Rapid EHR development and implementation using web and cloud-based architecture in a large home health and hospice organization.

Health care organizations have long been limited to a small number of major vendors in their selection of an electronic health record (EHR) system in the national and international marketplace. These major EHR vendors have in common base systems that are decades old, are built in antiquated programming languages, use outdated server architecture, and are based on inflexible data models [1,2]. The option to upgrade their technology to keep pace with the power of new web-based architecture, programming tools and cloud servers is not easily undertaken due to large client bases, development costs and risk [3]. This paper presents the decade-long efforts of a large national provider of home health and hospice care to select an EHR product, failing that to build their own and failing that initiative to go back into the market in 2012. The decade time delay had allowed new technologies and more nimble vendors to enter the market. Partnering with a new start-up company doing web and cloud based architecture for the home health and hospice market, made it possible to build, test and implement an operational and point of care system in 264 home health locations across 40 states and three time zones in the United States. This option of "starting over" with the new web and cloud technologies may be posing a next generation of new EHR vendors that retells the Blackberry replacement by iPhone story in healthcare.

2008 refinements to the Medicare Home Health Prospective Payment System.

On January 1, 2008, Centers for Medicare and Medicaid Services (CMS) implemented refinements to the Prospective Payment System (PPS). This is the first change to the way CMS reimburses Medicare patients receiving home health services since the inception of PPS in 2000. The calculation for the exact episode payment has changed significantly, but from a clinical management perspective, the focus must be on ensuring that both the Outcome and Assessment Information Set (OASIS) assessment and the International Classification of Diseases (ICD)-9 CM coding are completed accurately-the same things all clinicians should be doing currently! This article will describe the structural, payment adjustment, and base rate changes for Medicare home care reimbursement that were implemented by CMS on January 1, 2008.