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How home health agencies can address the interoperability gap
Home health agencies report being held back in interoperability, building workarounds to keep up while they evaluate solutions.
While most home health agencies have adopted EHRs, true interoperability remains out of reach for many providers. As of December 2023 nearly 80% of Medicare-certified home health agencies used an EHR, but only 28% were electronically exchanging information with outside providers at the point of care and just 18% could integrate that shared data into their clinical workflows.
Data exchange is a critical need in home health
At Bayada Home Health, internal data sharing and a portal for referring partners has significantly improved care coordination.
"Sometimes we go in expecting one thing, but through documentation and team communication, we realize a patient needs something else -- a hospice referral, a social worker or daily wound care," said Joe Zazworskey, home health division director of clinical practice and leadership at Bayada.
"If our nurse calls and says, 'I can't get this blood pressure managed,' the [referring] physician can read the notes and make a decision in real time," Zazworskey adds.
But while Bayada has portal-based data sharing, broader interoperability remains a challenge.
"Older, more established EHRs have challenges moving quickly in the interoperability space," said Laura Kreiser, the home health agency's director of product management. "Without a migration to a newer platform, we're being held back in our ability to integrate both internal and external systems."
Why interoperability is hard to achieve in home health
In home health, the need for flexibility has also led to fragmentation. "Home health workflows are mobile, decentralized and often rely on paper or legacy systems -- making interoperability uniquely challenging," said Suhas Uliyar, senior vice president of product management at Oracle Health.
Compounding the issue is a regulatory gap. Unlike hospitals, home health has few federally mandated interoperability standards and incentives. Platforms may have only been designed to meet varying state-level Medicaid requirements for electronic visit verification documentation, resulting in a patchwork of formats.
"There was no financial incentive for competitors in home health to work together to come up with standard language or a format for information to be shared," said Tim Ingram, executive vice president of interoperability at Axxess, a cloud-based home health EHR provider.
Ingram experienced this fragmentation firsthand when his mother transitioned between hospice providers to be at home for end-of-life care. "She had to sit through a two-and-a-half-hour intake -- all to repeat information the first provider already had," he said.
The next steps for home health agencies
For organizations like Bayada, waiting on vendors to modernize isn't an option. "We would prefer to rely on our EHR vendor, but we're standing up internal solutions just to keep moving forward," Kreiser said. "Organizations of our scale may be forced to migrate in order to bring us up to speed with this century's technology."
To expand interoperability, home health agencies should begin by assessing their current EHR data exchange capabilities and their vendor's planned upgrades.
Next, mapping current workflows can help identify inefficiencies that open data exchange could solve, including continued reliance on fax, phone or duplicate data entry. "The goal is that, regardless of where you're receiving care, your provider has access to the information they need -- without having to ask the same questions over and over," said Ingram. "We're building tools like Axxess Exchange to make interoperability easier, faster and more scalable."
If migrating makes sense, look for a platform that supports FHIR, C-CDA and direct messaging, and can plug into national frameworks like CommonWell, Carequality and the Trusted Exchange Framework and Common Agreement. "We support home health integration through standards-based exchange and deep connectivity with HIEs and QHINs," says Uliyar.
TEFCA and the future of home health interoperability
While TEFCA participation isn't mandatory, experts predict it will become the industry standard, while highlighting the benefits. "We expect TEFCA to be a game-changer for home health…empowering caregivers with timely hospital discharge data, medication histories and care plan updates," says Uliyar.
Ingram agrees that streamlining data exchange through TEFCA could resolve many of today's inefficiencies. "Every week we get a connection request and each one needs to be individually evaluated. It's incredibly inefficient. With TEFCA, we can skip ahead to a future where everyone is connected."
Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.
