Community
Health and Counseling Services (CHCS) is a private
non-profit organization that provides community-based
home health, hospice, mental health, and behavioral
services to adults and children in central, eastern,
and northern Maine. More than 7,000 people benefit
each year from the efforts of over 700 professional,
support, and management staff of the agency.
CHCS
believes that, whenever possible, care is best given
in a familiar setting where family and friends can
become part of the support and recovery process.
The services that are offered are designed to enhance
the quality of life for those who are facing health
challenges. The mission of CHCS is to provide community
health services that are needed and valued by the
individuals served.
The
important care services that CHCS provides to its
clients include a variety of administrative and documentation
requirements that are needed to ensure proper and
well-documented care, as well as third-party reimbursement.
As with any other business entity, efficiency and
data accuracy are of the utmost importance.
An
immediate business challenge CHCS faced was making
their current paper-based clinical documentation
system more timely and accessible from remote locations.
Clinical documentation includes the reporting of
client status and services rendered by field-based
paraprofessionals or Home Health Aides. These paraprofessionals
are caregivers who visit client homes to assist with
personal care needs, working under the direction
of clinical professionals. In the past, all record
keeping for paraprofessionals was paper based, and
Aides had to come into the office (often from remote
rural locations) to turn in time sheets for payroll
and billing, which required later keying by a data
entry operator. In addition, they had to record on
paper their client related information for clinical
flow sheets.
Program
Development Coordinator for CHCS, Ruthanne Singal,
remarked, "We considered what we could do for
the Home Health Aides that would be simple and easy
to use, and meet our two main goals: clinical documentation
and payroll/billing." Valerie Levy, Manager
of Management Information Systems at CHCS, recalls, "From
trade journals and national conferences we attended,
we had heard about telephony as a data collection
mechanism for Home Health Aides and Homemakers."
The
search began for a telephony vendor that met the
requirements of CHCS. Jim White, Systems Analyst,
found iMessaging Systems, Inc. through an Internet
search and was intrigued and impressed with iMessaging’s
iSeries-controlled iVoice telephony solution. Shortly
following Jim’s find, Valerie visited the iMessaging
Systems booth at a COMMON conference and was equally
impressed: "iVoice was of interest to us because
of its integration with the iSeries where all of
our corporate data resides. We looked at other telephony
providers and outsourced solutions, but we wanted
the data directly on the iSeries because of the confidential
nature of the information we handle. Also, we needed
a vendor that was flexible and easy to work with;
and we needed a contract that had a heavy support
component, because we anticipated a complex system
design. iMessaging listened to those needs and wrote
a contract that was reasonable and met our needs.
They were great to work with through the sales process
and didn’t disappoint throughout the implementation."
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iVoice
system collects client visit information
from staff in the field.
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The
Simple Solution – How it works
CHCS quickly determined that iVoice was the right solution and that iMessaging
Systems could handle the involved "voice" application design
and coding effort. iMessaging’s technical team went to work to
guide the CHCS staff through the design phase of implementation, and
after many iterations, a call flow was developed that met the approval
of CHCS staff. "We never had support from a vendor at this level
that was so responsive and so absolutely correct. We needed the telephony
process to be quite complex, but the iMessaging technical team worked
with us to guide our call flow and manage the initial voice application
development," commented Ms. Levy.
The iVoice system works by collecting information at the start and end
of each client visit. It also collects Home Health Aide travel time and
mileage. When a paraprofessional first enters the home, they dial iVoice
and place a "begin call". This action creates a timestamp of
the Aide’s arrival at the client’s home. Similarly, upon
departure, an "end call" is placed. As part of the "end
call," the system also prompts the paraprofessional for "intervention
codes" and a "care code" which indicates to iVoice what
task was performed and who administered the care. The care code might
indicate the Aide, a caregiver, or the client, for example. Interventions
may include activities such as "gave client a bath," "took
vital signs," or "personal care under the treatment plan prepared
by a nurse." Adding to the complexity, a good many of the intervention
codes require values and ranges such as blood pressure, pulse, and temperature.
