Home Health, Hospice Lack Data Sharing Standards

Patient data often lives in silos, making it difficult for home care and hospice providers to coordinate care, a new report has found.

The 2018 State of Connectivity report, commissioned by the National Association for Home Care & Hospice (NAHC) and sponsored by post-acute technology provider Forcura, surveyed industry executives and experts about the barriers they face in data sharing and interoperability. Data challenges still exist in the home health and hospice spaces, despite the Meaningful Use and the Health Information Technology for Economic and Clinical Health Act (HITECH).

Interoperability refers to technology that enables the secure exchange of electronic health information, allowing for the complete access and exchange of data for authorized users.


Washington, D.C.-based NAHC is a nonprofit organization that represents 33,000 home care and hospice organizations.

Meaningful Use, the electronic health record incentive program, was renamed Promoting Interoperability in April by the Centers for Medicare & Medicaid Services (CMS). HITECH was enacted as part of the American Recovery and Reinvestment Act of 2009. It promotes the adoption and use of health information technology.

The biggest barrier to electronic data exchange is the large number of referral sources providers are receiving patients from, as many referral sources have different communication systems, according to the report, released Monday.


Agencies work with an average of 396 referral sources, but the larger the organizations, the more referral sources they have. Additionally, even as businesses across the globe shift to digital and connected methods, over 50% of referrals are still received by manual methods in home health and hospice care — 24% by phone and 27% by fax.

Manual processes are typically time consuming and tedious. Similarly, they commonly lead to mistakes due to human error or other factors.

Even something as simple as transposing the wrong number on a patient address or telephone number can be a big problem, Rachel Manchester, chief nurse and director of clinical quality for home health for Providence Home and Community Care, said as part of the report. Automation could eliminate those mistakes, she said.

Exchanging patient care information is typically done manually, either by fax (about 76% of the time) or hand delivered (about 53% of the time), according to report.

“Electronic messaging is in play, but physicians apparently do not like having to go into multiple portals when [they] use different vendors,”NAHC President William A. Dombi said in the report. “Interoperability would help a lot.”

The Office of the National Coordinator for Health Information Technology (ONC) is making strides in terms of interoperability.

In January, ONC released a draft of its Trusted Exchange Framework — which would create a trusted nationwide network and a set of principles for exchange. The final proposal should be released before 2019.

While government interventions are helpful, some industry leaders agree that technology vendors should lead the charge.

“The government is driving conversations around the common standards, but its going to be companies like ours that will have to drive home and adopt the standards,” Craig Mandeville, founder and CEO of Jacksonville, Florida-based Forcura, said in the report. “We have to help providers using technology to absorb information in a consistent manner.”

Cost of services was another barrier identified in the report.

In fact, some agencies may face project costs of up to $15,000 per integration project, not including yearly maintenance fees, Joan Williams, director of health information management at Lower Cape Fear Hospice, said in the report.

More than 200 U.S.-based respondent participated in the survey. Nearly all of the responses came from home health care and hospice professionals. Roughly one-third of all respondents were either CEOs or presidents at their organizations.

Written by Kaitlyn Mattson

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