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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Washington D.C., 2014
Toward Eective and Ecient Health IT Adoption
in Home Healthcare: A Qualitative Investigation of
Maryland Home Health Agencies
Güneş Koru
, Dari AlHuwail
, Maxim Topaz
, Mary Etta Mills
, Anthony F. Norcio
ealth information technology (HIT) becomes a critical tool in home healthcare as its utilization increases.
Compared to other types of healthcare providers, HIT adoption levels among home health agencies(HHAs)
have traditionally been lower.
Furthermore, various eligibility issues prevented HHAs from receiving nan-
cial incentives for adopting electronic health records (EHR),
which can be considered among essential HIT
systems. Most HHAs in the United States (US) are in a position to adopt HIT solutions in highly budget constrained
settings where it is crucial to achieve eective and ecient HIT adoption. In this context, eectiveness means creating the
maximum value possible with limited resources; eciency means minimizing the overheads of HIT adoption. We conducted
a qualitative study to obtain rich contextual information strengthening the evidence base about the (i) HHAs’ challenges and
opportunities related to delivering care and conducting business,which should derive HIT adoption strategies and decisions to
achieve eectiveness (ii) contextual determinants of HIT adoption that should be managed to achieve eciency by minimizing
Methods: Semi-structured phone interviews were conducted with the executives and managers of thirteen Maryland HHAs.
Maximum variation was used in recruitment by considering the HHAs’ size, organization type, business model, geographical
areas served, and age. For each recruited HHA, one interview was conducted involving either two participants, one knowl-
edgeable in HIT and the other in home care, or involving only one participant knowledgeable in both areas. The topical
areas were based on (i) a number of established systems analysis techniques such as problem analysis, duration analysis,
activity-based costing, outcome analysis,and technology analysis to document the HHAs’ challenges and opportunities (ii)
the constructs in the Rogers’ diusion theory
to uncover the contextual determinants of adoption. The interview transcripts
provided the raw data analyzed using the Framework method.
The analysis of qualitative data included constructing an
index, open coding, summarizing and sorting, and eliciting descriptive and explanatory accounts.
Results: (i) Coordinating clinical and administrative work ows was stated as an important challenge. Complying with
the strict and changing Federal rules for reimbursements, therapy assessments, and physician approvals was described as
excessively time consuming and costly, particularly for smaller HHAs. It was reported that HHAs use telephone and fax as
the primary means of health information exchange (HIE). Most participants complained about not having adequate access
to patients’ medical history during admissions. Hiring and training qualied clinicians was considered to be a challenge for
HHAs. Some participants noted that the scheduling and training diculties increase greatly as the number of part-time
employees increase. Educating and training patients and caregivers was found to improve outcomes, but it required overcom-
ing cultural, educational, and agerelated barriers. Smaller HHAs experienced signicant diculties with getting referrals.
(ii) Most HHAs lacked dened processes for analysing their HIT requirements driven by their actual improvement needs,
evaluating alternative HIT solutions, and making HIT adoption decisions. Perceived complexity of using HIT was mentioned
as a challenge but the HHAs were able to train most clinicians successfully if their training budgets allowed. Still, the partic-
ipants mentioned that using EHR at patients’ home presented usability issues which sometimes detracted from the quality
of interaction. The participants perceive HIT to be useful but they said the opinions varied among their clinicians. While
larger HHAs customized HIT solutions to a certain extent, most HHAs avoided customization to prevent future problems.
Vendor lock-in o ccurred commonly because HHAs lacked in-house IT resources and tried to reduce the compatibility issues
between the existing and new systems. HHAs’ service-oriented social norms and values were found to be consistent with
using HIT for improvement. The participants valued peer advice and used their association as a communication channel to
increase their HIT awareness and knowledge.
Discussion: It seems that HHAs’ clinical, administrative, and management functions require a strong coordination which
can benet from HIT. Increasing HHAs’ awareness about existing HIE capabilities and developing better HIE infrastructures
could improve the quality of care by facilitating admissions and care delivery. Education and training of patients and care-
givers is a promising area for quality improvement. Regulatory agencies should consider that frequent changes in regulations
will require changes in HIT systems increasing HHAs’ costs.
Conclusion: The majority of the participating HHAs have made considerable progress in HIT adoption without receiving
University of Maryland, Baltimore County
Brigham and Women’s Hospital & Harvard Medical School
University of Maryland School of Nursing
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H3IT: Home Healthcare, Hospice, and Information Technology Conference Washington D.C., 2014
nancial incentives. Most of them were interested in increasing their HIT adoption levels. Developing an evidence-based HIT
adoption environment and culture is likely to benet HHAs in their HIT projects.
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