Products & Technology

In the Palm of Your Hand

How handheld devices can optimize provider efficiency and cut costs.

In today’s funding climate, the name of the game is controlling costs. Providers must find ways to slash operating costs in order to protect their margins as CMS’s reimbursement ceiling gets lower and lower. One of the ways providers can do this is through leveraging technology, and one technology in particular can put a whole world of cost-cutting efficiency right in providers’ palms: handheld computing.

Handheld devices and personal digital assistants (PDAs) can enable staff in the field and in the back office to leverage newfound automation that can drastically reduce the need for time and staff to be dedicated to what are otherwise repetitive tasks. Moreover, they can help boost accuracy, improve responsiveness and ensure proper documentation.

In the Field

Documentation is particularly important when handling deliveries, repairs and emergency calls. So is ready access to important information, as well as the ability to collect and either transmit or store information. In these aspects, handheld computing can be a boon to drivers in the field.

“The great thing about using a PDA device with [barcode] scanning capabilities built into them is that there are no mistakes.”
— Spencer Kay, CEO, Fastrack
Healthcare Systems

The driver can go out with the device, which contains the orders he or she must deliver for the day, and at each call, can then scan the barcodes on the products to ensure the correct DME is being delivered, so as to minimize mistakes. The handheld device also can capture quantities of product being delivered, as well as serial numbers and lot numbers. Above all, handheld devices can capture patient signatures, which is critical from a documentation standpoint. If a patient refuses all or part of an order, the mobile device can be used to document why the patient refused the order.

“When the driver’s finished with the delivery, he or she can click a button on the device and using wireless communications, it sends the order back to the server, which will automatically confirm it,” says Spencer Kay, CEO of HME software system provider Fastrack Healthcare Systems. “It eliminates the need for a person in the back office to be sitting there, confirming orders.

“So if you think about it, at a typical provider, if that’s one person, or two people, or three, or four, depending on the size of the company, you eliminate that function,” he continues. “There’s a lot of savings right there.”

Another key benefit to handheld computing is accuracy, Kay says. A common delivery mishap scenario is that a driver comes back to the HME location at 5 p.m., goes home, and bright and early the next morning another staff member comes in to try and confirm the orders, but cannot read the driver’s handwriting. This can lead to accidentally entering in the wrong quantities, serials numbers and other key pieces of information into the HME management system.

“The great thing about using a PDA device with scanning mechanisms built into them is that there are no mistakes,” Kay says. “It reads the barcode, and it reads it 100 percent accurately.”

Computers Application Inc., which also supports handheld devices, provides similar functionality, according to Brian Williams, marketing manager for the HME system manufacturer. “There is a barcode that is printed on to every delivery ticket,” he says. “You can scan the order number and scan the products, serial number, and lot number data that is going into or coming out of the home.”

Another feature CAU integrates is a complete customer list to help employees who are on call access customer information the on the fly.

“That way that employee can view customer rental and purchased equipment detail, and also have access to their primary and co-insurance payors,” Williams says. “This allows them to check for deliveries and service and warrantee and repairs and other types of field work.

“It’s a quick handy way to get into a program, so that when you get a call at 1:30 in the morning so that you can first of all quickly make sure it’s your customer and verify that it’s your equipment,” he explains. “So before you have to get dressed and take a 40-minute drive in the company truck to discover it’s not your equipment, a customer list prevents that.”

“We took a demonstration unit to one of our clients and they took it and whipped it against the cement floor of the warehouse. If it can survive that, then I think it can survive day-to-day use in the field.”
— Brian Williams, Marketing Manager,
Computer Applications Unlimited

Moreover, because the information is typically being communicated in real time with handheld devices, if there is an error for any reason, that error will be more quickly discovered, and can then be addressed that much quicker, rather than having to roll the truck a second time, which is costly.

And of course, because the driver is sending the information back to the office in real time, that means the deliveries are being confirmed in real time. This leads to additional efficiencies that can benefit other aspects of the HME business, such as finances.

“So, at 10 o’clock in the morning, if you wanted to do a billing run, you could send out bills,” Kay explains. “You could do it again at 2 o’clock and again at 4 o’clock. From a cash-flow standpoint, nothing gets delayed. It can be very immediate, and I think that’s a key issue.”

Moreover, orders can be sent in real time to the staff member in the field to take care of emergency and on-the-fly orders.

“The way our system works, on the screen, you always can see where the driver is,” Kay explains. “So if you get a new patient and it’s an emergency, you can find the driver that’s closest to that patient and send that driver and, assuming he or she has inventory on the truck, send the patient the order.

