Hospice Providers Leverage EHR Interoperability for Palliative Care Referral Management

Technology is becoming a critical point of access and growth when it comes to fueling palliative care referrals. Electronic health record (EHR) interoperability will be key to building a sustainable palliative care patient census, as more providers re-examine the ways they collaborate with other health care organizations throughout the continuum.

The complexity of referral management represents the most significant hurdle towards the financial stability of palliative care programs. Nearly half of the 328 providers who responded to a 2020 National Hospice & Palliative Care Organization survey indicated that referral management was their biggest concern.

EHR interoperability would go a long way toward streamlining these processes, according to Nick Knowlton, vice president of strategic initiatives at ResMed and board chair of CommonWell Health Alliance. Interoperability is the capability of different information systems to connect across organizations in order to exchange individual or population health data.

“[Hospices need to] evaluate the financial implications of your interoperability strategy. Your referral sources really want to be able to interoperate with you, and that need is only growing over time,” Knowlton told Hospice News during a recent episode of the Palliative Care Executive Webinar Series. “The need is big enough to say that they would actually switch providers if they could gain better interoperability — [interoperability] is incredibly important to referral sources to the point where they will switch their referral relationships to support it.”

Having an interoperable EHR can “open up more swimlanes for working with referral sources and other care providers,” according to Knowlton.

CommonWell Health Alliance is a not-for-profit trade association focused on improving health care data exchange. Health care solutions organization ResMed is the parent company of MatrixCare, a provider of home-based care and long-term post-acute care technology systems.

Roughly 70% of home health and hospice organizations reported seeing annual increases in the number of referral sources who request data during the past two years, according to a recent survey from market analysis firm Porter Research and MatrixCare. The respondents included 700 health systems, physician groups and home-based care organizations, with 74% indicating they would be more likely to refer to post-acute care providers that have interoperable systems. This is up from 60% from a similar study in 2019.

“It can certainly hurt your profitability as an agency to lack automation and have too many manual processes,” said Knowlton during the webinar. “Not having interoperability in place can also lead to high care delivery costs and can lead to patients falling through the cracks, because maybe you can’t get the right information on them to justify care.”

Hospices should communicate with referral sources and technology vendors to determine how patient information can be integrated and translated across health care systems, according to Knowlton. Some EHRs allow clinical and nonmedical notes to be logged and updated in a single area and shared across multiple palliative care settings’ systems.

Knowlton told Hospice News sister publication Home Health Care News in July that oftentimes EHR records do not contain sufficient information to guide care decisions if they are not up-to-date on interventions from patients’ other health care providers.

Different palliative care settings such as hospitals, clinics or community-based providers may have different regulatory requirements for EHR. The U.S. Centers for Medicare & Medicaid Services (CMS) requires health care organizations that participate in some value-based payment models to use certified EHR technology (CEHRT).

CEHRT are IT products that comply with criteria established by CMS for certain programs, such as the Merit-Based Incentive Payment System. The Office of the National Coordinator (ONC) maintains the standards, which exist in multiple editions.

Information sharing is among the most important features that hospices should be looking for in a palliative care EHR system, according to Jessica Rockne, senior product manager of MatrixCare by ResMed. An EHR that meets requirement criteria and shares patient information across the board can help ensure smooth transitions across care settings.

“You’ll need the ability to easily transition your patients into hospice when the time comes,” Rockne told Hospice News. “All of that information should be able to be sent electronically to build a patient record and share the details of the palliative care visits in your hospice chart.”