Home health systems are computer-based information systems designed to support care of the sick in the home. Home health systems primarily support home health and hospice programs provided by home health agencies (HHAs). Home health is more than “care in the home.” It focuses on the continuity of care from the hospital to the community, public health concepts of disease prevention and health promotion, and out-of-hospital acute illness services.
Home care is the oldest form of health care and yet the newest. Home health nursing, previously called care of the sick in the home, is one of the earliest developments in the field of public and community health. Care of the sick at home traditionally has been provided by voluntary nonprofit agencies, such as visiting nurse associations (VNAs), organized to provide out-of-hospital services (Saba & McCormick, 1996). In 1966, with the introduction of Medicare and Medicaid legislation, home health programs emerged from hospital-based ambulatory care, health maintenance organizations, and proprietary home health agencies.
The programs and providers increased in number and size. They increased faster than all other organized providers in the health care industry because Medicare primarily addressed the health care needs of the aging population. As this population grew, more health services were required, resulting in an increase of health care costs that required cost containment. As a result, health care began to shift from acute short-term hospital care to community home-based and chronic longterm care. Patients began to be discharged “sicker and quicker” and required more health care services in the home. Home health systems were initially introduced as management information systems designed to manage the flow of information in the proper time frame and to assist in the decision-making process. The early home health systems were introduced in large visiting nurse associations and other nonprofit HHAs as billing and financial systems. They were developed for the sole purpose of improving cash flow, holding down costs, and addressing the federal regulatory needs for HHAs.
They were designed to furnish the information required for payment by Medicare, Medicaid, and other third-party payers for reimbursement for services. Home health systems were generally developed by commercial vendors who obtained the computer system hardware and developed the software to process the services data provided by the HHAs. The computer vendors owned the home health system and were responsible for maintaining and updating them. Home health computer vendors were usually contracted by the HHAs to provide billing services and financial management, without the HHAs having to develop their own system. With the introduction of the microcomputer and online communication systems, local area networks (LANs) and wide area networks (WANs) were introduced, designed to advance and enhance the home health systems.
They were used to link state and local units, to share hardware and soft-ware, and to integrate data (Saba & McCormick, 1996).Home health systems are designed not only to collect and process home health data required by the federal government and third-party payers for reimbursement of services but also for the efficient management of the HHA. They focus on billing and financial applications, such as general ledger, accounts receivable, accounts payable, billing, reimbursement management, and cash management. They also may include other management applications, such as scheduling, patient census, visit tracking, cost statistics, utilization reports, accounting statements, and discharge summaries.
Newer home health systems have emerged that are designed to focus on the patient encounter and visit during an episode of care. They include clinical applications used to assess and document the care process, to generate care plans, and to prepare critical pathways or protocols that outline the critical events.
These newer systems are using the electronic information superhighway to communicate patient information for continuity of care from hospital to the home, to the community, and back to the hospital. The systems also offer other applications that focus on decision support, evaluation of care, and measurement of outcomes across set-tings, time, and geographic locations. The systems are considered part of the lifelong longitudinal record containing patient-specific health-related data.
HHCC systems are being used to identify care needs in terms of care components and their respective nursing diagnoses and interventions and to determine resource use in terms of nursing and other health providers.
They are being designed to document the clinical care pathways and record protocols for an entire episode of care. Further, they are being used to determine care costs and provide a payment method for managed care organizations offering home health care services.