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 Eﬀective and Eﬃcient 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 ﬁnan-

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 eﬀective and eﬃcient HIT adoption. In this context, eﬀectiveness means creating the

maximum value possible with limited resources; eﬃciency 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 eﬀectiveness (ii) contextual determinants of HIT adoption that should be managed to achieve eﬃciency by minimizing

overheads.

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’ diﬀusion theory

to uncover the contextual determinants of adoption. The interview transcripts

provided the raw data analyzed using the Framework method.

4–7

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 ﬂows 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 qualiﬁed clinicians was considered to be a challenge for

HHAs. Some participants noted that the scheduling and training diﬃculties 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 signiﬁcant diﬃculties with getting referrals.

(ii) Most HHAs lacked deﬁned 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 beneﬁt 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

H3IT: Home Healthcare, Hospice, and Information Technology Conference Washington – D.C., 2014

ﬁnancial incentives. Most of them were interested in increasing their HIT adoption levels. Developing an evidence-based HIT

adoption environment and culture is likely to beneﬁt HHAs in their HIT projects.

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