Home Care Interoperability Partnerships Drive Continuity of Care
The Pennant Group Inc., a holding company for more than 120 home health and hospice agencies as well as more than 50 senior living communities, has developed tech interoperability partnerships with acute-care health systems such as Scripps Health, John Muir Health and Hartford Healthcare. Pennant CIO Bryant Saxon recently spoke with Healthcare Innovation about creating integrations between acute and home health and hospice systems to drive continuity of care.
Healthcare Innovation: Do you try to unify the technology platform across all your home health and hospice agencies or are they using a lot of different solutions at each one?
Saxon: It's a mix of both. We are always striving toward standardization, but we also pride ourselves on having petri dishes where we explore different technologies. A unique part of our operating model is tied to our culture of local decision-making, so I feel like it's my job in a centralized innovation team to keep the petri dishes going, identify the ones that are working, and implement them broadly.
HCI: I was interested that you developed partnerships with Scripps, John Muir and Hartford Healthcare. I also understand you work closely with your main health IT vendor Homecare Homebase on these. Could you talk a little bit about how those partnerships came together, and why interoperability between systems is key to making those work?
Saxon: With a health system, you have the greatest opportunity to deliver high-quality care if you can coordinate each part of patient movement across the care continuum through information sharing. Where Homecare Homebase and Pennant come in is that oftentimes health systems are using a system that is sub-optimal for a particular service line. Maybe it's great for the larger hospital system, but maybe not for post-acute care or home care. So we come in and implement specialized solutions to address all of these specific gaps that can get created. The biggest one is physician order signing. In the native EMR that the hospital system is using, we allow them to sign orders that are generated from HomeCare Homebase.
We bring value to the hospital system also by alerting them of proper billing opportunities where they're providing care coordination. Patients are using things like Epic MyChart as a single application for seeing their chart, so we make sure they can see other EMR medical record data inside of My Chart.
Medical record exchange has been the big focus, but now we're working on things like reconciling medication lists and real-time notifications of patient activity in the health system. Maybe the home care nurse needs to know that the patient has a doctor's appointment tomorrow, and they want to know the results of that visit before their next visit.
HCI: Let’s say the acute care systems is on Epic, and you go in and do that integration work. Then you go work with a different acute care provider that's also on Epic. Is the work mostly already done or is it starting over from scratch because their version of Epic is different, and it takes about the same amount of work to actually get that done?
Saxon: Our current system takes about eight to 12 weeks to implement. There is some customization, but there is a product that we're implementing that is repeatable, and an implementation method for it. We're actually trying to make the implementation period shorter over time.
HCI: Are there any particular challenges that your team has to work through with the acute care EHR and with CIOs at the health system level to make this happen?
Saxon: So I've been part of three, and I would say all three have been a little different. But we have developed some best practices and are getting them all on the same road map, and we're hoping to add more partnerships as the health systems are willing. I would say, probably the biggest challenge is establishing that first relationship with the health system, but I think the technology part is pretty easy actually.
HCI: Have you been doing this long enough that you've been able to see results like cutting down on redundant paperwork or efficiencies in the care transitions that people notice or can measure?
Saxon: Yes, we've seen increased patient volume based on preference and value that is created, so we're able to respond more quickly to referral requests. We're able to initiate care faster, too. You can measure that — the amount of time from when the discharge happens to when the referral and the admission happens. And reduced hospitalization is another one that we focus on. So those are our key metrics for success.
HCI: We hear all the time, on the acute care side about trying to cut down on the administrative burden for clinicians. It sounds like that's one of the benefits here.
Saxon: Yes, for the home care clinicians, specifically, that's where they're getting a life-changing experience. For them, clinical documentation is more specific. There are better compliance checks and better continuity.
HCI: On the acute care side in the EHR market now, a lot of people are highlighting the potential of AI, and they're focused on using scribes and voice technology. Is any of that taking place here?
Saxon: We had some earlier use of voice to text and then they would review narratives for completeness, and that's been common in the industry for several years. Pennant does currently have a pilot with one company and has explored technology in this space for the last year. We're trying to be very safe with how it works. We expect to have parts of the documentation for all our clinicians done that way by the end of the year, and increasingly in the future. I think point-of-care documentation is changing from checkbox questions to narratives and prompting if the necessary parts of care were provided or not and using voice technology to respond to those questions. We also have deployed telehealth to monitor patients’ vitals at home.
HCI: Anything else you want to mention about this integration work?
Saxon: Although Homecare Homebase is the primary vendor we work with, we have other integrated partners and our own technology suite. Homecare Homebase is at the center of it, because it's the main health record for home health and hospice. But I also want to emphasize Pennant’s internal development. We have a 10-person development team that builds solutions to optimize many parts of the healthcare process, such as home health episodic management. We do automated texting and reminders to patients. We have other third-party partners that provide things like document management, workflow, coding, and Oasis services, background checks, eligibility checks, and health information exchange connectivity for access to sharing patient information. We are working with Kno2 on interoperability.