“And the driver can add products to an order in the field,” Kay continues. “So, if it was a respiratory patient and the driver sees that he or she needs a mask, the driver could add that to the order if they deem it is necessary.”

Also, with mobile computing tied to an HME system, the data that is received can be used in ways specific to the HME process. For instance when a driver captures a patient’s signature, the order that is transmitted back to the office can be turned into an full image of an order than can be stored in the patient’s file for documentation, Kay says.

“If the next day or week, the patient calls up and says ‘I never received the order,’ you can look it up and see that you have the order, and that the patient signed for it. This is also important for collections,” Kay explains. “When someone calls and denies they received something you can say ‘I have your signature right here on the order.’ And if necessary, you could even email it to the person, if they had email.”

Williams adds that incoming signatures can be time and date stamped, as well, to ensure their veracity in the case of a dispute.

Points to Take Away

  • Providers are seeking any and all ways to bolster declining profit margins and preserve cash flow in a down funding marketing.
  • Technology plays a key roll in this regard, and one of those technologies that can truly help cut costs is handheld computing.
  • Handheld computing can create a number of efficiencies in the fields and in the back office to free up staff that can be put to better use.
  • Various HME billing and business management systems support handheld technology.

In the Back Office

Of course handheld devices are also useful in the back office. Particularly for inventory control. The big benefit for handhelds in the back office comes down to one thing: barcoding. Barcoding has three main benefits: it ensures changes in the inventory are correctly recording, it increases efficiencies, and lets inventory be managed in real-time.

“What barcoding does is eliminates human error,” says Robin Campbell, senior systems consultant for Computers Unlimited. “It allows people to use scanners to identify equipment and the movement of that equipment, and that’s the key to the inventory control —being able to track where that equipment is at any point, and, for accreditation purposes, where it has been.

“If you don’t barcode, you’re writing down serial numbers and that just creates havoc,” she continues. “People make mistakes, people can’t read the writing, and it creates extra work.”

That said, barcoding, like grouping and coding products, is a process. “Your inventory isn’t just sitting in the warehouse so that you can decide, ‘Okay, let’s go barcode it today,’” she explains. “It’s everywhere.”

But once barcoding is in place, new efficiencies begin to flourish. For starters, assuming that inventory control is integrated with the point of sales system, barcoding means instant inventory updates after every sale.

If warehouse staff are using handheld scanners, they can update the inventory system in real time if they are using wireless handhelds, or in close to real time, if they use handhelds that are synchronized via charging units, Campbell explains. In either case, as staff stock items in bins, or pull them for orders, the inventory system will be updates as to the changes in remaining stock.

That sort of system also helps when picking orders, Campbell says. Handheld units can be used to pick orders, sorted by bin numbers. So, the warehouse worker can go from bin to bin, pulling items, scanning them, and updating the system and the order.

The Devices

Of the providers that offer handheld computing solutions (see “Learn More” for descriptions of some offerings available on the market), the devices of themselves vary. They can be as simple as a standard personal digital assistant or bona fide wireless, handheld computing platforms. Besides wireless capability, standard features include a barcode scanner and the ability to enter and store signatures.

For Fastrack, Kay recommends providers use a device from handheld computer manufacturer Symbol Technologies that also has Bluetooth so that drivers can use Bluetooth enabled devices, especially printers. “So you can actually print receipts or forms in the field,” he says.

Another device Fastrack recommends is a Windowsbased Samsung device that is akin to a small tablet PC with a 7-inch screen that is actually a complete computer.

“The benefit of that is that we can store more information on there,” Kay says. “On that devices we can also do maintenance tracking. So if the person going out needs to read meter settings, or is fixing a piece of DME in the field and needs to record what parts were used or how much time and labor cost, you can do that.”

Also, the tablet supports a point of care software solution. So, for instance, a respiratory therapist working with an HME can go out in the field and perform an assessment or need to collect clinical information, the RT can do so, Kay explains.

Durability is a key consideration. For CAU, the provider is using Palm platform for its handheld computing, focusing specifically on the Janam XP20 and XP30 (the color version of the XP20). These are heavily ruggedized units to hold up to the rigors of field and warehouse use.

“They’re very durable,” Williams says. “We took a demonstration unit to one of our clients and they took it and whipped it against the cement floor of the warehouse. If it can survive that, then I think it can survive the day-to-day use in the field.”

Some handheld devices also incorporate cameras, which Kay says could be a real boon to collecting other documentation. For instance, a camera could be used to take a picture of an insurance card.

“Or if you’re doing wound care, you could take a picture of the wound,” he says. “And then you could send the image back into the system and store it in the patient record. So there is a lot of functionality you can get into, and depending on the device that functionality can change.”

