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Coming: a new era of long-term care software.

The mid-November meeting of the American Society of Consultant Pharmacists (ASCP) saw the introduction of a suite of long-term care-oriented software products that could be the first steps in an information management revolution. Developed by NeighborWare Health Systems and called ACE (Accessible Clinical Environment), this first component addresses the needs of long-term care providers and institutional pharmacies. These programs are, according to company co-founder and Chairman Michael G. Bronfein, "the first pure object-oriented software to come to the commercial marketplace, and NeighborWare's HealthObjects is the first object-oriented computer-aided software engineering tool designed specifically for the healthcare industry."

What is "object-oriented" and what's so special about it? Object-oriented programming is the current state-of-the-art in software development. "Objects" are pre-written mini-programs that make up an inventory of off-the-shelf program parts (a sort of "Tinker Toys" concept). The programmer links together the "objects" he needs to assemble an application to perform a function, such as patient billing or medication management.

Earlier computer programming techniques required that code, or instructions, be written for each incremental step a computer would be asked to execute. Programs created in this way could require millions of lines of custom-written computer code, and this sort of software development is both difficult and expensive. It also creates a high probability of "bugs" -- errors in a program. Writing programs in these languages is like General Motors designing a new automobile and having to create a new screw, nut, or bolt every time a fastener is called for, rather than reaching for them off-the-shelf.

HealthObjects has been developed using the Smalltalk object-oriented programming language. It is a package of common features and functions found in existing health care information systems. These have been prefabricated into software building blocks which are then used by applications developers to assemble programs in a fraction of the time and cost it would take using traditional methods. NeighborWare licenses HealthObjects to other health care software companies that either convert their existing software to its standards or write new software. It also will perform the conversion function for them for a fee.

Programs developed using HealthObjects are able to share information with each other and to operate "en suite". The goal is to create interoperable products that can manage patient care across its entire continuum without having to redundantly enter data -- the "one-time entry" that everyone thinks of as ideal.

"Information management needs for admission, discharge, or transfer of a patient," says Bronfein, "are exactly the same for a physician's office, nursing home, or hospital. We have built objects covering all that, and programs using those objects are able to seamlessly pass the information from one database to another."

Baltimore-based AssurQual, a developer of clinical and financial management information systems for long-term and subacute care, is currently having its quality and financial management software rewritten using HealthObjects. The same is being done for the home infusion patient management software of Automated HomeCare Systems of Tulsa, Oklahoma. At the ASCP meeting, Bronfein announced that McKesson Health Systems has signed an agreement to become the exclusive distributor of the ACE system. These three companies are the first in a series of strategic product and marketing alliances that NeighborWare plans to implement in order to develop a broad base of HealthObjects developers.

NeighborWare Health Systems was started in 1994 by Bronfein, President and Chief Executive Officer of Maryland-based NeighborCare Pharmacies, a provider of integrated pharmaceutical care through a network of outpatient, infusion therapy, and institutional pharmacy services, and by Michael L. Russo, a California-based software design engineer who is the company's Managing Director and Chief Operating Officer.

Bronfein recalls the impetus that led to the creation of NeighborCare and its HealthObjects programming environment: "About two-and-a-half years ago as the CEO of NeighborCare, I was thinking about the future of my company and what it needed to be in order to be a leader in our industry. What were the attributes we needed to possess in order to be able to gain and maintain market share at a rate disproportionate to our size, and thereby be able to get returns which were at or better than the market for firms of our nature? I came to the conclusion that we had to move from a distributive-based company to an information-based company. Future value in the pharmaceutical management business was not going to be related to an ability to get the pills from point A to point B. That was really a commoditized operation that would go to the lowest-cost producer. The area where you would be able to get the kind of additional margin that would create real shareholder value would come from an ability to manage the information of therapeutic pharmacology and to disseminate it to users in a way that made it possible for them to improve the quality of care, reduce costs, and improve outcomes."

Bronfein began a search for software that would help move NeighborCare toward his ideal of information management and found, much to his dismay, that existing programs did not integrate well -- if at all -- and had very poor communications capabilities. He called Russo, who had co-developed the first information management software product for the home infusion industry. Some months later the two formed NeighborWare.

NeighborWare's ACE product is indicative of hopes to see HealthObjects applications enter and eventually dominate the marketplace. An institutional pharmacy will purchase ACE and then license it to its client nursing homes to be run on hardware they own or lease. According to Bronfein, a typical nursing home would need two touch-screen-equipped computers and a couple of remote "cruise pads" at each nursing station. The pads used are Zenith Data Systems touch-screen data-entry tablets. Cost of the hardware for a 120-bed facility, Bronfein says, would be about $40,000, or $1,000 a month to lease. NeighborWare is recommending that pharmacies license the software for $7 per bed per month. A 120-bed nursing home would have ongoing monthly expenses of approximately $1,000 for equipment and $840 for software. Total annual expense would be $22,080 -- in the range of half the cost of one full-time nurse, according to Bronfein.

NeighborWare conducted a study that indicated on average it takes four minutes to write, fax , and get confirmation of an order to a pharmacy. He says that an order can be punched into the ACE system in from 45 to 75 seconds. Bronfein's NeighborCare Pharmacies services 10,500 nursing home beds and sends out over 200,000 orders a month. That comes to an average of at least 19 prescriptions per bed, per month. Using the median of 60 seconds to place an order via the ACE system, these numbers show a savings of 1,368 hours a year, approximately 65% of one 40-hour-per-week employee.

An order placed through ACE would involve selecting a patient from a touch-screen menu, selecting a drug from another menu, working your way through a series of predirected "advices," and then confirming the order. Once the order has been confirmed, the nursing home's database for the patient is automatically compared to the pharmacy's database for the drug to check for any treatment, dietary, or other clinical issues that might cause adverse outcomes. Only after this process does the software automatically place the order via modem. Finally, once the pharmacy accepts the order, information is fed back to the nursing home's computer, updating an the relevant databases.

It is this use of the touch screen and customized menus that Bronfein sees as crucial to the acceptance of any computerized health care management system in the nursing home environment. "The computer has to be like an appliance," he explains. "It has to be as easy to use as a microwave, so easy to use that anybody, whether they have ever touched a computer or not, is going to be able to use it."

Object-oriented programming, with its speed, reliability, and low-cost, combined with the portability of data-entry pads and the ease of use of touch screens, looks like it will be the wave of the future for nursing home health care information management. It allows for true bedside computerization without the need for individual computer hook-ups or the level of training required for use of traditional programs on portable computers. The take-one-from-column-A and one-from-column-B approach of object-oriented programming makes it far easier for software developers to create applications that can be easily customized by a user without any programming skills, yet that retain full communications functionality between programs authored on the same platform.

NeighborWare's HealthObjects is slated for rollout later this year. This may well signal a new era for longterm care software -- not just ease of use, but ease of programming for your facility's specific needs.
COPYRIGHT 1996 Medquest Communications, LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Author:Patterson, David
Publication:Nursing Homes
Date:Jan 1, 1996
Words:1449
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