught about medications."

For instance, a patient with congestive heart failure could be put on a low-sodium diet. As a visiting nurse, Felszer said home care "is really all about teaching in general." The Tablet lets Felszer and her nursing colleagues focus on patient education and just about eliminate the time spent and delay involved with doing paperwork.

Small wonder

The device powering this improvement in productivity is powerful and lightweight. Various manufacturers make Tablet PCs. VNS uses Fujitsu's Stylistic ST4000 Tablet PC, which weighs a little more than 3 pounds, is less than 1 inch thick and provides a 10.4-inch display. Storage of 40 to 60 gigabytes per Tablet is built in. That's easily enough for each clinician to carry around an entire caseload, which at VNS is 25 to 30 patients per clinician, along with their complete demographics. Password protection means that a Tablet accidentally left behind on a table at a diner, while regrettable, won't yield its secrets the way a briefcase of papers would.

The Tablet PC is the latest generation of Microsoft Windows devices that users interact with via a pen, although each unit at VNS also includes a separate keyboard, linked to the Tablet by an infrared signal, whenever needed. Other features include a pop-up on-screen keyboard and handwriting recognition. Drop-down boxes reduce choices between options to little more than pointing and clicking at them.

"When we were using paper, every diagnosis had a different paper form to fill out," Felszer said. "If you didn't go to the office, you didn't have the right form."

Paper-buried visiting nurses also had to practice the art of total recall: Who did I see today? How were they doing? What was my diagnosis? Nurses had 48 hours to get their paperwork into the VNS headquarters in Manhattan-relatively easy for Felszer, but daunting for other nurses living in the outer boroughs. Now, Felszer can complete her notes in the patient's home, even as she's talking to the patient, and upload that information to VNS's servers that night or the next morning. "I can't tell you what a world of difference that makes," she said.

Under the old system, Felszer had to conjure up even deeper memories. Every two weeks, there was a "route sheet" to fill out, requiring nurses sometimes to think back as far as 10 working days and document each patient they saw during that period.

Now, Felszer's routine is considerably smoothed. Each morning, she commands her Tablet PC to connect to the VNS servers via phone lines. Without leaving her house, she can file reports, receive new patient charts and access the latest company news via e-mail.

Profit sharing

Because per diem visiting nurses are paid according to how many patients they see in a day, reducing the time needed to complete paperwork results in more money in their pockets. These nurses can even file their reports by 10 p.m. on a pay-period-ending Thursday and get paid in full the next day.

Felszer also can connect to VNS servers during the day to receive more frequent updates, if need be. It helps, she said, to identify those patients on her regular rounds who have an "RJ11" phone jack that can be easily plugged into the Tablet PC, just in case.

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