Investigating the Challenges and Opportunities in Home Care to Facilitate Effective Information Technology Adoption.

BACKGROUND: As home care utilization increases, information technology (IT) becomes a critical tool for providing quality home care. However, most home health agencies (HHAs) in the United States are in a position to adopt and leverage IT solutions in budget-constrained settings, where it is crucial to address important and pressing challenges and opportunities for achieving effectiveness in IT adoption.

OBJECTIVES: (1) Explore HHAs' challenges and opportunities related to delivering home care as well as performing administrative functions and conducting business, (2) learn about current IT implementation levels and activities in home care, and (3) make recommendations to facilitate efforts and initiatives designed for adopting IT in home care effectively.

METHODS: Semistructured interviews were conducted to elicit rich contextual information from the participants recruited from 13 local HHAs in one of the states in the United States. Established systems analysis techniques were used to ask questions during the interviews. Framework, a qualitative research method, was used to analyze the qualitative data obtained from the interviews.

RESULTS: Coordinating clinical and administrative workflows was an important challenge. Inadequate access to patients' medical history and difficulties with medication reconciliation detracted from the quality of care. Hiring, training, scheduling, and retaining qualified personnel constituted another important challenge. Training and educating patients, caregivers, and families hold important opportunities for improving the quality of care. All except one HHA adopted electronic health records (EHR) but many continued to struggle considerably in their day-to-day functions. Health information exchange (HIE) seems to be the most needed technology. Telehealth solutions were perceived to be promising but their added value and financial viability in the long run were questioned.

CONCLUSIONS: The recommendations for effective IT adoption include keeping a quality improvement focus, keeping a holistic organizational perspective, considering potential information exchange problems, addressing education and training needs, experimentation with telehealth if resources permit, considering organization size, and reducing lengthy procedures and excessive documentation requirements. The relevant stakeholders, such as home care professionals, IT vendors, and policy makers, should consider the recommendations from this study to facilitate success in future IT efforts and initiatives in home care.