summarizes selected characteristics of US HHH agencies in 2007. Nearly 75% of HHH agencies provided only home health services, 15.3% only hospice services and about 10% provided both services. About 30% of agencies were part of a chain and nearly two-thirds were FP.
Selected characteristics of home health and hospice care agencies, United States, 2007
In 2007, 43% of HHH agencies reported current use of EMR. Of non-users, nearly 31% reported that they had plans to obtain an EMR system within the next year. There were marked differences in EMR use by agency type and these differences did not uniformly reflect previous patterns. shows EMR use overall and by agency type for both 2000 and 2007. During the 7-year period between 2000 and 2007, the approximate proportional increase in use of EMR for all agencies, home health only, hospice only, and mixed agencies were, 33.1%, 20.2%, 164%, and 64.8%, respectively.
Use of electronic medical records systems* in home health and hospice care agencies, United States, 2000 and 2007.
In total, 40% of all agencies reported current use of EMR for patient demographics, nearly 34% used systems for clinical notes, and 23.2% and 21.3% used systems for computerized decision support systems (CDSSs) and computerized physician order entry (CPOE), respectively (). Key functions, including test results, test reminders, public health reporting, and sharing of medical records were not available in most EMR systems that were in use at the time of the survey. It is worth noting that for some functions, EMR system capacity was available but not used.
Use and functionality of electronic medical records systems in home health and hospice care agencies, United States, 2007.
Nearly all agencies with EMR systems used them for recording demographic information and about 50% used them for CPOE. Use of EMR systems for public health reporting and for sharing of medical records was sufficiently limited to preclude reporting of reliable estimates in most analyses. Nearly 95% of HHH agencies reported using an electronic billing system and 83% used electronic systems for accounting. Inventory control was managed infrequently by electronic systems (15.2%). In total, 36% of HHH agencies reported using satellite broadcast capabilities, more than 80% reported providing internet access to staff, and 26% reported having a website with patient education materials (data not shown).
Approximately 20.6% of HHH agencies reported current use of telemedicine and, of these, the overwhelming majority (87%) provided home health services. Less than 13% of agencies providing only hospice services used telemedicine. More than 90% of agencies that provided home health services and that were using telemedicine engaged in routine telephone monitoring, about two-thirds used routine non-video monitoring, and about one-quarter provided email access to health professionals (). Many telemedicine functions were sufficiently infrequent to prevent reporting of stable estimates of their use.
Current telemedicine capabilities among home health agencies using telemedicine*, United States, 2007.
Of HHH agencies reporting use of telemedicine, approximately 38% reported that less than 5% of current patients were using telemedicine, with about equal proportions (30.7%) of agencies reporting that 5–20% and ≥20% of current patients were using telemedicine (data not shown).
Nearly 29% of HHH agencies reported using a system for electronic PoCD. Of agencies reporting PoCD use, 66.8% and 30.4% reported that ‘some’ and ‘all’ direct care staff used these systems, respectively, and 35.1% and 49.1% of respondents reported that ‘some’ and ‘all’ of administrative staff used them, respectively. Among HHH agencies using electronic PoCD, OASIS, email communication with staff, and scheduling appointments were the most common functions for which these systems were used (). It is worth noting that among agencies using PoCD, 93.3% and 98.2% of home health only and mixed agencies, respectively, used this technology for OASIS data capture.
Point of care documentation, by function and agency type, among home health and hospice agencies using these systems, United States, 2007.
Relative to FP HHH agencies, NP agencies used more EMR (70.1% vs 27.9%, p<0.001) and PoCD (63.1% vs 9.4%, p<0.001), and compared to agencies that were part of a chain, stand-alone agencies used more PoCD (33.7% vs 18.7%, p<0.05). Finally, HHH care agencies with patient case loads at or above the median used more PoCD (, panels A–C).
Relationship between selected agency characteristics and current use of technology among home health and hospice care agencies, United States, 2007.