Nearly 3,000 Visiting Nurses Now Access Patient Records At Point Of Care

By  William Atkinson — July 24, 2008

The Visiting Nurse Service of New York (VNSNY), the largest not-for-profit home healthcare organization in the U.S., has been providing home healthcare to patients in New York City since 1893.

Today, the organization's nearly 3,000 clinicians (nurses, therapists, and intake specialists) deliver a wide range of services, including pediatric care, elder care, psychiatric assessments, AIDS treatment, and short-term and long-term interventions.

Over the years, VNSNY has worked to become a leader in using technology to improve the efficiency and accuracy of its services, as well as improve communications. In fact, since the 1990s, the organization has been working to eliminate the need for clinicians to utilize paper forms.

For example, in order to simplify access to patient data for clinicians, VNSNY provided them with tablet PCs. This gave the clinicians remote access to the organization's main database via dial-up or 802.11 wireless connections at any of their regional offices.

The technology worked well. However, over time, the I.T. team began to notice spikes in data traffic. One of these spikes tended to be at the beginning of the workday, when clinicians connected to the network to download new patient information to their tablet PCs. The other was at the end of the workday, as clinicians spent time uploading new data from their visits that day.

"This would happen because clinicians were dialing in at the same time, since this was the only way they could download and upload their caseloads," says Randy Cleghorne, VNSNY Director of I.T. / Chief Technology Officer. "Mornings were always the worst, because not only were the clinicians dialing in, but the office staff was also logging in and updating case information."

These spikes in data transmission eventually began to cause a slowdown in access to the servers. This, in turn, threatened the productivity improvements that VNSNY had realized.

Around this time, cellular data carriers began offering significantly faster transmission speeds across their networks than had previously been available. VNSNY's I.T. team saw this as a way to bridge the gap in data access to their remote workers, and thus began deploying wireless data cards to the clinicians.

This provided more ubiquitous access to information any time of the day and freed the clinicians from having to access data via dial-up or from VNSNY's Wi-Fi network. However, the increased access to information created new challenges for the I.T. team. It had shifted data access from dial-up, to WLAN, to wide area network (WAN). In other words, while the initial goal was to streamline technology and make things easier for the clinicians, each new technology tended to add layers of complexity.

Another increasing concern for the I.T. team was ensuring data security. Accessing data across cellular data networks on an "anywhere anytime" basis required securing the communication. There also needed to be protection against the possibility of viruses accidentally being downloaded onto clinicians' devices, and then passed along the internal network, thus infecting other tablet PCs.

The I.T. team wanted to achieve two results: streamline the switch between different network technologies, and ensure that data transmissions were secure.

The team considered three solutions, and ended up selecting Mobility XE mobile VPN (www.netmotionwireless.com) from NetMotion Wireless. Mobility XE is a software-only Mobile Virtual Private Network (Mobile VPN) that provides secure, continuous remote access to network resources and applications from mobile devices over any wired or wireless IP-based network.

The other options required a lot more infrastructure in terms of additional software and hardware. In sum, they would have required too much work and effort to install.

"Mobility XE was easy to implement, because we built it into the standard image," says Cleghorne. "Every time we order a tablet, they press the image, so it comes already installed. No one here has to do any other configurations of the software." The I.T. team has installed Mobility XE on the tablet PCs of its nearly 3,000 clinicians. Its current tablet provider is Lenovo (www.lenovo.com). VNSNY also uses Cisco access points for Wi-Fi, with Funk Software's Odyssey Access Client (www.juniper.net).

Results and Benefits
The clinicians now have point-of-care access to information. Data is secured via AES encryption, and the Internet site is controlled to protect against viruses.

"The most important benefit is ease of use," says Cleghorne. "In fact, the clinicians report how easy this is to use." In addition, the clinicians' application sessions can now seamlessly roam across different networks without user intervention.

Another benefit is consistency. "Our applications team and testing/support team said that, in the past, if they used wireless and entered a 'dead zone,' communications would stop, applications would crash, and the data would become corrupted," says Cleghorne. "They were very pleased when they went out and did their own testing on Mobility XE. They would enter dead zones, including subway stations, come out of the dead zones, and be able to re-establish the connections, the transmission would continue, there was no loss of data, and there was no data corruption."

The Future
As the I.T. team continues its rollout of remote access, more divisions of VNSNY, such as the hospice team as well as some social workers, have been receiving remote access capabilities,. "We also want to provide access to some of our business users, who have asked about using NetMotion on their laptops," says Cleghorne. "In addition, we also want to be able to get more reporting out of the system, and this is being worked on."
Cleghorne and her team also want to see how the technology works with VoIP. "If we can leverage NetMotion and get better voice performance, I would like to see if we could use it for that," she concludes.

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