Recover Health is on a mission: To make health care at home safer through innovation

Recover Health is a Medicare-certified and industry-leading home health agency. Its 1,500 employees -- including nurses, therapists, and other highly trained professionals -- bring a full range of health care services to the doorsteps of its clients across six Midwestern US states, including those managing chronic illness or disease, recovering from hospitalization or surgery, or dealing with specialized needs.

Like many innovative organizations, Recover Health was an early adopter of technology empowering its mostly field-based staff to tap into critical client information on the fly. Previously, the company used three separately licensed commercial products. Together, these enabled capabilities to store, edit, and deploy data in PDFs down onto company-provided Apple tablets. Staff could then use these tablets to instantly view and update clients’ information in forms including admissions documents, with client signatures collected during household visits, as well as get on the same page virtually for face-to-face team meetings, consultations, and training.

But as COVID-19 swept the world in March 2020, the company’s previous document solution stopped working as expected, presenting the company’s frontline staff with having to default to pen and paper. Not only was paper inefficient; amidst a pandemic, it was also less safe.

Rapid Innovation in Health Care - Powered by PDFTron

Recover Health needed to restore remote document capabilities and fast -- to keep pace with pandemic-accelerated demand for its services and eliminate paper-related exposure risks to its staff and vulnerable clients receiving care at home.

In PDFTron, Recover Health found a responsive technology partner that immediately understood the urgency of the situation. Collaborating with PDFTron, and with features consolidated into a single, cross-platform document processing SDK, including support for Xamarin, Recover Health could roll out a uniquely branded form filling app for iOS and Android in less than a month and later, add further features and platforms to continually enhance the user experience.

“Our employees, including nurses, and of course, clients, are putting their lives in the hands of our business,” company CIO John Fraser stated. "From start to finish, from my first conversation with PDFTron, to the time I had our app up on the App Store, the total duration was 24 days. Partnering with PDFTron, we could use technology as a differentiator to improve quality outcomes; we could innovate to make our employees and clients safer -- to improve our efficiency and do so in a meaningful way.”

Business Challenges

  • Recover Health’s previous remote document and form filling solution failed at a critical juncture
  • Having to default to paper would counteract the company’s Emergency Preparedness Plan based on strict infection control standards and CDC guidelines
  • It would also impact the company’s ability to scale its services safely at a moment of escalating demand for them

The Results with PDFTron

  • Created a branded form filling app in less than 25 days to eliminate paper forms and paper-related COVID-19 exposure risks
  • Eliminated high costs and inefficiencies of paper, including turnover times on admissions forms reduced from 48 hours with paper to seconds digitally
  • Streamlined cross-platform development with Xamarin, enabling fast roll out of new features on Android and iOS platforms so users could BYOD to work
  • Consolidated features into a single vendor providing long-term support for additional document features, file formats, and platforms, including Android, iOS, and the web
  • Continued success measured in high levels of user satisfaction based on direct feedback from nurses to Recover Health CIO John Fraser and his team

Background

The home health care industry is diverse in the range and intensity of services offered to meet the diverse needs of clients. Some may only need an aide once or twice a week to drive their car, help with errands, tidy up the house, or do meal preparation. Recover Health takes service a step up, providing a full range of professionalized in-home care, including, for example, skilled nursing, as well as physical, occupational, and speech therapy.

COVID-19 presented Recover Health with many unprecedented challenges as it did for healthcare providers around the world. Demand within its industry and for Recover Health’s specialized at-home services specifically boomed as patients and their families decided to isolate safely at home as long as possible. Recover Health served 12,000 clients in 2020 alone.

Just as demand went through the roof, however, the company ran into issues with their previous software combination used to power admissions and remote access to client documentation in PDFs and MS Office format files. A vendor update to one of three critical components made it impossible for teams to update certain documents and some files got corrupted.

“It got so bad that during the middle of a pandemic, when we should have people isolated and doing less transmission of paper, pens and so on, we had no choice but to go back to paper,” said Fraser. “It had the opportunity to create a significant risk for our business, our employees, and our clients. Additionally, paper’s just horribly inefficient. We pride ourselves on having a reduced windshield time -- a concept we use to describe the time our nurses, therapists and other professional staff that are highly skilled, spend time in their cars, driving.”

Defaulting to paper, Fraser estimates staff would spend a lot more time behind the wheel with trips to the office back and forth to fetch and file paperwork, even with strategies to reduce such trips.

“During that time, they can’t coordinate with a doctor; they can’t see a patient. They are effectively operating as unproductive employees,” he added.

