Integrating home health care into medical records
Electronic communications maximize benefits
By Ralph A. Korpman, MDChief Health Care Scientist
Medaphis Corp. and Per-Se Technologies
Atlanta
Historically, home health care has been carried out by independent organizations that provided limited-scope services in a home-only setting. But as capitation takes hold throughout the country, it is becoming clear for health care providers, payers, and patients, that home care is often the most beneficial way of providing major portions of patient care.
A central challenge remains — how to seamlessly integrate a growing number of roaming home care workers into the enterprise’s core information processing system. In order to integrate home health care personnel into a contemporary information technology environment, you must address minimum requirements related to electronic communication: a venue-transparent electronic patient record, real time communication, best practices support, integration of personnel, and mobile computing.
The current and historical patient’s record must be available on-line at the patient’s home for use by the home care worker. In the past, written notes such as "Check the patient’s toes," were passed on to the home care nurse. This kind of instruction seems straightforward enough until you recall how complex most patients’ situations are. For example, what if a patient also is being treated for an arrhythmia and the home care worker fails to check his heart medication because his referral notes only pertain to the patient’s toes?
In the emerging health care delivery system, the home care provider may be the primary interface between the patient and your health care system. The caregiver thus needs to know far more about the patient than merely procedural instructions. The caregiver should know what medications the patient is taking, what appointments are coming up (and whether arrangements have been made to get the patient to those appointments) and, because health is so intrinsically related to environment, some information about the patient’s socioeconomic status — lives alone; niece visits twice a month. Accordingly, the home care provider needs access to a comprehensive electronic patient record. Anything short of this informational requirement means that the caregiver is likely to make inefficient, ineffective visits, during which he or she may be delivering less than good care.
Real-time communication
The need for movement and updating of patient information works both ways. The notations that the home health care worker makes at the patient’s home must immediately be fed back to other caregivers. There should be only one record for a patient, incorporating inpatient, outpatient, and home care notes in an integrated fashion.If a patient arrives at the emergency department in an ambulance, and the chief complaint is that she is lightheaded, emergency department doctors need to know that the home care worker gave the patient a new drug (or a new dose) this morning. When caring for capitated patients, one cannot rely on the old way of doing things, which typically depends on the home care provider’s clinical notes, which are often typed up a week after the visit and forwarded to medical records staff for filing. The old, mostly manual system is fraught with potential gaps and problems that a properly designed, venue-transparent electronic record corrects. To provide patient care, not venue care, all observations from home care providers must be integrated in real time into the patient’s electronic medical record.
An electronic communication system should integrate home care personnel seamlessly into the health care delivery system. The system should provide operational support for the caregiver, who may not know certain things about the patient that could affect his or her health. After all, the caregiver may never have seen the patient before and may never see him or her again, but that caregiver’s visit may represent the patient’s only interaction with the health care system for an extended period.
An electronic work optimization tool should be integrated into the medical record to present the caregiver with a list of things he or she should be looking for during the visit based not only on the home care order but also on clinical information and observations of the patient by any member of the caregiving team.
Mobile computing
A key technology component of delivering good home care is a real-time interactive mobile computing device. The caregiver should not visit the patient and then have a lag time until clinical information is entered into the system. This off-line approach causes a loss of much of the potential advantage of providing home care in a venue-transparent environment. The mobile device must be able to give the home care giver access to the patient’s records and to support real-time integration with best practices and operational support during the home care visit. For example, notebook computers running over cellular networks can allow the same access to patient records from any patient’s home as would be available if the caregiver were accessing the information from within an inpatient facility[Dr. Korpman is founder, chairman, and chief executive officer of Health Data Sciences Corporation, now part of Per-Se Technologies. He is a certified physician executive, a Distinguished Fellow of the American College of Physician Executives, and a professor at Loma Linda (CA) University School of Medicine.]
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