title: Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  Researchers compared workflow, financial billing, and patient outcomes before and after implementation to evaluate the impact of a homecare point-of-care EHR.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Drexel University College of Nursing and Health Professions , Philadelphia, PA, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Sockolow
authors.affiliation: University of Pennsylvania School of Nursing , Philadelphia, PA, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Bowles
authors.affiliation: Abington Memorial Hospital , Abington, PA, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Adelsberger
authors.affiliation: University of Pennsylvania School of Nursing , Philadelphia, PA, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Chittams
authors.affiliation: Temple University College of Health Professions and Social Work , Philadelphia, PA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Liao
mesh_terms: D004282:Documentation / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010549:Personal Satisfaction; D019095:Point-of-Care Systems / Q000706:statistics & numerical data; D013997:Time Factors
keywords: Evaluation studies; aged; clinical information systems; homecare; patient care team; technology evaluation