Products & Technology

In the Palm of Their Hands

How HMEs are using handhelds to extend their software gains.

Over recent years, HME providers have made tremendous gains in productivity through implementing software systems designed specifically for their businesses. While most providers originally implemented their software systems to help them more quickly and effectively bill Medicare, Medicaid and private payor insurance, these systems have truly blossomed into much more, as declining reimbursement rates have forced providers to seek outevery efficiency and cost-cutting measure they can find.

Now, HME software is extended to various departments beside billing: specially designed HME information technology is used for inventory control and automatic reordering; it is used for document imaging and retrieval; it helps providers plan their delivery routes; software provides management with detailed reports and "executive dashboards" that help them monitor and fine tune their business performance; it automates outbound patient follow-ups and reminders; and it even helps HMEs pursue new revenue streams such as cash sales by providing marketing and point of sales tools and functionality. Undoubtedly, the entire spectrum of the HME business has enjoyed the efficiency gains that dedicated HME software has brought.

Well, almost. A large segment of HME professionals don't sit behind a computer. For them, they might enjoy some secondary gains from software, but they haven't experienced that "efficiency at the click of a button" that staff in the back office have been enjoying. That is until recently.

Recognizing the fact that providers need to push their technology gains beyond the confines of the desktop, HME software companies are starting to develop solutions for handheld devices that delivery drivers and other staff can take into the field with them. The fit for such solutions has been hand-in-glove.

Such is the case for North Carolina oxygen and HME provider Family Medical Supply, which uses handhelds in its daily operations.

"Operationally what handhelds have done for us is, compliance-wise, our paperwork is better, cleaner," says Brad Heath, operations and compliance coordinator for Family Medical Supply. "And, our orders are honestly billed faster. Our billers can look at [claims] the very next day."

A Case Example

When orders are entered into Family Medical Supply's software system, they are transmitted from order intake to the dispatcher, who assigns it to a specific handheld unit. It can be assigned while the driver is on site, or while the driver is on the road.

"[The drivers] receive their queue of orders for the day, and during the day they might receive orders that have come up for the territory they are working," Heath says. "We know that they either have the inventory, or it might be a pickup."

Once at the patient's location, the devices can be used to properly document deliveries, pickups and service calls, as well as collect patient approvals and acknowledgements.

"We have all of our signature pages, instructions, waivers and assignments of benefits on the handhelds," Heath explains. "So our drivers are able to get those signatures.

"We do have our paperwork that we leave in the home — a booklet of supplier standards, warranties and so forth — but our sales orders are able to be printed off, our receipts are able to be printed off and left with the patient," he adds.

Moreover, the devices take the drivers through various questions that they must answer to ensure they adhere to all compliance policies and procedures. Once the delivery staffer leaves with the signatures and documentation after the delivery, the unit will automatically send that documentation back to system so that staff in the back office can confirm the delivery has been made and a claim can be filed, he says. And, at the end of the day, when the driver returns to the office, all the forms can be downloaded from the device and put into Family Medical Supply's documentation. While the claims could have been filed immediately, Heath says that as a matter of policy, Family Medical Supply, doesn't process them until it sees those forms and confirms all the documentation.

"Theoretically, you could confirm those orders as soon as they're delivered," he says. "If you're sure all the information is right. … But we look at them the very next day and get everything billed out, provided it has all the compliant documentation that it needs."

And let's not forget the chicken scratch factor. Heath notes that when his drivers are entering in serial numbers of equipment, whether they are scanning in barcodes or keying in the numbers manually, no one has to decipher hardtoread handwriting hieroglyphics at a later time. The handheld is the Rosetta Stone for legible paperwork.

"So it's actually increased our productivity in managing our inventory, as well," Heath adds.

Beyond Deliveries

The benefit of handhelds isn't limited to documenting deliveries and similar calls. Trucks can be treated as warehouse locations and the stock within them can be removed or reallocated in the HME's inventory management, as well.

And, the devices can be used to help other field staff beyond delivery drivers. For instance, handhelds can also be used to assist in patient care, says Spencer Kay, president of HME software company Fastrack Healthcare Systems Inc.

"We also offer a point of care application primarily for respiratory therapists," he says. "We can send the RT information about the patient — basic demographic information, certain clinical information the RT needs — and the system allows the HME company to create its own forms, and they can put those forms in the Fastrack application, and then Fastrack sends those forms that the therapist needs to his handheld device."

So, when the therapist is out in the field, he or she has everything she needs to perform an assessment at the patient's home. And if the RT is delivering a piece of equipment, he or she can confirm the delivery, as well.

Likewise the devices can be used for equipment maintenance, Kay notes.

"If [a technician] is going out to the patient's home, they can actually indicate through the system what work has been done, how many hours they spent, what parts they used, and that will all go back to the server and into the patient record," he explains.


There is another functionality that handhelds can bring to the field, and that is GPS and route planning. There are various tools available from HME software that help HMEs organize their delivery routes and plan them in the most optimal fashion. This helps cut down on delivery time, increase driver efficiencies and reduce mileage — and all that cuts costs in what comprises a significant portion of HME provider overhead.

