Coronavirus Pouring Gasoline on Interoperability Fire for Home Health Providers

Historically, home health providers and their partners throughout the continuum of care have struggled with interoperability. But during the COVID-19 public health emergency, it’s more crucial than ever to have timely and accurate information, industry insiders say.

Broadly, interoperability is the capability of different information systems to connect across organizations in order to exchange individual or population health data. 

Home health agencies — the providers increasingly on the front lines of the coronavirus — have largely gained a reputation for being archaic when it comes to their interoperability efforts. Many have made significant strides in recent years, though hospital interoperability has, at times, remained a pain point, according to Scott Pattillo, chief strategy officer at Homecare Homebase (HCHB).

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“We’ve seen home health providers shine when it comes to interoperability when extending their electronic medical record (EMR) capabilities,” Pattillo told Home Health Care News. “Where we’ve seen home health struggle is in interoperability with the individual hospital systems.”

Dallas-based HCHB provides cloud-based software solutions for home health and hospice providers. Overall, HCHB’s clients visit 90 million patients annually, making the company a national expert in interoperability discussions.

When it comes to receiving referrals, in particular, many home health providers still rely on outdated processes such as fax machines and phone calls.

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In fact, 36% of home health and hospice organizations use fax machines to obtain referrals, with another 20% using phone calls as their main source of referral receipts. Only 4% use an EMR system, according to one recent industry report

A main reason more home health providers haven’t invested in interoperability is it’s often harder to quantify or see the true value in dollars and cents.

Providers often have trouble recognizing the potential value versus the sometimes high costs associated with interoperability, Bud Langham, chief strategy and innovation officer at Encompass Health Corporation (NYSE: EHC), told HHCN.

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“It’s difficult to sometimes ascribe value to it in a tangible way,” Langham said.

Another challenge is all of the disparate platforms providers are required to engage with, according to Langham.

“In any particular market, you may need to be integrated with a half dozen EMRs and multiple [electronic health information exchanges] that all talk to each other differently,” he said. “It’s not simple to aggregate that information into one repository where everyone accesses, shares and utilizes that information effectively.”

Even when providers are utilizing EMR systems, oftentimes it still requires the attention of hospital IT staff, according to Pattillo.

“With home health being significantly smaller than other venues of care, [providers] can struggle to get the attention of hospital IT staff on those projects,” he said. “We’ve seen larger providers have success, but the smaller ones have a harder time getting the attention of the big hospitals.”

For home health providers that already face challenges when it comes to interoperability, the COVID-19 emergency is only exacerbating the issue. More than ever, patients are flowing in and out of hospitals, with hospitals looking to quickly discharge individuals back home whenever possible to alleviate capacity.

“COVID-19 is only going to pour gasoline on the fire, as far as the distraction of the hospital IT groups,” Pattillo said. “When you are talking about integration with those groups, they are extremely busy at the moment. I know a number of the CIOs from the hospital systems are on multiple calls every day just dealing with COVID-19-specific challenges.”

On the flip side, it’s never been more important to be able to communicate clinically about a patient, according to Pattillo.

“[COVID-19] has actually spurred conversations that weren’t taking place before, about the importance of needing to understand clinical information about a patient more holistically,” he said.

For example, it’s important to know which patients have been exposed to the virus, which ones have been infected and which ones are at risk. More information allows for effective care plans.

“It’s critical to have timely information because of the level of anxiety, angst and concern surrounding providing care for patients in an environment where this virus is putting everyone at risk,” Langham said. “I need to know if my patients have signs or symptoms consistent with COVID-19, or diagnosis or test results. Every minute that goes by that we don’t know puts other people in harm’s way.”

Having to wait for weeks instead of days for results creates a domino effect of consequences, according to Langham

“It puts a strain on supplies, in a time when we can’t really afford any extra strain,” he said. “Not having timely information means we would use supplies unnecessarily.”

During the COVID-19 emergency, Langham stresses the importance of providers being able to articulate the value of interoperability to physicians, partners and referral sources.

“If we can’t explain the ’why’ behind doing something other than sending a fax, then we are in trouble,” he said. “Be able to articulate that value in terms of timeliness and translate that into patient outcomes and safety.

In a new report released last week, researchers from the Duke-Margolis Center for Health Policy outlined a three-part strategy for how to improve data interoperability to better tackle the COVID-19 virus. Essentially, the 21-page report argued that the U.S. health care system and its stakeholders need to focus on better using existing infrastructure to encourage interoperability.

Ultimately, the success of COVID-19 containment as the United States reopens will depend on the timely sharing of key information related to testing, contact tracing, and detecting and acting on new outbreaks, the report states.

“Containment strategies across the country depend on effective collaboration of public health authorities with health care providers, laboratories, and community-based organizations to conduct testing, support effective contact tracing, quickly discern new patterns in health care use plausibly related to COVID-19, and identify ways to improve all of these activities over time,” researchers wrote. “But public health, health care, and testing organizations have never had to work together with the scale or urgency required for COVID-19 containment.”

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