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Home care IT is one of the orphans of meaningful use, a branch of healthcare that has not received much federal attention and has been afflicted by serious interoperability problems.
Now Micky Tripathi, founding president and CEO of the Massachusetts eHealth Collaborative (MAeHC), is looking to boost home care IT in the nonprofit consulting group's home state, starting with a survey of home health organizations. Similar to long-term care and behavioral health, home care has not been eligible for meaningful use incentive payments.
Partly as a result, many home healthcare agencies have little, inadequate or not fully functional IT infrastructure making patient transfers and access to patient health records trickier than they need to be in an age of widespread EHR adoption.
Tripathi says home care needs IT
Micky Tripathifounding president and CEO of the Massachusetts eHealth Collaborative (MAeHC)
"A lot of [home care providers] have been left out of meaningful use. That doesn't mean they can stand still. They can't," Tripathi, who is closely associated with an international health IT interoperability initiative called the Argonaut Project, which MAeHC is oversees, said.
Tripathi and his MAeHC team are working on behalf of the Home Care Alliance (HCA) of Massachusetts and home healthcare providers that are not members of the trade group on a survey of providers' IT gaps, according to Brittney Darner, a spokeswoman for MAeHC.
The $50,000 home IT project is partially publicly funded with $10,000 from the Massachusetts eHealth Institute, the state health IT agency, with the state portion going to expand the scope of the survey MAeHC is conducting to include non-HCA providers, Darner said.
Identifying home care IT gaps
The home care survey is designed to show where providers are on a four-tier ranking of IT preparedness and establish a roadmap for how each organization can improve.
The tiers are:
- The organization may have an electronic-record-keeping system or some kind of EHR, but the system is rudimentary.
- The organization may have some kind of documentation technology, but it interfaces only a little or not at all with other providers or with patients.
- The organization may have a federally certified EHR, such as one from a major vendor, but the provider is only using it to manage and document home care data and not taking advantage of interoperability features.
- The organization is fully implementing its EHR and using it to exchange information with other organizations.
While early survey returns show most home health providers are using some sort of electronic technology, there are still many IT gaps at most agencies, Tripathi said.
Bridging the gaps
Once the survey of 200-plus home care providers is done, MAeHC will perform a gap analysis for each organization to identify at what points it needs help.
The main strategy to bridge those gaps will probably be the same for most home care agencies: connect them to the Massachusetts health information exchange, Tripathi said.
How they connect could be via several health information exchange tools, such as HL7, Direct messaging and possibly even Fast Health Information Resources (FHIR) -- a new health IT exchange standard still in development by the Argonaut Project and Health Level Seven International. However, Tripathi cautioned that widespread use of FHIR likely is still several years away.
Improving interoperability in home care
Home care providers could also have gaps in staff expertise, Internet connectivity and ability to finance IT upgrades, Tripathi said.
Another common problem is that providers may only be using CMS' outcome measurement program of Medicare eligibility for home healthcare agencies, which can't be exchanged easily.
They also may not be able to create or exchange CCDAs, the Consolidated Clinical Document Architecture documents developed by HL7 International for health data exchange in meaningful use-certified EHRs.
Tripathi said MAeHC could help agencies develop CCDA-like patient records that could be more easily transferred to or be received from other healthcare providers.
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