Hospitals, Home Health Fail IT Interoperability

Health IT Boosts Patient Care, Safety

Home healthcare agencies and hospitals exchange very little clinical data online, according to a new report on home healthcare IT from KLAS, a research firm based in Orem, Utah. And that misstep can be quite expensive.

Because of new Medicare rules penalizing them for readmissions, hospitals are increasingly interested in breaking down the walls that separate them from post-acute-care providers, including home healthcare agencies. Other new government initiatives, including payment bundling and accountable care organizations, have also increased the focus on home care.

The KLAS report shows that "best-of-breed" home healthcare electronic health records (EHRs), such as Delta, Thornberry, and Homecare Homebase, score highest on their ability to meet the complex regulations of the Centers for Medicare and Medicaid Services (CMS). But those applications are not integrated with hospital EHRs, so it is difficult to exchange clinical data with them.

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Vendors such as Allscripts, Cerner, McKesson, and Meditech offer home healthcare EHRs as part of their enterprise systems for hospitals. But, in the KLAS ratings, these applications all scored at least 12 points lower than the best-of-breed products in their ability to jump through the CMS hoops that allow agencies to bill quickly for their services.

Despite this drawback, one might still expect many of the hospitals that own home health agencies to use the enterprise EHRs. But, although hospitals owned 60% of the agencies in the KLAS sample, only 15% of the respondents reported they were sharing any electronic data with hospitals. All the providers interviewed by KLAS said they had a distance to achieve effective data sharing.

"There is a gap across the market," said report author Erik Bermudez. "Usually enterprise vendors have an interoperability advantage, but that is not the case yet in home care. Only a couple of vendors are sharing data with affiliated hospitals and clinics--and even they don't do it well."

Home healthcare agencies would like to share information online with hospitals and other providers, said Latoya Thomas, associate director of the health IT program of the National Association of Home Care & Hospice (NAHC), in an interview with InformationWeek Healthcare.

When physicians refer a patient who is about to be discharged from the hospital to home healthcare, Thomas explained, they fill out a "plan of care" document that includes information about the patient's hospitalization and medical history. But even if that document is sent online from the hospital's EHR to a home healthcare EHR, it comes across as a block of text that is hard to search for specific information. The same thing happens when a patient is readmitted, and the home healthcare agency sends the hospital its updated plan of care. So it would be better if the systems were integrated or could exchange discrete data.

"It's not necessarily the fault of home care agencies for not adopting systems that can speak with hospitals," Thomas added. "Bigger hospitals have closed systems that don't communicate with anybody except their own systems. It's hard for a home health agency to adopt one system that can communicate with all the hospital systems and physician practices that they do business with."

Some large healthcare organizations have made strides in integrating home health IT with their enterprise systems. At the Cleveland Clinic, for instance, a home healthcare nurse can pull up key clinical data from the group's enterprise EHR, including lab results, medications, and prior care plans. Home healthcare progress notes flow into the group's enterprise system.

A few other big groups, including Partners Healthcare in Boston and St. Vincent's Health System in Indianapolis, are working on similar links between inpatient and home health IT systems. But overall, the nation's hospitals have a big job ahead of them to stay informed on what happens to patients after discharge.