Remote computing: An Rx in home IV therapy
By Jeff Johnston, RN, BSN
Vice President, Clinical Services
Definitive Homecare Solutions
Columbus, OH
Home infusion companies are increasingly under pressure to reduce costs, save time, perform additional services, and provide more and better documentation and outcomes information. One way to satisfy these pressures is to automate operations as much as possible, and more recently, to implement companywide integrated information systems.
While automating functions at the office (such as prescription processing/label generation, clinical documentation and billing/reimbursement) has significantly increased efficiency, these advances have typically not included activities performed outside the office, such as nursing visits, off-site billing and multiple branch operations. Infusion companies see the obvious advantage of extending their computer networks to nurses in the field, specifically to produce clinical documentation while in the patient’s home, in the hospital, at home, or wherever. This documentation function is traditionally done with pen and paper, or with an in-house computer system when the nurse can come into the office.
Enter remote computing, which is nothing new to homecare. What is challenging for homecare companies (and the software vendors that provide these capabilities) is making this benefit seamless, error-free, and essentially "transparent" to the users of the system.
There are three ways to implement a remote computing solution, each of which has its advantages and disadvantages.
1. Remote access:
This is when a laptop or home personal computer (PC) controls a PC that is at the office. The remote PC literally works off the office PC – the keystrokes on the laptop push the keys of the office PC.
Remote access is by far the simplest and least confusing of all remote solution options. Essentially, all that is happening is that the remote PC dials up and takes control of an office PC that is "waiting for a call." This is accomplished with off-the-shelf software such as PCAnywhere, Carbon Copy, Reach Out, etc. This setup requires at least one PC at the office with a modem, a dedicated phone line, and remote software (PCAnywhere) set up in "host mode."
Remote access requires that the user be connected (via a phone line) when any work is being done. This is the major disadvantage of remote access. If the nurse wants to enter an assessment form at the patient’s house or while in the car, it could be difficult to find a phone jack to connect into the host PC. Another disadvantage is that any time a remote user is connected, no other remote users can connect unless there are multiple host PCs for them to dial into. This may not be a problem for small companies, but for larger companies with many users, busy signals could become frequent, requiring the need to purchase more PCs for the office.
You can quickly set up remote access and give nurses and home users a way to work beyond the office.
2. Remote node:
A laptop or PC connects to the office network as if the PC were at the office connected to the network.
Remote node may sound the same as remote access, but it is technically very different. With remote access, a PC is simply taking over control of another PC, and at the office it looks as if a ghost is using the computer. In remote node, the remote PC has an identical connection to the office network (Local Area Network, or LAN) as all other PCs at the office, except it is accomplished using a dial up phone connection, which is slower than a LAN. This setup is also sometimes referred to as a WAN (Wide Area Network).
Connection can be brutally slow
In a LAN, all PCs have their own local drive (the "C:" drive) and high-speed access to a server’s drive ("F:" drive). The server’s drive is where multi-user home infusion software and patient records are stored. In a WAN, remote PCs also have access to this server drive; however, the connection can be brutally slow, to the point where bringing up programs and operating them is not practical. This lack of speed is akin to complaints about the World Wide Web being too slow to retrieve fancy home pages – there is only so much information that can be transmitted over phone lines with current modems. By contrast, in a remote access situation, only screens and keystrokes are actually transmitted over the phone line, so remote access setups appear to be much faster to the end user than remote node.
3. Off line/on line:
A laptop or PC runs a specialized version of a program that allows the user to enter/modify information while disconnected (off line), then in a "flash," send this information to the office system (on line), at the same time being updated with any new information from the office system.
Both remote access and remote node can be implemented with whatever software is being used at the office. Although, you can use any software with these two remote computing methods, they can offer disadvantages such as the need to be connected with a phone line while the user works and also the potential for very slow connections.
Off line/on line almost completely eliminates the needing to be connected with the phone line while working, in addition to the resulting lack of speed. However, it requires much more intelligence in the software being used. In other words, this remote computing method must be programmed into your software by the vendor.
Users can be anywhere
In off line/on line, remote users have their own copy of the software loaded on their PC (on the C: drive) and can bring it up and use it at any time, regardless of whether they are connected to a phone line. For example, the users can be in a patient’s home, at the hospital, in their cars, at home, or anywhere else. Any information entered must be "tagged" to be sent to the host at a time that is convenient to the user. At this time (each evening, for example), the user simply connects the phone line and executes a special command or function in their software to transmit the information they have entered, such as assessment forms, medication profiles, plans of treatment, care plans, discharge summaries, progress notes, etc. This information is received at the host system (office) and can be processed each morning, so all information from all remote users is "appended" to the main system, and all the reports and forms are printed at one time, including a log of what was done.
In summary, each remote computing method has advantages and disadvantages. An infusion company looking to move forward with remote computing immediately should consider setting up remote access. In the future, most software vendors will be implementing some sort of off line/on line solutions built right into their products. These new offline/online capabilities will take time since they require more sophisticated methods of synchronizing the data from each remote site. But with software vendors and infusion companies working together, someday this panacea of universal, completely integrated information systems will become a reality.
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