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Kindred Healthcare, Inc.

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To increase the productivity of its rehabilitation therapists, improve the accuracy of data required for billing and other business purposes, and generate the best possible patient outcomes, Peoplefirst rehabilitation replaced paper-based processes with a mobile application powered by Afaria from Sybase.

Business Challenge

Key Benefits

Sybase Technology


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Mobile Solution Enables Kindred Healthcare to Put People First
Kindred Healthcare, Inc. is a healthcare services company that through its subsidiaries operates hospitals, nursing centers and a contract rehabilitation services business across the United States. The contract rehabilitation services business – Peoplefirst – is the nation’s second largest contract therapy company, employing over 8,000 individuals the majority of whom work directly with patients at over 600 locations across the country. Peoplefirst delivers a full range of therapies including physical, occupational and speech. The therapists’ mission is to help patients reach their highest level of functioning in order to live as productive and pain-free lives as possible.

In the course of a typical day, a therapist might work with 10 patients. Historically, the therapists (or a secretary) had to spend an hour at the end of each day at a desktop PC keying their handwritten patient treatment notes – patients seen, time spent with each patient, and other treatment related information – into the company’s centralized billing system.

This paper-based system created problems for Peoplefirst. The time spent keying information into the system was time that could have been better spent working with patients. Additionally, as with any paper-based system that requires re-entry into a computer system, errors were inevitable. This could cause problems with reimbursements from the healthcare facilities who are responsible for billing services to insurance companies and Medicare.

Replacing Pen and Paper
To improve the quality of care delivered to patients, enhance its therapists’ productivity and increase the accuracy of the patient data required for billing and other purposes, Peoplefirst decided to develop and deploy a mobile system to replace pen and paper.

“We created a custom application called Point-of-Care Mobile,” explains Keith Bickett, project manager for Peoplefirst. “We’d had an application called Point-of-Care that ran on desktop PCs, which is what the therapists used to enter their handwritten information. By mobilizing this application, we eliminated that intermediate step. That allowed our therapists to spend more time with patients while maintaining more accurate timekeeping and therapy service information. In turn, Peoplefirst was able to generate more accurate bills.”

Device Management Essential
Point-of-Care Mobile was developed to run on HP iPAQ Windows Mobile devices and to connect wirelessly with the company’s centralized database in Louisville, Kentucky. Recognizing that it would be deploying thousands of iPAQs to its therapists across the country, Kindred’ IT team knew from the start that a proven and robust device management solution would be an integral part of its mobile system. Device configurations would have to be monitored and maintained, software updates distributed, treatment codes required for billing purposes routinely updated, security policies enforced, patient data securely synchronized and more. Of course, the device management solution had to be proven and reliable.

Afaria Meets Kindred’s Requirements
In the process of creating the proof-of-concept for Point-of-Care-Mobile, Kindred’s data support team pushed for the use of Microsoft SMS as the management solution, as Kindred was already using Microsoft SQL Server.

“We tried using SMS,” Bickett recalls, “but we couldn’t get it to work successfully wirelessly. It simply couldn’t do everything we needed it to do.”

Kindred then explored other options. The company’s research, working in conjunction with analyst firm Gartner Inc., led it to Afaria, which it further researched, including speaking with Afaria users.

Kindred relied on the Afaria skills and mobility expertise of Sybase Professional Services to help it integrate Afaria into its solution and accelerate the completion of its proof-of-concept. The company then began rolling the Point-of-Care Mobile application out to its therapists in stages, eventually deploying to 8,000 devices.

The Point-of-Care Mobile system consists of HP iPAQ devices running the Windows Mobile operating system. Also running on the devices are the Point-of-Care custom application and the Afaria client software. Therapists sync their devices twice a day – in the morning to get their treatment schedules and at the end of the day to transmit their time keeping and treatment code information. Software updates can be pushed to the therapists’ devices as required. At Kindred-owned facilities, wireless connectivity between the devices and the company’s centralized database is via Kindred’s WAN. At other facilities that have contracted Peoplefirst to provide rehabilitation services, connectivity is via VPN over DSL. A typical sync session lasts about 90 seconds.

Important Clinical and Business Benefits
“Moving from paper to Point-of-Care-Mobile has produced important benefits for Peoplefirst and for our patients,” says Bickett. “The most important benefit is that our mobile system has eliminated the need for therapists to spend hours each week re-entering their time-keeping and treatment information into desktop PCs for transmission to our centralized systems. This allows them to treat more patients and/or spend more time with each patient, which is critical when your focus is producing the best possible clinical outcomes.”

“In addition,” Bickett continues, “the information we capture now is more timely and accurate, which allows us to generate more accurate invoices and improve our cash flow. Management also benefits by being able to view information in near real time, which allows them to optimize scheduling, monitor treatment plans and progress, and meet compliance requirements more efficiently and effectively.”

Point-of-Care Mobile has produced additional, somewhat unexpected benefits. The use of this mobile solution has helped Peoplefirst secure rehabilitation contracts from healthcare facilities impressed by its efficiency and accuracy compared to the paper processes still used by many other rehabilitation businesses. And the solution has proven to be a valuable recruiting advantage in the competition among rehabilitation organizations for the finite pool of therapy graduates each year.

Afaria Key to Future Mobile Deployment
“Afaria is a critical component of our solution,” says Bickett. “It has allowed us to deploy a solution to centrally manage thousands of devices, ensure the integrity and security of those devices and the information contained on them, keep the devices updated in terms of application software and clinical information.  Afaria has helped us improve productivity, data accuracy, billing efficiency, and most importantly, patient outcomes. We’ve been extremely pleased with its functionality, performance and reliability.”

Based on the success of Point-of-Care-Mobile, Peoplefirst is planning to deploy another mobile application to enable therapists to capture more clinical information.

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