Help Is at Hand(held).

Meet the new personal digital assistants that will keep you informed

The touch of a caring nurse's hand is a powerful gesture: It can soothe the pain of an ailing resident and bring a smile to a careworn face. Yet emerging technology is bringing even more "power" to physicians', nurses' and other caregivers' hands in the form of personal digital assistants (PDAs)--handheld computers designed for a wide range of applications.

Several manufacturers (e.g., Palm, Inc., Compaq Computer Corp., Hewlett-Packard Co.) produce PDAs, and various types of operating systems (e.g., Palm OS and Windows CE) exist. As the price of this technology continues to slide, companies have recognized its potential uses for long-term care.

MDS Support

Resource Systems (New Concord, Ohio) develops software for PDAs to help facilities comply with regulatory guidelines. One of their latest products is CareTracker, a software application that captures assessment data, activities of daily living (ADLs) and other supportive documentation for the Minimum Data Set (MDS). "It doesn't complete the MDS," explains Larry Triplett, president of Resource Systems, "but it provides justifiable supportive information that can be used for the MDS. Our mission is to try to help facilities collect data: to get information out of the minds of caregivers and into an electronic form where it can do some good."

At the end of each shift, the PDA prompts the caregivers (usually nursing assistants) to answer a series of questions about each resident. The information collected by the PDA is then downloaded into a desktop PC or the Internet, where the data are organized to create reports that monitor ADLs, depression indicators, bowel and bladder conditions, wound assessments, behavior symptoms, etc. Then the information is relayed to the facility's existing MDS compliance management system.

While many facilities already collect these data by using paper charts, Triplett points out the advantages of Resource Systems' electronic system: "What we hear time and time again is that it is so easy to just copy what the last shift put down instead of thinking, 'During this shift, how difficult was it to get the resident in and out of bed?' When one simply copies what the prior shift wrote, the accuracy and credibility of those data are questionable. But with our system, a caregiver can't see what the prior person wrote." Triplett adds that when CareTracker is implemented in facilities, nursing assistants frequently claim not to recognize a question asked by the program, when in fact it's a question they have actually been answering all along by copying what the previous shift wrote.

Triplett points to an example to demonstrate the power of CareTracker compared with that of paper-based tracking. By using the software, a facility in New Concord, Ohio, raised its annual reimbursement rate by about $67,000--most of this increase was in the mood and behavior category. Prior to installation of the program, nursing assistants were indicating that residents' behavior didn't change much, instead of taking the time to answer the 16 questions on this topic. Thus, when CareTracker forced them to answer the questions (CareTracker insists that certain data be provided before a caregiver can proceed), the staff realized that many residents needed to be at a higher Resource Utilization Groups (RUGs) level.

Reference Material

While Resource Systems helps staff with compliance issues, Hudson, Massachusetts-based Skyscape, Inc., takes a clinical approach. The company takes medical reference titles from publishers such as F.A. Davis, Lippincott Williams & Wilkins, and Lexi-Comp and converts them into a format suitable for PDAs through a technology called ART--Advanced Reference and Transaction system.

"This is the backbone of our technology," explains Sandeep Shah, president and CEO of Skyscape, "which allows us to take information from a variety of sources, whether they are publishers or Web sites, and make it suitable for a handheld platform that can be used at the point of care."

Users load a Skyscape title (trial versions are available), costing about $45 to 50 with discounts for volume and purchasing multiple titles, into their PDAs by visiting www.skyscape.com or by purchasing a CD-ROM at a bookstore that sells medical references. Reference titles include the 5 Minute Clinical Consult from Lippincott Williams & Wilkins, the Nursing Drug Guideby F.A. Davis and the Drug Information Handbook/or Nursing by Lexi-Comp. In February the 5 Minute Emergency Consult was released, and more titles, particularly for specialists, are planned soon.

