HCS 483 Week 1 Introduction to Health Care Information and Technology Example

A Nurse's Tablet, a Visit Log and a Hospital Discharge Summary: Mapping the Information Systems of a Mid-Sized Home Health Agency

[Student Name]

University of Phoenix

HCS/483: Health Care Information Systems

Week 1 Assignment

[Instructor Name]

[Date]

The agency, its systems and its figures are composites written for a model paper; federal requirements come from the sources listed.

At 7:40 on a Tuesday morning, a home health nurse sits in her car outside a patient's house and opens her tablet. She reviews the patient's medication list, the orders from the physician and a hospital discharge summary that arrived the night before. During the visit she records vital signs, wound measurements and teaching in the agency's electronic record. When she leaves, her visit time is logged automatically, and by evening the visit is on its way to becoming a claim. Behind that routine sit several information systems. This paper maps the systems of a composite home health agency with about 140 staff and 900 active patients and considers what they do well and poorly.

Referral Intake and Hospital Records

Most new patients arrive after a hospital stay. Referrals come by fax, by a hospital's referral portal or occasionally through the regional health information exchange. The intake coordinator enters demographics, insurance and orders into the agency's system and attaches the discharge summary. Because hospitals and the agency use different vendors, much of this information is retyped by hand. That duplication is the first and largest weak point in the agency's information flow.

The Point-of-Care Electronic Health Record

Clinicians document on tablets using the agency's home health electronic record, which is designed for work in homes rather than in a hospital. It holds the plan of care, visit notes, medication lists, wound photos and communication with physicians. It can work offline and synchronize later, which matters in rural areas with poor cellular coverage. Physicians sign orders through a web portal, although some still prefer fax.

The Federally Required Assessment Data

Medicare-certified home health agencies must complete the standardized patient assessment known as OASIS, which records the patient's condition and function, at the start of care and at defined points afterward. The data are built into the electronic record and transmitted to the federal Medicare agency, where they feed payment and for publicly reported quality measures. Because the same assessment answers drive both payment and the agency's public star ratings, the accuracy of what a nurse enters on a tablet in a patient's kitchen has direct financial and reputational consequences.

Electronic Visit Verification

The agency also provides Medicaid-funded personal care, such as help with bathing and dressing. The 21st Century Cures Act requires states to use electronic visit verification for these services, recording the type of service, the person receiving it, the date, the location, the worker and the times the visit began and ended (Centers for Medicare and Medicaid Services, n.d.). Aides check in and out on a smartphone application that captures location. The system reduces billing for visits that did not happen, but aides report frustration when a patient lives where the phone cannot find a signal, and visits then require manual correction.

Scheduling and Billing

A separate scheduling system matches clinicians to visits by location, skill and patient preference. A billing module turns completed visits and assessments into claims to Medicare, Medicaid and private insurers. Payment for Medicare home health depends on patient characteristics drawn from the assessment and diagnosis codes, so errors in either system can reduce payment.

Benefits and Drawbacks

Menachemi and Collum (2011) reviewed the benefits and drawbacks of electronic health record systems. Benefits included better access to information, fewer errors from illegible writing, improved communication and support for quality measurement and billing. Drawbacks included high start-up and maintenance costs, workflow disruption during implementation, privacy and security risks and the time burden of documentation. The agency's experience matches both lists. Legible, shared records and automated claims help. Tablets and software licenses are expensive, and nurses report spending up to two hours a day on documentation, often after visits end.

A Setting Left Behind

Hospitals and physicians received large federal incentives to adopt electronic records under the HITECH Act, and adoption among eligible hospitals accelerated sharply after the program began (Adler-Milstein & Jha, 2017). Home health agencies were not eligible for those incentives. As a result, many adopted systems later and with fewer standards for sharing data, which helps explain why the agency still receives so many referrals by fax.

Security in the Field

Home health carries security risks that a hospital does not. Tablets and phones travel in cars and sit on kitchen tables, so a lost device could expose patient records. The agency encrypts every device, requires a passcode and can wipe a device remotely, and the electronic record times out after a few minutes of inactivity. Staff are trained not to discuss patients within earshot of neighbors or to photograph wounds on personal phones. These safeguards follow the HIPAA Security Rule's requirements for protecting electronic health information, applied to a workplace that has no walls.

Data the Agency Could Use Better

The systems hold more information than the agency uses. Assessment data could show which patients are most likely to be readmitted to the hospital, and visit logs could show which clinicians spend the most time traveling. Linking the two could guide scheduling and early outreach. The agency's quality manager currently exports spreadsheets by hand once a quarter; a simple reporting dashboard would turn stored data into weekly decisions.

Gaps a Manager Would Fix First

Three gaps stand out. First, faxed and retyped referrals create delays and transcription errors; joining the regional health information exchange and requesting electronic discharge summaries from the two largest referring hospitals would address most of the volume. Second, double entry between the visit verification application and the electronic record wastes aide time; the vendor offers an integration the agency has not bought. Third, rural connectivity limits both systems; offline-capable devices and signal boosters for aides in the two most remote counties would reduce manual corrections.

Conclusion

A home health agency runs on a web of information systems: intake, a point-of-care record, a federal assessment data set, electronic visit verification, scheduling and billing. Each serves a purpose, and each connection between them is a place where data can be delayed, duplicated or lost. Seeing the whole map is the first step toward managing it.

References

Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. Health Affairs, 36(8), 1416-1422. https://doi.org/10.1377/hlthaff.2016.1651

Centers for Medicare and Medicaid Services. (n.d.). Electronic visit verification (EVV). Medicaid.gov. https://www.medicaid.gov/medicaid/home-community-based-services/guidance/electronic-visit-verification-evv/index.html

Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, 4, 47-55. https://doi.org/10.2147/RMHP.S12985