But this functionality doesn't have to be limited to dispatch and its management of the trucks. The drivers, using handhelds, can harness these efficiencies as well, says Richard Pearlman, logistics product manager for ESRI, a company that makes GPS route planning software for HMEs called ArcLogisitics.

Dispatch can use route-planning software to generate a day's routes and give them to drivers with a schedule, maps, turn-by-turn directions, and everything the driver needs to do their job. But the data can also be used on driver's handheld devices. Navigation is built into some HME systems and extended to their handhelds, and it can be integrated into systems that don't already incorporate it.

In ArcLogistic's case, the data can be exported and integrated into handheld HME systems or integrated by a plug-in framework, Pearlman says.

"Out of the box, it can import and export data in a variety of formats, whether its comma-delimited files, spreadsheets for moving data back and forth between the route optimization and a thirdparty management system," he says. "Additionally it can also support direct SQL queries into third party databases. And these work both ways. So we can write data into third-party systems or read data out of them."

As far as handling the integration between a route-planning/navigation system and HME software, Pearlman says providers should expect integration assistance. In ESRI's case, its resellers and partners will work with the HME to facilitate the integration.

The Devices

Providers have a number of options when it comes to the devices themselves. Handhelds can range from a smart phone such as an Android phone or iPhone, to a handheld computer running a full operating system, to a dedicated, ruggedized device designed specifically for delivery professionals and field technicians. What type of device is used has a lot to do with what that device is being used for says R. Michael Clark, director of operations for CPR+, which also offers handheld solutions for HMEs.

"Our Delivery Plus product is deployed on a ruggedized handheld device that essentially has the requirement of two things: a Windows operating system and a laser scanner," he says. "We have certain recommended devices, but it's an operating system-dependent application, so really any device running that operating system would be able to run Delivery Plus.

"… When we're referring to ruggedized, we mean it can take a beating so that it's ideal for the warehouse and the field, because they're going to drop these things," he continues. "These are meant to take a beating and last a while, and they have a higher price to that refl ects that."

And this is something worth considering. For providers hoping to get by on a smart phone, there are limits to that scenario. Units that can stand up to rough treatment also include features such as laser scanning units, which are generally not available on a smart phone, Clark notes. There are add-ons, but the integrated scanner becomes critical in inventory management.

In terms of how the devices connect with the provider's systems, it depends on if the provider uses a software system that is installed on their site, or if they use a web browser or special client software to access an HME system that is hosted by a software company. In either case, the device uses wireless data network service (such as AT&T or Verizon, for example) to reach out to the system. Then it either connects with the hosted service, or directly connects via the Internet with the provider's on-site system.

Implementing Handhelds

Apart from special integration work such as that described by Pearlman, surprisingly there isn't much to implementing handheld devices in a typical HME environment.

"Some people believe they have to have their entire warehouse serialized before they can take advantage of an efficiency like this," says Jana Macon, vice president of Strategic Services for HME software company Brightree LLC. "When someone thinks, 'What do I have to do in order to put a point of delivery system in place,' this is a really big mountain in their minds, but it is not true."

As Heath mentioned, a serial number on a product doesn't have to be barcoded. It can be manually keyed in, so that the provider can still gain the efficiencies, she says. The information can go back to the biller.

So the process starts by determining where the provider is at in terms of their inventory, and then the provider can, over time, transition to a fully barcoded environment. But in the meantime that provider is still gaining all the other efficiencies of deploying handheld devices in its business, Macon explains.

"And we can help them implement a process to do it over time," she adds. "We put them on a process of, as your equipment comes in to be cleaned, you clean it, you barcode it, you label it, and you're done. So over a period of months, maybe a year, all of your equipment has been barcoded."

And, as mentioned, the provider will need a wireless data plan, but chances are, the provider already has a wireless data plan in place, Macon notes.

"That's part of the ROI that we do with the provider," she says. "[The wireless plan] pays for itself in the first month, because most providers will tell you it costs $50 if I have to go back and collect one missed signature from a patient. If I save him from having to do that just once, I've saved the cost of the data plan — probably twice."

If anything, the key element in implementing handheld devices has less to do with any sort of systems integration, and has much more to do with education and training.

"We have a structured training program; we go on site with [providers]; we train their drivers with the devices; we ride in the truck with them to make sure everything is going smoothly," she says.

And if anything, staff usually are drawn to this technology. There will always be curmudgeons who resist change, but generally the efficiencies of handhelds and step-by-step processes of their software sell themselves.

"I think you get both responses," Macon says. "It is change. So the younger drivers love it — love it. The older drivers they're a little unsure, but the devices are quite easy to use. … So that side is a bit of a relief to them. They know they're not going to forget the signature, they know they're not going to forget the serial number, because they can't finish their stop without those things."

This article originally appeared in the June 2011 issue of HME Business.

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