This article is part of the HHCN+ membership
Sentara Home Care Services lost $2 million in one year due to unclaimed services. Company Problems: Inadequate Electronic Health Records (EHR).
It wasn't just finances. Patient care has also been compromised due to issues with the scheduling platform, according to Sherry Kesler, Home Health Director of Sentara Health. The company's previous EHR software was sunset and was given only eight months to Sentara Home Care Services to completely convert it to the new system. The Rush meant that when providers switched to the new EHR, the technology was not fully equipped to handle the complexity of home health services.
“Healthcare is healthcare, but once you enter a specialized program like home health and hospice, you need a partner that can help you stay compliant without focusing solely on compliance,” Kessler told Home Healthcare News. “From home healthcare EMR, from billing to patient care, everything in between needs to be able to handle it. It's not just what it has to do.”
Provided by Sentara Home Care Services includes skilled nursing, hospice and infusion therapy. This is the home-based care arm of Sentara Health, a non-profit health care system headquartered in Hampton Road, Virginia.
After the original EHR went to sunset, Sentara Home Care Services now uses Epic Systems. Epic said it was great in many areas, but its offerings are not entirely up to date on the needs of home health operators. In September, the company announced that it had successfully launched several Wellsky products that will be used in conjunction with Epic to meet reporting and monitoring needs.
The Sentara Home Care Services 'EHR disruption exemplifies the high stakes nature of EHR systems that are robust for home health organizations. Proper selection of EHR is a high stakes process and can result in large payoffs, or extreme results, as shown not only by Sentara situations, but also by other home health providers who have recently experienced the EHR selection process.
“EHR functions as the central nervous system of the tissue,” Jonathan D'Souza, chief product and technology officer at HarmonyCares, told HHCN. “We manage everything from how we schedule patients to actual clinical workflows. From actual clinical workflows to how our organization pays, to how we interact with our insurance companies with a focus on billing, billing, billing, and ultimately reimbursements.
Based in Troy, Michigan, Harmony Care offers home-based services in 14 states, including primary care, radiology, palliative care and hospice care. We employ more than 200 primary care clinicians.
Harmonycares performed live in June with new EHR, Athenahealth.
D'Souza explained the “mixed bag” and description of homemade systems and commercial solutions used throughout the sector, but Kesler said that providers primarily understand the importance of robust EHRs, and that most providers have the same level of system.
“Some organizations adapt hospice or home health platforms, while others build custom solutions,” Nikki Davis, Senior Vice President of Contessa Health's Palliative Care Program, told HHCN in an email. “Integration with a wider health system is often limited, which can hinder continuity of care. Contessa's use of Myunity is ahead of many programs that still rely on manual processes and siloed systems.”
Based in Nashville, Tennessee, Contessa offers a range of home care services, including hospital-level care, rehabilitation care and palliative care. The company has 12 health system partners and 30 health planning partners, serving patients in nine states. Amedisys Inc. (NASDAQ:AMED) acquired Contessa in 2021 for $250 million.
Contessa switched EHR to MyR this year with Netsmart as part of a broader program expansion and migration from Netsmart's Myavatar platform.
Choosing a priority
The exact timeline is different, but EHRS changes are a six-month to two-year process. It is important to know when to change your system and what challenges may arise.
In the case of HarmonyCares, it has become clear that the company will need a new system to meet its strategic priorities and aspirations for expansion over the next three to five years.
“There is always a set of issues and opportunities in the evolution of companies that relate to the technology roadmap,” says D'Souza. “Part of the strategic process is determining that the opportunity bubbles up to the top of the priority list as we are ready to make that investment.”
Once a company determines that a new platform is needed, it should outline specific requirements.
Contessa prioritized EHR, which could record the care of the entire person, including not only clinical data but also social, mental and psychosocial factors. It also had to be tailored to the Medicare claims requirements for palliative care, supporting interdisciplinary teamwork and leading an improved dementia experience (GUIDE) model.
HarmonyCares needed a system that was as streamlined as possible for providers, creating the best possible experiences and allowing deeper patient provider interactions at home. They also needed to be able to support interdisciplinary teams, including care managers, social workers and pharmacists. Finally, EHR needed to be able to support HarmonyCares' goal of becoming the largest provider of value-based home care in the country.
“We didn't want something to be a walled garden,” D'Souza said. “We wanted something more scalable, so we were able to innovate on top of it.
When looking for tools to supplement Sentara Home Care Services' current EHR, Kesler prioritized user-friendliness and quality reporting and monitoring. Kessler compared the EHR to a grocery store. Each one needs something shoppers need. The question is how easy it is to navigate the aisles.
Make their choice
Once a provider determines the criteria, only a finite number of EHR vendors can fit the bill, experts said.
“Myunity was chosen because of its ability to support its ability to support its ability to integrate with other systems,” Davis says. “We also support multiple visit modalities, including face-to-face, telehealth, and telephone encounters.”
Once they decided what that prioritization was, HarmonyCares issued a “Suggestion Mini Request (RFP)”. A combination of operations stakeholders, clinicians and technology team members then began the selection process.
Sentara Home Care Services conducted face-to-face interviews with vendors to determine the optimal fit. The problem, Kessler said, is that it is not always possible to understand product limitations by looking at it.
“I never imagined that I had to ask the epic if I could schedule a color code,” she said. “For home health, we want to have colour coding. I didn't know that when I was interviewing a vendor, so I'll use that as an example. I'm doing it now.”
Sentara Home Care Services chose Wellsky because the data it provides is easily interpreted and feasible, Kesler said.
When deliberating between vendors, providers should also consider the cost of the system they choose.
“Where do you land on the focus spectrum on the Cadillac?” D'Souza said.
Another major friction point that came up for HarmonyCares when considering EHRS is that one system could be better with one capacity, but not robust with another. These concerns can complicate the process of choosing a new EHR, but when you go back to the original reasons your company needs, it can help you overcome these challenges.
“To always return to the key strategic priorities we use when considering why we need a system in the first place helped us overcome these two major friction points,” D'Souza said.
