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Investigating the Challenges and Opportunities in Home Care to Facilitate Effective Information Technology Adoption

Published:November 20, 2015DOI:https://doi.org/10.1016/j.jamda.2015.10.008

      Abstract

      Background

      As home care utilization increases, information technology (IT) becomes a critical tool for providing quality home care. However, most home health agencies (HHAs) in the United States are in a position to adopt and leverage IT solutions in budget-constrained settings, where it is crucial to address important and pressing challenges and opportunities for achieving effectiveness in IT adoption.

      Objectives

      (1) Explore HHAs' challenges and opportunities related to delivering home care as well as performing administrative functions and conducting business, (2) learn about current IT implementation levels and activities in home care, and (3) make recommendations to facilitate efforts and initiatives designed for adopting IT in home care effectively.

      Methods

      Semistructured interviews were conducted to elicit rich contextual information from the participants recruited from 13 local HHAs in one of the states in the United States. Established systems analysis techniques were used to ask questions during the interviews. Framework, a qualitative research method, was used to analyze the qualitative data obtained from the interviews.

      Results

      Coordinating clinical and administrative workflows was an important challenge. Inadequate access to patients' medical history and difficulties with medication reconciliation detracted from the quality of care. Hiring, training, scheduling, and retaining qualified personnel constituted another important challenge. Training and educating patients, caregivers, and families hold important opportunities for improving the quality of care. All except one HHA adopted electronic health records (EHR) but many continued to struggle considerably in their day-to-day functions. Health information exchange (HIE) seems to be the most needed technology. Telehealth solutions were perceived to be promising but their added value and financial viability in the long run were questioned.

      Conclusions

      The recommendations for effective IT adoption include keeping a quality improvement focus, keeping a holistic organizational perspective, considering potential information exchange problems, addressing education and training needs, experimentation with telehealth if resources permit, considering organization size, and reducing lengthy procedures and excessive documentation requirements. The relevant stakeholders, such as home care professionals, IT vendors, and policy makers, should consider the recommendations from this study to facilitate success in future IT efforts and initiatives in home care.

      Keywords

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      References

        • Goldberg J.
        • Johnson M.
        • Pajerowski W.
        • et al.
        Home Health Study Report.
        L&M Policy Research prepared for Centers for Medicare and Medicaid Services, Washington, DC2011 (HHSM-500–2010–00072C)
        • Hughes S.L.
        • Ulasevich A.
        • Weaver F.M.
        • et al.
        Impact of home care on hospital days: A meta-analysis.
        Health Serv Res. 1997; 32: 415-432
        • Office of Information Products and Data Analysis
        Medicare & Medicaid statistical supplement: OIPDA.
        Centers for Medicare & Medicaid Services (CMS), Baltimore, MD: OIPDA2013
      1. Centers for Medicare and Medicaid Services (CMS). National health expenditure projections, 2012. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/. Accessed October 5, 2015.

        • Berwick D.M.
        • Nolan T.W.
        • Whittington J.
        The triple aim: Care, health, and cost.
        Health Aff (Millwood). 2008; 27: 759-769
        • Sockolow P.S.
        • Bowles K.H.
        • Adelsberger M.C.
        • et al.
        Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes.
        Appl Clin Inform. 2014; 5: 445-462
        • Russell D.
        • Rosenfeld P.
        • Ames S.
        • Rosati R.J.
        Using technology to enhance the quality of home health care: Three case studies of health information technology initiatives at the Visiting Nurse Service of New York.
        J Healthc Qual. 2010; 32: 22-29
        • Buntin M.B.
        • Burke M.F.
        • Hoaglin M.C.
        • Blumenthal D.
        The benefits of health information technology: A review of the recent literature shows predominantly positive results.
        Health Aff (Millwood). 2011; 30: 464-471
        • Resnick H.E.
        • Alwan M.
        Use of health information technology in home health and hospice agencies: United States, 2007.
        J Am Med Inform Assoc. 2010; 17: 389-395
        • Dougherty M.
        • Williams M.
        • Millenson M.
        • Harvell J.
        EHR Payment Incentives for Providers Ineligible for Payment Incentives and Other Funding Study.
        US Department of Health and Human Services, Washington, DC2013
        • Stolee P.
        • Steeves B.
        • Glenny C.
        • Filsinger S.
        The use of electronic health information systems in home care: Facilitators and barriers.
        Home Healthc Nurse. 2010; 28: 167-181
        • Benson J.A.
        • Michelman J.E.
        • Radjenovic D.
        Using information technology strategically in home care.
        Home Healthc Nurse. 1996; 14: 977-983
        • Creswell J.W.
        Data collection.
        in: Qualitative Inquiry and Research Design: Choosing Among Five Approaches. 2nd ed. SAGE Publications, Thousand Oaks, CA2007: 125-129
        • Lee A.
        • Mills P.D.
        • Neily J.
        Using root cause analysis to reduce falls with injury in community settings.
        Jt Comm J Qual Patient Saf. 2012; 38: 366-374
        • Goldratt E.M.
        • Cox J.
        The Goal: A Process of Ongoing Improvement. Third revised, 25th anniversary edition. North River Press, Great Barrington, MA2012
        • Goldratt E.M.
        The Haystack Syndrome: Sifting Information Out of the Data Ocean.
        North River Press, New York, NY2006
        • Giardina T.D.
        • King B.J.
        • Ignaczak A.P.
        • et al.
        Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients.
        Health Aff (Millwood). 2013; 32: 1368-1375
        • Schafer J.J.
        A root cause analysis project in a medication safety course.
        Am J Pharm Educ. 2012; 76: 116
      2. Morrison BP, Bird BC. Healthcare process analysis: a methodology for modeling front office and patient care processes in ambulatory health care. In: Proceedings of the 35th conference on Winter simulation: driving innovation. WSC '03. Winter Simulation Conference, 2003, p. 1882–1886. Available at: http://dl.acm.org/citation.cfm?id=1030818.1031078. Accessed April 29, 2013.

