VON Transforms it’s Technology and Working Methods with LIFE
From Canadian Healthcare Technology, March 2011 issue 
By Louise Crandall
In January 2009, the Victorian Order of Nurses Canada (VON) entered into a $10 million business transformation partnership with IBM. Nicknamed LIFE (Leveraging Information, Forging Excellence), this two-year project aimed to improve the quality of information and the way it gets used.
The project involved assessing VON operations, reorganizing processes, and implementing various technologies to integrate and improve business functions.
The agreement with IBM covered a wide range of activities: financing, business transformation, consulting, management of back-office functions, new hardware, portal software, and integration services to support new wireless handheld devices.
During 2009, IBM performed a technical assessment and operational review of the critical processes involved in delivering VON programs. They then recommended best possible solutions and an approach for implementing the changes.
Over 2010, a large portion of back-office functions were revamped, enabling VON’s 53 sites to become more integrated and efficient. As of January 2011, the various projects that make up LIFE have been fully implemented (or close to it).
One of these nine projects is Clinical Mobility. This four-month pilot project involves providing BlackBerry smartphones to 300 front-line nurses in Nova Scotia to use during their daily service calls to clients’ homes. The devices integrate homecare software from Procura for assignment scheduling, MedShare soft¬ware for care checklist captures, and Telus’s wireless network for connectivity.
The pilot’s overall purpose is to deter-mine whether these devices and applications help improve the delivery of nursing services for both the clients and visiting nurses. In particular, did they enable better scheduling, save time or reduce paperwork and duplication of effort?
At the field level, the smartphones are intended to improve communications between nurses and managers, as well as provide administrative efficiencies. For example, the devices allow nurses to fill out and submit care checklists electronically and to automatically track mileage and plan routes for efficient travel.
Up-to-date summaries of client information can be transmitted securely, and nurses receive client assignment information (including access maps to their homes) electronically rather than by fax.
As well as getting their schedules directly on the BlackBerry, they can receive alerts about any last minute changes. From the nurses’ point of view, reducing their administrative burden means they can spend more time caring for clients.
From an organizational standpoint, the project is expected to result in better service for clients, including improved clinical outcomes and satisfaction.
The processes for collecting and processing data for timesheets, billing and mileage claims are all facilitated. Comprehensive data gathering on things like time spent per visit, a key metric in maintaining efficient scheduling of the number and type of home visits is also made easier. This data is needed to assess operational efficiency (e.g., cost containment) and is also something that government funders require in reporting.
Additional benefits the VON is looking for include leverage to attract more health professionals to the organization (in a competitive employment environment), as well as a platform to implement full electronic care plans at a further date.
According to Sharon Goodwin, VON vice president and project lead, “If nurses can access patient health records in the field, they would be able to reference and update information without travelling back to headquarters. This would save time and pave the way for even better in-home care. With e-health, it would be easier for nurses to research treatments and develop care plans tailored to individuals. We expect that nurses will soon be able to chart trends in their patient’s care and better track outcomes. We’d eventually like to see field nurses be able to do all their client record-keeping through the device.”
The reaction of front-line nurses involved in the pilot has been positive, in spite of the fact that many are not familiar with the newer technologies. (A readiness assessment showed that 76 percent of participants had never or rarely used a BlackBerry.)
VON put a lot of effort and thought into the training program and the various levels of individual support needed. Goodwin explained, “It was important that our nurses actually liked using the smartphones and quickly saw the benefits, so their introduction to the devices was set up to facilitate this.”
She believes that, on a practical level, the nurses like the faster communications with their managers and corporate centres. “On a BlackBerry, they can look up information in their cars or at the client’s house instead of having to use their computers back at home.”
While most of the pilot participants appreciated having information at their fingertips, others singled out the GPS technology as particularly useful since they often travel around rural areas to visit clients. Others singled out the email or voice recorder as functions they use most often. One of pilot users commented, “I love using the BB in the field to gain proficiency without paperwork.”
A few weeks into the pilot, the Nova Scotia nurses began to rely less on the trainers or expert users and more on themselves. They started to support each other through informal lunch sessions where they compared their experiences and talked about how they are using the devices and the Medshare and Procura applications in their daily routines.
One of the lessons learned in the project has been the importance of peer-to-peer support for both training and deployment.
VON is now evaluating the project’s success in terms of performance outcomes and will then decide whether to provide mobile technologies to its nurses across Canada.
Louise Crandall is Manager, Public Affairs at VON Canada.
