Home care Web pages: Big help, or just hype?
Make Internet work for your internal customers
World Wide Web sites have become so popular, even tennis star Andre Agassi has one, albeit unofficially. Created by a fan, the site keeps you current on Andre’s career and even his recent marriage to Brooke Shields. So, if Andre gets one, why not you?
After all, it should be much easier for you than for Agassi’s fan club or even your free-standing competitors, for that matter. With a hospital affiliation, you have access to an information system and computer experts who can help you achieve whatever your goals for a Web page are.
When administrators at Valley View, OH-based CCF Health Care Ventures decided to design a Web page last year, the organization called on its management information services project leader, Sharon Kantura, for help.
More than just a brochure
Because of Kantura’s computer expertise and the organization’s considerable resources as a wholly owned subsidiary of The Cleveland Clinic Foundation, CCF Health Care Ventures was able to develop an interactive Web page, one that would not only give the organization an Internet presence with an on-line brochure, but also allow physicians to access patient records and approve care plans. (See related story on budget Web sites, p. 73.)
"We kicked around a lot of ways to get information to physicians," explains Kantura. "We have agencies in Ohio, West Virginia, and Florida. Our physician base is wide-ranging. We felt it would be very easy for doctors with Internet access to get into our agency for patient information. Other parts of the Web site are open to the general public."
Clinic doctors and the home care section will be linked via an intranet, the organization’s internal network.
CCF Health Care Ventures wanted a page that would serve four main functions:
• marketing CCF Health Care Ventures product lines;
• listing CCF Health Care Ventures employment opportunities;
• educating home care staff via the Intranet;
• giving hospital physicians access to patient files.
Development of the Web site began in August 1996. The project will be implemented in stages, beginning with Health Care Ventures’ intranet home page, which went on line in April; bringing a small physician group at The Cleveland Clinic on line; electronic physician signatures; marketing and human resources information; and full Internet accessibility within the next 6 months. The "B list" will bring staff education on line by next year, she says, along with increased marketing and human resources information.
"Once we have our Web page on the Internet, The Cleveland Clinic’s Web page would be able to link to our Web site," says Kantura.
While the Internet can help a business expand markets, that is not the only reason for designing a Web page, nor is it necessarily the best reason, says Pat O’Hearn, a market manager with U.S. Web Utopia, an Internet consulting firm based in Waltham, MA. Her company, she says, can develop a home page for under $500.
"Advertising just putting up a Web page is not a good use of the Web," says O’Hearn, who speaks at national home care conferences about the Internet. "It can be a tool enabling you to provide higher quality of care."
O’Hearn says the Internet is most useful when helping hospitals and agencies save money "by automating any kind of paper process."
That idea was the driving force behind CCF Health Care Ventures’ Internet project. Knowing that a brochure Web site one that just lists services and phone numbers was not enough, the provider wanted to streamline home care paperwork by enabling doctors to "approve changes in verbal orders and sign the 485 forms" electronically.
Currently, staff at CCF Health Care Ventures (whose physicians, Kantura says, are 75% hospital-based) complete computer-generated forms, then mail printouts to the doctors for signature. Electronic signatures would make that process obsolete.
Protocols protect confidential data
To access the interactive portion of the Web page, doctors go through a protocol known as a Secure Socket Layer, which includes a series of security log-ons, before they can view verbal orders, the 485, or access a list of their patients. Once the protocol is completed, physicians can then open a patient’s record with the click of a mouse. However, without the security codes, neither doctors nor anyone else can view confidential data.
"We’re doing a lot of things to ensure Internet security," says Kantura, "like ID codes, passwords, and a series of questions. All the information is encrypted. It doesn’t go through the World Wide Web in a format anybody can read."
As added security against hackers outside the hospital, CCF Health Care Ventures also has installed a firewall (see Internet glossary, inserted in this issue) to keep unauthorized users from entering its private network. This further ensures that patient confidentiality is protected. If hacking is detected, the agency-based computer sends a "cease and desist" warning to the hacker and denies access.
Once a patient’s record is accessed and, for example, the 485 is up on the screen, a physician can authorize care through a series of options, each with its own "button" for the doctor to click on. The doctor chooses a button by using the mouse to position the computer’s cursor over the button, and clicking the button with the mouse. For example:
• I accept this as being valid.
• I accept this with comments: (The doctor types in comments.)
• I reject or I disapprove of this because: (The doctor types in the reason.)
Although no actual signature appears on the on-line forms, the doctors sign a card that is kept on file at the agency’s office. It will be scanned into the agency’s computer system. "If an auditor requests an electronically signed document, the scanned signature will display," Kantura says. The form carries a disclaimer below the scanned signature, saying "This signature was captured electronically."
CCF Health Care Ventures has made sure it doesn’t run afoul of Medicare regulations, Kantura says, by engaging Ohio Medicare authorities in the Web site development process. Not all states allow electronic signatures, and Ohio was to vote on a bill this year, Kantura says. She adds that her agency wasn’t required to notify Medicare of its electronic signature plans, but sought its blessing anyway to head off any regulatory challenge.
The cost of the Web page project has run between $110,000 and $135,000, Kantura estimates. "This includes the Web server, security software, applications development [by the outside vendor], air travel for the vendor’s technicians, and staff training."
O’Hearn notes that a Web page can be bought at any price point, depending on the "degree of interaction, graphics, video, audio, or database all kinds of fancy bells and whistles." Costs may run from the under-$500 brochure to as high $1 million, which is the estimate for a page O’Hearn currently is developing for another customer. (See related story on p. 73.)
According to O’Hearn, an agency doesn’t even have to have computers to have a Web site. "There are companies that sell the connectivity to the Web and host the site for a fee," she notes. "That’s what happens for a lot of small businesses."
In offering advice to hospital-affiliated agencies that may wish to develop a Web site, Kantura acknowledges that you don’t have to spend a lot of money, especially if your only goal is niche marketing. "They can do that themselves," Kantura says of an agency wanting a Web brochure.
One option is to search the Web for firms that lease web space. One such company is Apollo Health Systems, an organization on the Internet that provides leasing of home care space for a fee. (See: http://www.homecare.org.)
The company also offers a search engine with links to home care providers nationwide. One such agency is the VNA of Maryland. It can be accessed at http://www.homecare.org/provider/ vnamb/. This is a good example of a brochure Web page.
For example, O’Hearn recommends a chat group where people can communicate with staff, having an expert answer questions about home health care.
But the key, she says, is having the information current. "You have to plan for a way to update and keep it fresh." To do that requires your own access, which you don’t have with a simple brochure page.
Kantura recommends having a plan in place before following through with the development of an interactive site like hers. She also advises getting three bids from software programming firms. "I told them what we wanted to do: reduce paperwork, create doctor signatures, and reduce on-line response time so that all bids contained the same scope of work," she explains.
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