Nursing Care in Home Health System
Home Health Systems
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.
History of Home Care
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 has traditionally 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 long-term care. Patients
began to be discharged "sicker and quicker" and required more health
care services in the home.
Initial Purposes of Home Care
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.
Initial Home Care Receivers
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 software, and to integrate data (Saba &
McCormick, 1996).
Design and Management of Home Care System
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 manage-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 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 settings, 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. Furthermore, they are being used to determine care costs and provide a
payment method for managed care organizations offering home health care
services.
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