Mobile documentation challenges persist in home health

The mobile documentation gap

Point-of-care documentation is considered a standard of care for maintaining accurate clinical data. "We encourage documentation in the home as much as they can," said Joe Zazworskey, division director of clinical practice and leadership for home health at Bayada.

Home visits can involve complex assessments with numerous clinical data points. Zazworskey described a typical physical therapy session: "We take composite measurements on how people move. How are they turning? How are they sitting to stand? How are they walking, et cetera? It's a lot of data to gather, and those movements are then graded so we can see functional improvement over time."

With that level of detail, he said, capturing data in real time is vital. "To write it all down and to accurately transcribe it eight hours later after you've seen six, seven people and driven miles and miles in your day, it's not nearly as valid."

Despite widespread EHR adoption in home health, not all agencies have mobile documentation capabilities. A study of health IT adoption at more than 1,500 home healthcare agencies found that 19% provided no mobile devices to clinicians. Without them, staff often resort to paper charting or rely on memory to document patient care.

At Visiting Angels in Billings, Montana, intake documentation remains fragmented. Director Heidi Jones said the agency uses a hybrid workflow, with some data stored on paper and some in the EHR.

"Eventually we would like to get to that point," she said, referring to a fully electronic mobile workflow. "We have Medicaid certifications and don't have those forms [electronically] yet."

Barriers to a fully mobile solution

Agencies face other obstacles to implementing fully mobile documentation systems, including workflow redesign, staff training and limited support for e-signature capture.

"I miss paper," Jones said. "It's hard switching over and getting used to it when you're so used to paper. I like to have a paper file. We would print it off and have them sign [the intake form] anyway."

Even for agencies with full mobile documentation capabilities, inconsistent internet access in rural areas poses a challenge.

"That's one of the biggest challenges," said Tim Ingram, executive vice president of interoperability at Axxess. "You don't have Wi-Fi access, so you're kind of stuck. If you think about the number of patients in rural areas… that's also extremely important."

In the United States, about 66 million people live in rural areas, according to the U.S. Census Bureau. Rural residents often have less access to hospital-based services — making them more dependent on home health services. But broadband access remains uneven. The U.S. Department of Agriculture reports that 22% of rural Americans and nearly 28% of those in tribal areas still lack access to high-speed internet.

"Connectivity can be an issue," said Zazworskey. "If we were able to get them a 4G network, have a fast-moving device and do it in the home every single time, the data would be the most accurate."

Closing the gap

Some health IT vendors have introduced mobile documentation tools that allow clinicians to work offline and sync to the EHR when internet access returns. Ingram said this functionality helps address real-world conditions. "Not only can they document on the mobile device, they can do so disconnected," he said. Cost is another barrier. Unlike hospitals and physician offices, home health agencies have not received substantial federal incentives to digitize. Still, Zazworskey said real-time documentation supports Bayada's participation in value-based care programs.

"EHRs in general enable our value-based purchasing metrics across the board. In fact, I can't fathom submitting all that data to Medicare without an EHR," he said. "It's toward quality and toward clinician and patient experience that we're willing to invest in this."

Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.