Information Needs of Homecare Nurses During Admission and Care Planning

The demand for home healthcare (HHC) has grown for a variety of reasons, including an aging population, lengthening life expectancy, increases in individuals with multiple chronic diseases, and a desire by individuals and their families to remain in their homes. For 12 million older adults in the United States annually, transitioning into HHC requires skilled nursing care and other therapies to help these patients and their caregivers manage recovery and chronic disease. Admissions into HHC can be challenging because of the absence of, or limits to, electronic information flow between hospitals and home care agencies resulting in incomplete or inaccurate patient information. Health information technology (IT) can play an important role in supporting the timely and efficient collection, transmission, and synthesis of information needed for decision making during these transitions of care. However, home care agencies have been slow to adopt electronic health records (EHRs) and mobile technology. In addition, there has been an absence of the use of standardized documents for the electronic recording of health information and a lack of clinical standards for the information received by home care agencies. Unlike the teamwork communication in acute care settings, HHC clinicians operate independently in the home under physician orders with the admission being the first home visit at the start of the HHC episode.

To address these gaps in information, the research team analyzed and modeled information requirements, decision making, and workflow of home care nurses admitting patients to identify if and how IT systems supported their needs. This analysis led to the development, review, and dissemination of design and implementation recommendations.

The specific aims of the research were as follows:

• Characterize information requirements, decision making, and workflow for admitting nurses at three agencies using three different health IT systems. 
• Characterize if and how health IT systems support home care admitting nurses’ information requirements, decision making, and workflow. 
• Develop and disseminate design and implementation recommendations that addressed the strengths and challenges due to home care admitting nurses’ information requirements, decision making, and workflow. 

The team conducted a mixed methods data collection and analysis approach, including focus groups, observation, documentation review, interviews, and annual advisory board consultation. To examine nurses’ information needs and understand their decision making, researchers observed the admission in the patient home, and conducted focus groups with them. Based on knowledge of the HHC admission process, and in the absence of related literature, the team investigated decisions related to medication reconciliation, plan-of-care problems to include, visit timing and frequency, and inclusion of other disciplines and services, as use cases. Throughout the study, the team solicited input from the advisory board. The final product was the development, review, and dissemination of IT and EHR design and implementation recommendations.