title: Investigating the Challenges and Opportunities in Home Care to Facilitate Effective Information Technology Adoption.
abstract: BACKGROUND
  As home care utilization increases, information technology (IT) becomes a critical tool for providing quality home care. However, most home health agencies (HHAs) in the United States are in a position to adopt and leverage IT solutions in budget-constrained settings, where it is crucial to address important and pressing challenges and opportunities for achieving effectiveness in IT adoption.
  
  
  OBJECTIVE
  (1) Explore HHAs' challenges and opportunities related to delivering home care as well as performing administrative functions and conducting business, (2) learn about current IT implementation levels and activities in home care, and (3) make recommendations to facilitate efforts and initiatives designed for adopting IT in home care effectively.
  
  
  METHODS
  Semistructured interviews were conducted to elicit rich contextual information from the participants recruited from 13 local HHAs in one of the states in the United States. Established systems analysis techniques were used to ask questions during the interviews. Framework, a qualitative research method, was used to analyze the qualitative data obtained from the interviews.
  
  
  RESULTS
  Coordinating clinical and administrative workflows was an important challenge. Inadequate access to patients' medical history and difficulties with medication reconciliation detracted from the quality of care. Hiring, training, scheduling, and retaining qualified personnel constituted another important challenge. Training and educating patients, caregivers, and families hold important opportunities for improving the quality of care. All except one HHA adopted electronic health records (EHR) but many continued to struggle considerably in their day-to-day functions. Health information exchange (HIE) seems to be the most needed technology. Telehealth solutions were perceived to be promising but their added value and financial viability in the long run were questioned.
  
  
  CONCLUSIONS
  The recommendations for effective IT adoption include keeping a quality improvement focus, keeping a holistic organizational perspective, considering potential information exchange problems, addressing education and training needs, experimentation with telehealth if resources permit, considering organization size, and reducing lengthy procedures and excessive documentation requirements. The relevant stakeholders, such as home care professionals, IT vendors, and policy makers, should consider the recommendations from this study to facilitate success in future IT efforts and initiatives in home care.
authors.affiliation: Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD. Electronic address: gkoru@umbc.edu.
authors.forename: Güneş
authors.initials: G
authors.lastname: Koru
authors.affiliation: Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD.
authors.forename: Dari
authors.initials: D
authors.lastname: Alhuwail
authors.affiliation: Department of General and Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Topaz
authors.affiliation: Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Norcio
authors.affiliation: Department of Partnerships, Professional Education, & Practice, School of Nursing, University of Maryland, Baltimore, MD.
authors.forename: Mary Etta
authors.initials: ME
authors.lastname: Mills
mesh_terms: D001292:Attitude to Computers; D016494:Computer Security; D003219:Confidentiality; D004059:Diffusion of Innovation; D057286:Electronic Health Records; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008490:Medical Informatics / Q000193:education; D020380:Needs Assessment; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D017216:Telemedicine; D014481:United States
keywords: Home care agencies; health information technology; home care quality; home care workflows