Once
the visit is complete, and all information is captured
by iVoice and posted to the iSeries, a complete client
progress note documenting the visit is available.
In addition, billing and payroll for the Home Health
Aide is updated, and mileage reimbursement is recorded.
Ruthanne Singal notes, "The system ends up being
really a full service time-keeping application."
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Mike
Soucy
Senior Programmer/Analyst
Community Health and Counseling Services
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One
initial hurdle CHCS had to overcome was the editing
requirements of the client documentation and time
sheets. Valerie Levy notes, "After iVoice has
completed the call transaction, a time sheet is produced
for the entire week, and a supervisor needs to be
able to review and check for duplications or inconsistencies
to ensure all data is accurate prior to sign off
for payroll and billing. When we first began to test
the telephony system, we had omitted design of this
important step." But Michael Soucy, CHCS Senior
Programmer/Analyst and Websphere guru, came to the
rescue by developing a web-based edit tool for CHCS
management. Now, the entire process has been automated,
using iVoice to collect the Home Health Aide data
and a web-based interface to allow management to
audit the data.
Another
hurdle faced by CHCS was acceptance of the telephony
interface by the paraprofessionals, but the implementation
team was very surprised at the results. Elizabeth
Rolfe, RN, manager of two CHCS Health Services Area
Offices, recalls, "We were pleased with how
quickly the Home Health Aides who are not familiar
with technology caught on to the system." Also,
CHCS uncovered some other interesting information.
During the pilot, each Home Health Aide was asked
to continue to record information on paper while
using iVoice, and it was determined that the paper
trail was not matching the telephony data. CHCS was
surprised to find telephony was collecting the data
more accurately than the paper system they had relied
on for years. One of the issues was the rounding
factor used for time worked – the automated
system always got it right!
Benefits
of iVoice
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Programming
iVoice is very easy. It's "one of
the best IT products I have worked with
in 33 years in MIS. The documentation and
procedures are rock-solid."
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iVoice
has proved very beneficial to CHCS staff. Ms. Singal
states it this way: "The reports produced by
the telephony application are wonderful and have
already helped us to identify problems. Also, we
now are getting faster and better clinical quality
with the progress reports provided. The telephony
system ensures that there is a clearly legible printed
progress note for every client visit. This is a great
advance from the handwritten notes used in the past."
iVoice
programming, operations and support have been a big
plus to CHCS. Michael Soucy was trained by iMessaging
technical services during the initial installation.
He notes, "When I had the opportunity to create
the second application, I found the programming very
easy to do. I had little trouble." Jim White
adds that iVoice is "one of the best IT products
I have worked with in 33 years in MIS. The documentation
and procedures are rock-solid."
CHCS
is already finding other uses for the iVoice system.
A state licensing requirement mandates that CHCS
demonstrate that overnight staff is awake in the
organization’s numerous off-site group homes.
CHCS decided that iVoice would provide a simple solution
to their reporting dilemma. Now, overnight staff
simply dials in to iVoice periodically, and the system
recognizes the CallerID and timestamps the call,
satisfying the state requirement. The staff only
needs to dial the number and wait for iVoice to pick
up. This replaced a voicemail system that required
someone to access each voicemail message and document
each call. In addition, the voice mailbox occasionally
became full and missed some calls. This never happens
with iVoice.
Valerie Levy says, "I imagine that there will be other applications
that come up in the future that we have not even thought of yet. We are
already considering using iVoice for time reporting of our administrative
staff."
More
about Community Health and Counseling Services
CHCS provides services to three client groups: (1) adults with severe
and prolonged mental illness who need assistance in achieving and maintaining
independence while living within their community; (2) children and families
who are in need of intensive help in dealing with emotional and behavioral
problems; and (3) persons who are homebound either with a terminal illness
or recuperating from a serious illness, or who may be in need of home
health services while dealing with a disability.
CHCS
is both a Medicare/MaineCare certified home health
agency and a comprehensive community mental health
center, one of the few combined institutions anywhere
in the country. CHCS Home Health and Hospice services
are CHAP Accredited with Commendations.
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