Community Health and Counseling Services (CHCS)
Home Health Aides Stay Connected with iVoice
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 timesheets 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 Solutions 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, Solutions 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."
The iVoice system collects client "visit" information from staff in the field.
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 "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."
One initial hurdle CHCS had to overcome was the editing requirements of the client documentation and timesheets. Valerie Levy notes, "After iVoice has completed the call transaction, a timesheet 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
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.