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Not only is the information being uploaded from these
Tablet PCs more accurate than past reports at VNS, communication
between nurses is better. For example, Felszer will
file a final report Friday night, and any nurses who
are in touch with her patients during the weekend can
refer to the most up-to-date information and treatment
plans.
"Nurses who have been used to paperwork for a
long time probably took a little longer to get used
to it," Felszer said. "Computers do have problems,
and it's frustrating at times. I've never had it completely
go down on me. But everybody at the office is so helpful.
The help desk is wonderful."
In the VNS offices, the Tablets also get the benefit
of a high-speed connection thanks to a Wi-Fi network.
Despite the dramatically more automated job that the
Tablet enables, Felszer retains the human touch that
distinguishes nursing. "I maintain eye contact,"
she said. "It's very easy to just use the pen and
tap."
As with smaller devices, the Tablet PC can contain
a full database of drug contraindications that VNS nurses
can consult on the fly. This process is known as the
Drug Utilization Review. "After I input all the
medications into the tablet, I tap the 'DUR' button,"
Felszer said. "It runs through every medicine."
Software sorts drug interactions into four categories,
ranging from "don't ever use these together"
to "no interaction at all" between the drugs.
At Level 2 and above, the nurse must notify a physician
and document the DUR. "
A lot of times, it really helps with patients who go
to clinics," Felszer said. "Physicians don't
always know what other medications they're taking."
Back in the office, a nurse can tap a button and generate
a printout about a new medication's side effects, then
hand this printout to the patient at the next visit-all
of which is a whole lot easier to lug around than the
old drug book, not to mention more up to date.
VNS has not encountered any of the problems that plagued
earlier laptop computers, Rick Stazesky, director of
information systems, said.
"We've been active users of pen computing since
1995," Stazesky said. "We're a fairly seasoned
organization, experienced in what this does for us.
Laptops are not meant to be lugged around all day and
open and closed constantly. Our applications require
more storage space than is available on PDAs and Pocket
PCs. Over the years, we've progressively enhanced the
mobile computing application that runs on the pen computers,
now called Tablet PCs. We've gotten excellent life out
of them."
Nurses traveling by car can recharge the Tablet during
the day by attaching to a charger that fits into the
vehicle's cigarette lighter. Nurses on foot or on public
transit can swap in a second charged battery without
losing any work.
Stazesky doesn't have any hard figures on what the
Tablet PC's return on investment has been for VNS, but
he notes that fewer back-office staff are needed now
to handle data entry functions. "We just believe
it really has improved our documentation standards,
and cut down on errors," he said. "Clinicians
can see what the other clinicians document."
As VNS's critical-path knowledge bases accumulate in
each Tablet PC, there's also a greater standardization
of the quality of nursing care, Stazesky said. "The
way a nurse in the Bronx is treating a diabetes 1 patient
is now essentially the same as how a nurse in Staten
Island does it," he said. "Before, every nurse
had it in their head. Now, it's more consistent."
Fresh analyses of treatment plans can be input into
the VNS servers, and IT staff can distribute updated
plans online via the nightly data swap between the servers
and the Tablets.
Within the next year, Stazesky foresees using the powerful
graphics engine in the Tablet PC to make video training
for nurses and patients available right on the Tablet.
Other handy databases, such as the guide to ICD-9 diagnosis
codes, help drive reimbursements VNS receives from other
payers, particularly Medicare.
As in other cases, this nursing informatics push is
leading the way for initiatives elsewhere in health
care. "Other providers in the health care network
have the same patients as us," Stazesky said. "The
next step is we hope to electronically share with them
any important data we're picking up about their patients.
At the point where insurance companies, hospitals and
physicians are ready to receive this data, we're ready
to share that information."
Point-of-care computing is where such broader automation
starts, he said.
Felszer has only one request of the hardware wizards
who made this latest generation of mobile device possible.
"Our old tablets had a small handle on the outside
casing, kind of like a briefcase handle," she said.
"I miss that," she said with a chuckle.
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