The National Center for Health Statistics (NCHS) Data Brief No. 45 for September 2010 entitled "Electronic Medical Record Adoption and Use in Home Health and Hospice" by Anita Bercovitz, Manisha Sengupta, and Patricia Jamison provides a baseline for Electronic Medical Record (EMR). This is significant, as this information will be the "before" snapshot prior to the American Recovery and Reinvestment Act (ARRA), which included financial incentives for meaningful users of EHRs.
Some of the key findings using data from the National Home and Hospice Care Survey, 2007, were:
* "In 2007, about 5,900 of the 14,500 providers of home health or hospice care (41%) had electronic medical records (EMRs), and an additional 2,200 (15%) planned to have EMRs within the next year. Providers who offered both hospice and home health care were more likely to have EMRs than providers offering only home health care, but did not differ from providers of hospice care only" (Bercovitz et al., 2010).
* "Among providers with EMRs, 98% used components for recording patient demographics and 83% for clinical notes, and over one-half used clinical decision support systems or computerized physician order entry" (Bercovitz et al., 2010).
* "Nonprofit and government providers, providers jointly owned or operated with other health care organizations, and providers with over 150 patients were more likely to have EMRs" (Bercovitz et al., 2010).
Readers are encouraged to access and review the entire 7-page brief by visiting http://www.cdc.gov/nchs/data/databriefs/db45.pdf.
Independence at Home: A year from now, January 2012, begins a part of healthcare reform (HCR) called "Independence at Home Chronic Care Coordination Pilot Project." This pilot is directed toward high-cost Medicare beneficiaries with multiple chronic conditions. The following is from the "Independence at Home Demonstration Fact Sheet":
The Independence at Home (IAH) Demonstration, authorized by Section 3024 of the Affordable Care Act, will test a service delivery model that utilizes physician and nurse practitioner directed primary care teams to provide services to certain Medicare beneficiaries in their homes. Participating practices will be accountable for providing comprehensive, coordinated, continuous, and accessible care to high-need populations at home and coordinate health care across all treatment settings. Participating practices may share in any savings under the demonstration program if specified quality measures and savings targets are achieved.
Demonstration Design
The legislation mandates that the participating practices form a legal entity that has experience in providing home-based primary care services to clinically ill high cost Medicare beneficiaries. According to the Affordable Care Act, the IAH participating practice will report on quality measures to monitor and evaluate the demonstration, utilize electronic health systems, and accept other criteria as determined appropriate by the Centers for Medicare & Medicaid Services (CMS).
The demonstration will define an applicable beneficiary as an individual who has been determined to be entitled to benefits under part A and enrolled under part B, not enrolled in a Medicare Advantage plan or the Program of All-inclusive Care for the Elderly, must have two or more chronic illnesses as designated by CMS, must have a non-elective hospital admission within the past 12 months, must have two or more functional dependencies requiring the assistance of another person, and must meet other criteria as specified by the legislation. This demonstration, currently under development, is slated to begin January 1, 2012, and will run for 3 years (Centers for Medicare and Medicaid Services [CMS], 2010).
This January issue of Home Healthcare Nurse features the following articles that address safety aspects of home health and hospice. "10 Organizational Characteristics That May Prevent Falls in Home Healthcare and Hospice" explores agency organizational cultural contributions in the prevention and management of falls. Wound care management can be complex and costly for patients and caregivers. In the "Role of the Wound Ostomy Continence Nurse in the Home Care Setting: A Patient Case Study," the author makes the case that as the clinical and operational challenges in home care services become more acute, quality and safety remain important goals. Because wounds comprise over a third of all care in home care, specialized nurses can provide the expertise to promote quality care. "An Anticoagulation Safety Program in Home Care" addresses the complexity of the growing patient population of older adults on oral anticoagulation therapy. This organization initiated a specialized educational program for nurses and therapists related to this medication therapy and associated safety implications.
Regulatory oversight and changes seem to be unending. Charlene Ross, in "QAPI- How Do You Measure Up? Preparing for Public Reporting in Hospice: An Overview for Success," explains the requirements as well as the practical and operational aspects to guide managers and clinicians on the road to QAPI success. Andy Carter, President of the Visiting Nurses Association of American (VNAA), eloquently describes the nuances of an idea in proposed regulation and the "real-world" operational aspects of such an idea in his column, VNAA's Voice, in "Home Health Clinicians Play a Vital Role Educating Policymakers." Andy makes the case that we use our knowledge to educate and avoid unforeseen or unanticipated problems.
This New Year will be like none other in home healthcare and hospice. I thank you for thinking of Home Healthcare Nurse as your interdisciplinary journal and welcome your feedback and ideas for articles you would like to see addressed. I can be reached at [email protected].
Tina M. Marrelli
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