        • Staccini P.
        • Joubert M.
        • Quaranta J.F.
        • et al.
        Integration of health care process analysis in the design of a clinical information system: Applying to the blood transfusion process.
        Proc AMIA Symp. 2000; : 824-828
        • Federowicz M.H.
        • Grossman M.N.
        • Hayes B.J.
        • Riggs J.
        A tutorial on activity-based costing of electronic health records.
        Qual Manag Health Care. 2010; 19: 86-89
        • Goldberg M.J.
        • Kosinski L.
        Activity-based costing and management in a hospital-based GI unit.
        Clin Gastroenterol Hepatol. 2011; 9: 947-949.e1
        • Gujral S.
        • Dongre K.
        • Bhindare S.
        • et al.
        Activity-based costing methodology as tool for costing in hematopathology laboratory.
        Indian J Pathol Microbiol. 2010; 53: 68-74
        • Krug B.
        • Van Zanten A.
        • Pirson A.S.
        • et al.
        Activity-based costing evaluation of a (18)[F]-fludeoxyglucose positron emission tomography study.
        Health Policy. 2009; 92: 234-343
        • Shander A.
        • Hofmann A.
        • Ozawa S.
        • et al.
        Activity-based costs of blood transfusions in surgical patients at four hospitals.
        Transfusion. 2010; 50: 753-765
        • Wilt V.M.
        • Gums J.G.
        • Ahmed O.I.
        • Moore L.M.
        Outcome analysis of a pharmacist-managed anticoagulation service.
        Pharmacotherapy. 1995; 15: 732-739
        • Yates B.T.
        Analyzing Costs, Procedures, Processes, and Outcomes in Human Services: An Introduction.
        SAGE Publications, Thousand Oaks, CA1996
      3. Thyer B. The Handbook of Social Work Research Methods. 2nd ed. SAGE Publications, Thousand Oaks, CA2009
        • Martinsons M.G.
        Radical process innovation using information technology: The theory, the practice and the future of reengineering.
        Int J Inf Manag. 1995; 15: 253-269
        • Ritchie J.
        • Spencer L.
        Qualitative data analysis for applied policy research.
        in: Bryman A. Burgess R.G. Analysing Qualitative Data. Routledge, London, United Kingdom1994: 173-194
        • Ritchie J.
        • Lewis J.
        Qualitative Research Practice: A Guide for Social Science Students and Researchers.
        SAGE Publications, London, United Kingdom2003
        • Smith J.
        • Firth J.
        Qualitative data analysis: The framework approach.
        Nurse Res. 2011; 18: 52-62
        • Srivastava A.
        • Thomson S.B.
        Framework analysis: A qualitative methodology for applied policy research.
        Journal of Administration & Governance. 2009; 4: 72-79
        • Gale N.K.
        • Heath G.
        • Cameron E.
        • et al.
        Using the framework method for the analysis of qualitative data in multi-disciplinary health research.
        BMC Med Res Methodol. 2013; 13: 117
        • Read S.
        • Ashman M.
        • Scott C.
        • Savage J.
        Evaluation of the Modern Matron Role in a Sample of NHS Trusts.
        The Royal College of Nursing Institute and The University of Sheffield School of Nursing and Midwifery, Sheffield, UK2004
        • Gerrish K.
        • Chau R.
        • Sobowale A.
        • Birks E.
        Bridging the language barrier: The use of interpreters in primary care nursing.
        Health Soc Care Community. 2004; 12: 407-413
        • Emery D.
        • Cowan A.
        • Eaglestone B.
        • et al.
        Care Plus.
        The University of Sheffield, Sheffield, UK2002
      4. 104th Congress of the US. The health insurance portability and accountability act (HIPAA), 1996.

      5. Axxess, Inc. Axxess Home Health Solutions, 2015. Available at: http://axxess.com/. November 12, 2015.

      6. Allscripts. Allscripts Homecare, 2015. Available at: http://www.allscripts.com/en/solutions/post-acute-solutions/homecare/show/homehealth.html. November 12, 2015.

      7. McKessin Corp. McKessin Homecare, 2015. Available at: http://www.mckesson.com/en_us/McKesson.com/For%2BHealthcare%2BProviders/Home%2BCare/Home%2BCare.html. November 12, 2015.

      8. Allegheny Software Publishers, Inc. Allegheny Home Healthcare, 2015. Available at: http://alleghenysoftware.com/. November 12, 2015.

      9. Health Level Seven. Clinical Document Architecture, 2015. Available at: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7. November 12, 2015.

      10. Health Level Seven. Health Level Seven International, 2015. Available at: http://hl7.org/. November 12, 2015.

      11. Centers for Medicare and Medicaid Services (CMS). Home Health Compare, 2015. Available at: https://data.medicare.gov/data/home-health-compare. November 12, 2015.