Ever since the pandemic began, there has been increased emphasis on providing care in the home setting, and that has in turn put more focus on the electronic health record systems for those providing home care. KLAS Research has just published its second annual report on the shifts in that market, and Paul Hess, KLAS senior director of research, and one of the report’s co-authors, recently spoke with Healthcare Innovation about its findings.
HCI: What are some of the ways that the EHR market for home health providers is different from the market for office-based providers? Are there features that are more important to those users?
Hess: In home health, the workflow is unique in that the nurses are going into the home. They're out and about; they're driving their vehicle to different locations, caring for patients, and then they're on to the next house. The EHRs in the home health space have to accommodate that type of workflow. There is also a strong administrative view, so the administrators or owners back at the agency can see what's going on in terms of how things are being documented.
HCI: Does that mean it has to work in a mobile situation like on an iPad or something as well? It can't just be on a desktop system.
Hess: That's right. Most vendors have adopted an iPad or Android tablet of some sort. Laptops are also used but it's more mobile than you would typically find in a hospital.
HCI: When you talk to the customers in this space, do they have a wish list of things they would like to see improvements on from all the EHR vendors?
Hess: One big challenge that has nothing to do with EHR is staffing. Staffing in general in healthcare is pretty rough, but especially in post-acute home health or skilled nursing facilities. We're doing a related report that's about to be published that highlights what the biggest staffing challenges are and how providers are hoping to alleviate those. They're hoping that the EHR can help them document more efficiently, so they can do more with less staff, perhaps. Also, there are ongoing regulatory changes that require more complex documentation or at least different documentation than what agencies have been used to. To the degree that EHRs can help support that and keep up with all of those requirements and changes, that would be something else that is a common theme across the vendors.
HCI: Does your report identify differences between independent agencies and ones that are connected to a larger health system as far as how that would impact their decision-making?
Hess: Yes, definitely. There are big differences there. Health system-owned agencies are about 15 to 20 percent of the market. Those agencies oftentimes will look to their hospital EHR vendor, and if they offer a home health solution, they'll look at that and at some point switch over to that from more specific home health vendors. Epic is really large in the health system space, especially with the large health systems. A lot of agencies that are owned by health systems that run Epic, will eventually switch over. The big reason for that is because it integrates. There's not a need to enter the patient information twice.
HCI: If a home health agency is running some other EHR product, and the area health systems are on Epic, how are they exchanging data about the patient's health? Is it cumbersome today?
Hess: Honestly, the way they've been doing it for years is with a lot of faxes. There are some referral management solutions that help with referral handoff. It's less specific on the patient information being handed over and more just tracking where the patient goes from one point to the other. We're doing more work to highlight those intricate workflows and what vendors are doing to help support that and hopefully get to a place where there is an idea of this portable patient record — that no matter where the patient goes, the patient record can just flow with them, but we're a long way from that.
HCI: Do you also see differences in EHR decision making between large and small home health agencies?
Hess: An agency that has an average daily census of more than 1,500 is considered large in our report, and Homecare Homebase is really well represented there. They are very dominant in that space. They're seen as the vendor of choice if you're a large home health agency, and that's been the true for a long time. They have taken even more market share as some of the other home health vendors have been acquired. Homecare Homebase has taken over one by one these large agencies that were running something else like McKesson or Change Healthcare’s EHR, which was acquired by Netsmart. Those agencies are complex. They typically span several states. There are different regulatory requirements, documentation requirements, billing requirements from state to state if they're doing Medicaid, so it really does need robust reporting and financial functionality, which Homecare Homebase has.
HCI: What about among the smaller home health agencies?
Hess: The vendors that have been successful in that space offer solutions that have an interface that is really easy to use. The documentation is clean. You can implement it very quickly in the cloud and it is just quick and nimble, and doesn't take a lot of training. That's where we've seen WellSky do well.
HCI: What about other large EHR vendors besides Epic? For instance, does Cerner have a home health solution?
Hess: Cerner used to have a home health and hospice solution, but they decided to pivot and formed a relationship with MatrixCare and helped migrate their home health customers over to MatrixCare for their home health EHR. So Cerner is no longer in the business. Allscripts sold theirs off. Besides Epic, the only one that's left that operates in the hospital space is Meditech, which does have a home health and hospice solution that they acquired years ago.
HCI: We've been writing a lot about the roll-out of acute hospital at home programs, and we've seen vendors pop up in that space, and we've seen some of the health systems spin out their own companies to compete in that space. Is that market very different from what we’ve been talking about?
Hess: It's different, but there are some similarities, right? The actual workflow of clinicians going into the home is very much the same. There is going to be a higher need for remote patient monitoring, and having monitors that feed information back in real time, so they know how patients are doing at any point in time, regardless of whether there's a clinician there or not. There are several differences. There are some vendors that are focused on that specifically, but it’s still really early. The concept of home health is increasing and I think will only continue to increase. It's a less expensive option for care when compared to expensive hospital settings. If you can do the same thing in someone's home and have the benefits of being surrounded by family in a familiar environment, that helps with care as well. With the Baby Boomers retiring, we need to be a little more creative and think outside the box in terms of how we can care for that population.