Cost was a huge reason why this company bought 4,000 Galaxy Tabs rather than iPads

An old-fashioned paper-based patient form is filled out by a healthcare worker in a medical facility. Credit: Flickr by Thirteen Of Clubs

Bayada visiting nurses travel every day to patients' homes to provide health care. For years, they would finish their workdays in their own homes, completing piles of paperwork for each patient to document their care.

And worse, that paperwork didn't end when it was finally all filled out, said Ashley Wharton, the director of clinical strategy for the home health practice at Bayada Home Health Care. After nurses completed the documents and forms, they had to key them in manually to the company's centralized billing system -- which was built some 30 years ago.

"We have a geographically distributed workforce and clinicians can be in 5 to 7 clients' homes per day, so you can imagine how much paper that involved," said Wharton. "In the past that could have meant that they had to stop back in the office for paperwork."

With about 3,500 nurses and administrative staff members working from about 67 offices across 25 states in the U.S., the paper trail had become increasingly labor-intensive, costly, and much more difficult to manage and keep up to date.

About four years ago, Bayada realized something had to be done to get the cascading mess of forms and papers under control.

"The organization recognized the need to find an electronic medical records system that would work well and provide efficiencies into what was happening inside the organization and to support the clinical practice," said Wharton.

To find it, Wharton and his colleagues sent out RFPs to electronic medical records vendors such as McKesson and others, but the laptop-based products that were on the market at the time didn't cover the varying needs that Bayada had across its business. Bayada treats different kinds of patients ranging from children on ventilators to elderly Medicare patients, and the records system needs to be flexible enough to cover them all, said Wharton.

In early 2010, Wharton looked at Homecare Homebase, an application from a vendor he knew from a previous job. The version he'd seen ran on early Windows Mobile phones, but the product began looking more promising when he learned that Homecare Homebase would soon migrate it to the Android.

Bayada began a beta test and was very pleased, said Wharton. "It met our workflow needs and it met our clinicians' needs."

In late 2010, within three months of that first trial, Homecare Homebase released its Android version of its application.

"That was a true game-changer," said Wharton. "It wasn't just the screen real estate on a 7-inch tablet, but also the intuitive nature of the operating system as well. It made the training significantly easier and the response of the clinicians during the training it made it a much better experience all around."

Bayada next rolled out the Android app to one of its offices where it was used by 10 office staff members and about 40 nurses and other clinicians. The company evaluated user feedback and looked at the process efficiencies that could be gained, including the availability of real-time information on patients, which had not even been available before under the old, slow paper-based system.

"That accelerated our decision-making process" in early 2011, said Wharton. "We reviewed everything and made a decision about 60 days after the pilot had been running ... to go with it."

Today, Bayada is running about 4,000 Android-based Samsung 7-inch Galaxy Tab 7.0 Plus tablets, serving about 3,500 users across the country as well as about 300 office support staff members. The company maintains about 200 of the machines as spares in case of device failures, loss and new hires.

Today, almost 90 percent of the record-keeping for patients is now available to the mobile care-givers across Bayada using the tablets and Homecare Homebase, which has drastically improved the coordination of client care, he said. "If a client calls in with new information, it can be entered immediately and everyone can get that updated information instantly. The therapist following up in the afternoon on a client visit now has the ability to pull up that information," improving care and preventing duplication that occurred in the past.

The time savings and efficiencies can even be seen in the little things, such as care-givers no longer having to write out patients' names Social Security numbers 20 times a day, said Wharton.

"The clinician doesn't even have to come into the office anymore," he said. "The information on the client is on the tablet. They have the information before they even see the client."

Most of the feedback Bayada has been receiving from employees about the new system has been positive, he said. "One nurse said on Bayada's Facebook account that she'd been a home health care worker here for 7 years and she thanked us because it's given the woman her life back. Now she can finish her work during the work day."

Why Android tablets?

Bayada chose the Android devices over Apple iPads for a simple reason: Android is the prime platform being supported by Homecare Homebase, the application of choice for the project.

But why did Homecare Homebase standardize on Android?

Tom Maxwell, the chief strategy officer for Homecare Homebase, told CITEworld via emal that his company chose to support Android three years ago because back in 2010 only one mobile provider – AT&T – was offering service on iPhones and iPads and because Android devices were much cheaper to buy than iOS devices.

Other reasons were that at the time Android devices were available in many more sizes and configurations compared to iOS, and because it was more difficult to get apps onto the devices using the Apple Store, because each user required a separate account.

"We are not planning an iOS release in the near future," wrote Maxwell. "Our customers are not demanding the higher cost devices."

Moving to the app and the tablets "was the smoothest technology implementation that I've ever been involved in," said Wharton. "Obviously you run into 'gotchas,' but there was nothing worth mentioning."

The low cost of the Samsung Galaxy Tabs really helped make the project viable and successful, he said.

"The biggest piece for me, having been involved in buying laptops for clinicians in the past, the 7-inch tabs are at a price point – a couple hundred dollars each on contract – where they are almost disposable," he said. "It just makes it a much more viable option, compared to the cost of laptops."

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