A title does not operate in isolation--it is designed to interface with titles from other publishers to create an integrated information solution. R.J. Mathew, vice-president of marketing and business development at Skyscape, explains that the titles are designed so that a physician or nurse, for example, can look up a condition in the 5 Minute Clinical Consult, determine which drugs need to be prescribed by using one of Skyscape's drug guides and then reference the Interact title by First DataBank to look for drug interactions.

"If you try to do that in the print form, you'd have three 1,200-page books," Shah points out. "When an infrequently encountered condition arose, you'd have to open one book, find the condition, and while reading through that book, open up another and locate that source's information on the topic. Doing that process with paper is very cumbersome, not to mention the fact that you can't carry heavy books with you as you move from room to room." The electronic solution also enables nurses with prescribing privileges not to waste valuable time trying to locate and carry out the instructions from a physician or the medical director, Shah says.

Skyscape loads the entire title onto a user's PDA; thus, when a caregiver looks up a specific condition, the data are being pulled from information already loaded into the PDA, not by accessing data through a wireless Internet connection. Shah explains that wireless systems can be slow or become unavailable and that "if a user doesn't get the information within five seconds, the user is not going to trust using it next time." Skyscape does use wireless technology, however, to update information in a user's title; caregivers can use a wireless Internet connection to download new information to their PDAs. Updates for one year are included in each title's price.

In Development: Wireless Application

While Skyscape and Resource Systems are not dependent on wireless technology for their PDA applications, wireless components are at the core of a venture between Vigil Health Management, Inc., and WebWare Solutions, Inc., both based in Victoria, British Columbia. According to Nicola Chalmers, senior manager for investor relations and communications at Vigil, the companies are developing a system that uses wireless sensors to relay resident information to staff or family PDAs or to secure sites on the Internet. Chalmers says the Web-enabled system will run in a fully protected environment with stringent security protocols. The entire system's release date has not been announced, but Chalmers expects that it will be at least a year before it is available.

Chalmers explains how the system will benefit residents, families and staff: "At the current time, if a family member requires information on a resident, the facility, nursing or care staff have to talk on the phone and relay all that information, which takes up a lot of time. We are hoping to be able to give that information over the Internet and wireless devices, so that if a family member just wants to see 'if Mom was up a couple of times during the night,' the nurse can simply check that information on her PDA and the family member can look up the information on the Internet."

Making resident information available to families on the Internet brings up questions about resident privacy, Chalmers acknowledges, but she does not believe it will be an issue with the new system: "It's just providing the information in a different format. Information that nurses and families had access to previously on paper will now be available in an electronic format." (Chalmers says the system will be HIPAA compliant.) In addition to residents' activity profiles (e.g., how often residents move around during the night), families will have access to mealtimes, visiting information, messages from staff about residents' progress and data on how long it took staff to respond to residents' needs.

Chalmers says staff will benefit from having less paperwork, since data will be entered into a PDA at the point of care. They will also be able to access information on a resident quickly and easily. The technology is fairly easy to grasp, Chalmers suggests, but she acknowledges that long-term care generally adopts technology more slowly than other industries.

What's Ahead

The vendors agree that the future is promising for handheld and wireless technology. Skyscape says that facilities and individual physicians will be able to conduct prescription transactions by using their PDAs; they will also be helpful with billing functions and lab reports. Chalmers points to the continuing development of enhanced data storage capabilities, creating more effective wireless and PDA solutions and better care planning.

Projecting further ahead, Triplett believes wearable computers with voice activated controls will someday be standard gear for nursing assistants: "The next step for computers is for them to be wearable, as opposed to having to be carried like a PDA. While PDAs are helpful in getting close to the point of care, using your hands to operate a PDA stifles your ability to use your hands in the care process.

But some of the "technology of tomorrow" is already here, and long-term care facilities can capitalize on its uses. As Shah points out, "Many facilities cannot afford the state-of-the-art technology used by some hospitals, but the handheld solution is portable and fairly cheap. Today you can get a handheld unit for only a couple hundred dollars with minimal outlay for the software."