This is important to note, because for some HME software systems, the handheld device integration does not necessarily limit the provider to specific units. “We’re not locked into an particular PDA device or any specific handhelds,” Kay explains.

In terms of cost, for Fastrack, the tablet is the least expensive, and costs approximately $850. The Janam’s that CAU uses cost approximately $1,000 each, with barcode printers costing roughly $500. Software for the PDAs sometimes needs to be licensed as well, such as in the case of CAU, which has a suite of eight applications for its handhelds. Of course, the ROI can be almost instant due to the efficiencies the provider gains back.

“If you think about it, it could be as fast as week,” Kay says. “If you have two people sitting there confirming orders, and you pay them $500 or $600 a week plus taxes and benefits, [the handheld device’s cost] is almost nothing.

“But if you look at what it can do for your business, besides saving you money, but also being able to send out bill real time, it improves your cash flow as well as your accuracy.”


Learn More:
HME Software Systems with Handheld Options

Of the dozen or so software firms that offer HME billing and business management systems, here are some that are offering handheld computing support:

Brightree LLC

Brightree has partnered with AirVersent to provide the AirVersent’s 20/20 Delivery, a Software-as-a-Service (SaaS) product specifically engineered for mobile supply chain businesses. SaaS involves no software to install, custom programming, and no ongoing systems management and maintenance overhead. Instead, HME providers pay a subscription fee for each mobile worker using the system. 20⁄20 Delivery connects drivers in the field to computerbased order entry, warehouse management, route optimization, accounting, and customer service systems in the back office. Drivers are dispatched with electronic manifests on handheld computers, receiving work orders and manifests at any location and communicating their collected data in real time via wireless connections.

FastrackFastrack HME Enterprise System/SQL
Fastrack Healthcare Systems Inc.

Drivers carry a “cell phone-enabled” PDA or handheld computer that can record the patient’s signature, as well as products information, supplies and drugs, quantities, COD amounts collected and serial/lot numbers being delivered or picked up. The delivery data captured by drivers will automatically confirm the orders, pick-ups or exchanges at the HME provider’s office, eliminating the manual order confirmation process. Cash received from the patient automatically updates cash receipts. This increases accuracy of data entered into the system and improves customer service by insuring the correct products and quantities were delivered. Claims can then be sent to the main office. Fastrack also allows the driver to indicate items refused by the patient and the appropriate reason. The driver can print receipts and other documents from the delivery vehicle, as well.

Computer Applications UnlimitedSolution/One HME
Computer Applications Unlimited Inc. (CAU)

Solution/One HME PDA Computing features the Palm OS platform and a touch-screen interface for collecting accurate, real-time data via UPCs and custom bar code labels. This streamlines delivery, pickup, in-home service check, and inventory operations, as well as accurate delivered and picked up product quantities. Scanned serial and lot numbers also increase efficiency and accuracy. Customers can electronically sign the PDA to confirm delivery. For inventory, the system automates processes such as receiving stock, performing full or partial physical inventory, exchanging serialized equipment, assigning lot numbers, and transferring stock among locations.


QS/1 provides a mobile workstation solution for pharmacies operating an HME business that is based on a rugged, military-grade Panasonic Toughbook tablet PC and connects the QS/1 Windows Client to business servers using an integrated, wireless, broadband card, giving delivery drivers access to QS/1’s SystemOne HME management software. As new orders are received during the day, customer service reps can enter the orders and notify the appropriate delivery drivers that an order has been added to their route. A mobile printer can be used to print all necessary paperwork. Drivers can confirm deliveries and capture signatures. If the status of a transaction is marked as delivered, and all the necessary physician documentation is in hand, the claim can be billed before the driver returns to the pharmacy.

TIMS SoftwareTIMS Software
Computers Unlimited

TIMS Mobile Delivery enables same-day delivery, routed delivery, on-demand delivery and real time data available to drivers. Field staff can perform real-time pricing to accurately quote item prices, recalculate order prices for changed items or price a new order, while simultaneously updating TIMS. Mobile Delivery also recalculates fees, emulating all aspects of TIMS Order Entry. Mobile Delivery’s staging feature makes it possible to scan rental equipment and medical gases for a single patient’s orders, with automatic alerts prompting for any required information such as lot numbers or variable volume. For last-minute orders, drivers can easily perform multiple downloads throughout the day with only one upload at the end of the day. Without delay, print an order receipt with full order transaction details, time stamps and signatures. Uploading transactions to TIMS for billing requires one click on the mobile device to transmit the data over a wireless network.

This article originally appeared in the November 2009 issue of HME Business.


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