Appl Clin Inform 2014; 05(02): 445-462
DOI: 10.4338/ACI-2013-12-RA-0106
Research Article
Schattauer GmbH

Impact of Homecare Electronic Health Record on Timeliness of Clinical Documentation, Reimbursement, and Patient Outcomes

P. S. Sockolow
1  Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
K. H. Bowles
2  University of Pennsylvania School of Nursing, Philadelphia, PA, USA
M. C. Adelsberger
3  Abington Memorial Hospital, Abington, PA, USA
J. L. Chittams
2  University of Pennsylvania School of Nursing, Philadelphia, PA, USA
C. Liao
4  Temple University College of Health Professions and Social Work, Philadelphia, PA, USA
› Author Affiliations
Further Information

Publication History

Received: 27 December 2013

Accepted: 07 April 2014

Publication Date:
21 December 2017 (online)


Background: Homecare is an important and effective way of managing chronic illnesses using skilled nursing care in the home. Unlike hospitals and ambulatory settings, clinicians visit patients at home at different times, independent of each other. Twenty-nine percent of 10,000 homecare agencies in the United States have adopted point-of-care EHRs. Yet, relatively little is known about the growing use of homecare EHRs.

Objective: Researchers compared workflow, financial billing, and patient outcomes before and after implementation to evaluate the impact of a homecare point-of-care EHR.

Methods: The design was a pre/post observational study embedded in a mixed methods study. The setting was a Philadelphia-based homecare agency with 137 clinicians. Data sources included: (1) clinician EHR documentation completion; (2) EHR usage data; (3) Medicare billing data; (4) an EHR Nurse Satisfaction survey; (5) clinician observations; (6) clinician interviews; and (7) patient outcomes.

Results: Clinicians were satisfied with documentation timeliness and team communication. Following EHR implementation, 90% of notes were completed within the 1-day compliance interval (n = 56,702) compared with 30% of notes completed within the 7-day compliance interval in the pre-implementation period (n = 14,563; OR 19, p < .001). Productivity in the number of clinical notes documented post-implementation increased almost 10-fold compared to pre-implementation. Days to Medicare claims fell from 100 days pre-implementation to 30 days post-implementation, while the census rose. EHR implementation impact on patient outcomes was limited to some behavioral outcomes.

Discussion: Findings from this homecare EHR study indicated clinician EHR use enabled a sustained increase in productivity of note completion, as well as timeliness of documentation and billing for reimbursement with limited impact on improving patient outcomes. As EHR adoption increases to better meet the needs of the growing population of older people with chronic health conditions, these results can inform homecare EHR development and implementation.

Citation: Sockolow PS, Bowles KH, Adelsberger MC, Chittams JL, Liao C. Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes. Appl Clin Inf 2014; 5: 445–462