Evaluation

Fraser and his team initially considered several off-the-shelf commercial applications in their search for a rapid replacement to previous remote document capabilities. But they found none could meet all their requirements in one place; instead, Recover Health would be required to chain together vendor solutions as before, adding to the costs of support and user training with workflows split across multiple applications. It would also recreate the previously experienced uncertainty of having to rely on multiple vendors, each with their own roadmaps, bugs, and other issues.

With a background in software development and having spearheaded creation of other internal applications for Recover Health, Fraser considered directly embedding document capabilities using a PDF Software Development Kit (SDK) and thus building a new form filling application using readily available components. To get replacement features in the hands of users as soon as possible, such an SDK would need to support the entire workflow with features to convert Office documents, fill forms, annotate documents with electronic signatures, and synchronize changes in documents to a database in real time.

Fraser and his team also wanted a simple and intuitive UI out of the box, one they could quickly skin with their brand elements and tailor to match their workflow. Recover Health’s busy staff would have little patience or bandwidth to scale fresh software learning curves. Thus features would have to be centralized in a single UI, easy to use without any training to ensure user adoption and the success of the new application.

Lastly, many Recover Health clients live in rural areas, with spotty internet or limited wireless. The SDK would need to support advanced options for local caching of documents and offline use, and ensure changes made offline would synchronize accurately once a connection was re-established.

Solution

Fraser and his team contacted PDFTron after considering several commercial PDF SDK options. And in short order, as little as seven days, they moved from their initial discovery call into active development, with PDFTron proving flexible when it came to accommodating Recover Health’s licensing requirements.

“I got in touch with somebody almost immediately, and they really understood the sense of urgency that we had. They took our requests very seriously and engaged us with the right folks on the back end,” Fraser shared.

Working with the PDFTron SDK and collaborating with the engineers who built it, Fraser found he and his team could quickly and successfully add capabilities.

“We had technical questions throughout the implementation process, and the PDFTron team was very responsive -- they got back to us the same day, almost always.”

Leveraging PDFTron’s support for Xamarin, Recover Health could also streamline development on both Android and iOS, giving users the flexibility to bring their own devices to work and access forms and client data securely, including on their Android phones.

PDFTron’s cross-platform and mobile SDKs also came with advanced options supporting Recover Health’s requirements for remote and offline use, including features to enable local caching of documents. At the same time, Fraser and his team found PDFTron’s out-of-the-box UI usable as-is but also quickly tailorable to match their brand elements and desired feature set. They easily streamlined the user experience and made the UI feel like a natural part of their application and not somebody else’s software.

Finally, with the app live on the App Store, possibly the best outcome, shared Fraser, was the impact on users. They felt valued and listened to with their suggestions reflected in the final product, which made their work easier and not harder, for an exceptional user experience, less staff stress, and better client care.

Feedback from Recover Health Nurses:

  • “It felt really good knowing that we got to contribute feedback to make the product better.”
  • “We didn’t really need any training. It was obvious how to fill, sign and send in the admission paperwork.”
  • “With COVID-19, I felt safer not having to deal with paper and driving into the office as much.”

Collaboration Drives Efficiency and Better Quality Outcomes

In less than a month, Recover Health created a professional form filling app for its users to download and complete their tasks quickly. And greatly accelerating the company’s delivery was partnership and collaboration with PDFTron, providing comprehensive document SDK features, support for all modern platforms and languages, especially Xamarin, and highly responsive engineers.

Today, Recover Health continues to benefit from PDFTron’s technology backing in delivering satisfaction to its users. That backing includes a willingness to meet custom feature requests, such as providing a nightly build for Recover Health users who wished to use their attached iPad keyboards with their new form fill app.

“With what we thought should be a fairly big lift, PDFTron provided us this capability in a day and a half in our environment for us to look at,” said Fraser.

Estimated Savings with New Features vs. Paper

Since January 1, 2021, Recover Health staff submitted more than 3,800 documents electronically for a minimum of 1,083 client admissions and serving more than 5,000 clients. Fraser estimates, over a four month period, switching to digital processes conservatively saved the company 541.5 staff hours formerly spent on unproductive work -- savings expected to only grow as adoption increases.

By the Numbers

  • ~60% reduction in time spent filling out forms
  • ~80% reduction in trips to the office
  • Reduced average time to get paperwork from 48 hours to 10 seconds digitally

About Recover Health

We are a Medicare-certified home health agency providing a full range of home care services, including skilled nursing, physical, occupational and speech therapy. With offices throughout Colorado, Iowa, Minnesota, Nebraska, South Dakota and Wisconsin, we care for over 11,000 children, adults and seniors annually. We provide exceptional care allowing individuals to remain at home and live as independently as possible. Learn more at www.recoverhealth.org.