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Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes
Journal article   Open access   Peer reviewed

Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes

P S Sockolow, K H Bowles, M C Adelsberger, J L Chittams and C Liao
Applied clinical informatics, v 5(2), pp 445-462
01 Jan 2014
DOI: https://doi.org/10.4338/ACI-2013-12-RA-0106
PMID: 25024760
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.4338/aci-2013-12-ra-0106View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open
url
https://doi.org/10.4338/ACI-2013-12-RA-0106View
Published, Version of Record (VoR) Open

Abstract

Documentation - statistics & numerical data Electronic Health Records - utilization Home Care Services - economics Home Care Services - statistics & numerical data Humans Insurance, Health, Reimbursement - statistics & numerical data Outcome Assessment (Health Care) - statistics & numerical data Personal Satisfaction Point-of-Care Systems - statistics & numerical data Time Factors
Homecare is an important and effective way of managing chronic illnesses using skilled nursing care in the home. Unlike hospitals and ambulatory settings, clinicians visit patients at home at different times, independent of each other. Twenty-nine percent of 10,000 homecare agencies in the United States have adopted point-of-care EHRs. Yet, relatively little is known about the growing use of homecare EHRs. Researchers compared workflow, financial billing, and patient outcomes before and after implementation to evaluate the impact of a homecare point-of-care EHR. The design was a pre/post observational study embedded in a mixed methods study. The setting was a Philadelphia-based homecare agency with 137 clinicians. Data sources included: (1) clinician EHR documentation completion; (2) EHR usage data; (3) Medicare billing data; (4) an EHR Nurse Satisfaction survey; (5) clinician observations; (6) clinician interviews; and (7) patient outcomes. Clinicians were satisfied with documentation timeliness and team communication. Following EHR implementation, 90% of notes were completed within the 1-day compliance interval (n = 56,702) compared with 30% of notes completed within the 7-day compliance interval in the pre-implementation period (n = 14,563; OR 19, p <. 001). Productivity in the number of clinical notes documented post-implementation increased almost 10-fold compared to pre-implementation. Days to Medicare claims fell from 100 days pre-implementation to 30 days post-implementation, while the census rose. EHR implementation impact on patient outcomes was limited to some behavioral outcomes. Findings from this homecare EHR study indicated clinician EHR use enabled a sustained increase in productivity of note completion, as well as timeliness of documentation and billing for reimbursement with limited impact on improving patient outcomes. As EHR adoption increases to better meet the needs of the growing population of older people with chronic health conditions, these results can inform homecare EHR development and implementation.

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29 citations in Web of Science
31 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Medical Informatics
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