Adoption and Use of Electronic Health Records and Mobile Technology by Home Health and Hospice Care Agencies
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Data Science and Big DataHealthcare and ResearchStatistics and Probability
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Number 66 n May 20, 2013
Adoption and Use of Electronic Health Records
and Mobile Technology by Home Health and
Hospice Care Agencies
by Anita R. Bercovitz, Ph.D., M.P.H.; Eunice Park-Lee, Ph.D.;
and Eric Jamoom, Ph.D., M.P.H., M.S., Division of Health Care Statistics
Abstract
Objective—This report presents national estimates on the adoption and use
of electronic health records and mobile technology by home health and hospice
care agencies, as well as the agency characteristics associated with adoption.
Methods—Estimates are based on data from the 2007 National Home and
Hospice Care Survey, conducted by the Centers for Disease Control and
Prevention’s National Center for Health Statistics.
Results—In 2007, 28% of home health and hospice care agencies adopted
both electronic health records and mobile technology, while slightly over half
(54%) adopted neither. Sixteen percent of agencies adopted only electronic health
records. Adoption of both technologies was associated with number of patients
served and agency type. Agencies that were for-profit or were jointly owned with
a hospital were more likely to have adopted neither technology. Among agencies
with electronic health records, the most commonly used functionalities were
patient demographics and clinical notes. Among agencies with mobile
technology, functionalities for the Outcome and Assessment Information Set
(OASIS), e-mail, and appointment scheduling were the most commonly used.
Similar percentages of agencies with electronic health records or mobile
technology used clinical decision support systems, computerized physician order
entry, electronic reminders for tests, and viewing of test results.
Keywords: point-of-care documentation • health information technology •
interoperability • long-term care
Introduction
Use of health information
technology, especially at the point of
care, is often considered as a way to
improve care coordination and quality
(1). Mobile technology, such as tablet
computers and personal digital
assistants, represents an opportunity to
gather information at the point of care.
Collection of information at the care site
would be especially important in home
health and hospice care, where care is
provided predominantly at the patient’s
home rather than in an institutional
setting (2,3). If the agency also has an
electronic health record for the patient,
any information collected at the point of
care through mobile technology has the
potential to be integrated into the
electronic health record, making the
information available across provider
locations. Having this information
visible across all locations of care
supports timely decision making and
documentation. For example, having the
capability to view test results at the
point of care enables the provider to use
these results to make timely decisions
about treatment. Similarly, having the
capability to order medications,
treatments, or tests at the point of care
eliminates a time lag in both ordering
and documenting the treatment. Linkage
of the information gathered through
mobile technology to the electronic
health record may facilitate timely
decisions and concordance of patient
information across locations of care.
However, the utility of having both
electronic health records and mobile
technology is dependent on both
technologies having the same
functionalities and the ability to share
information.
Although the adoption of each type
of health information technology has
been examined independently (4–6),
little information is available on the
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Adoption and Use of Electronic Health Records
and Mobile Technology by Home Health and
Hospice Care Agencies
by Anita R. Bercovitz, Ph.D., M.P.H.; Eunice Park-Lee, Ph.D.;
and Eric Jamoom, Ph.D., M.P.H., M.S., Division of Health Care Statistics
Abstract
Objective—This report presents national estimates on the adoption and use
of electronic health records and mobile technology by home health and hospice
care agencies, as well as the agency characteristics associated with adoption.
Methods—Estimates are based on data from the 2007 National Home and
Hospice Care Survey, conducted by the Centers for Disease Control and
Prevention’s National Center for Health Statistics.
Results—In 2007, 28% of home health and hospice care agencies adopted
both electronic health records and mobile technology, while slightly over half
(54%) adopted neither. Sixteen percent of agencies adopted only electronic health
records. Adoption of both technologies was associated with number of patients
served and agency type. Agencies that were for-profit or were jointly owned with
a hospital were more likely to have adopted neither technology. Among agencies
with electronic health records, the most commonly used functionalities were
patient demographics and clinical notes. Among agencies with mobile
technology, functionalities for the Outcome and Assessment Information Set
(OASIS), e-mail, and appointment scheduling were the most commonly used.
Similar percentages of agencies with electronic health records or mobile
technology used clinical decision support systems, computerized physician order
entry, electronic reminders for tests, and viewing of test results.
Keywords: point-of-care documentation • health information technology •
interoperability • long-term care
Introduction
Use of health information
technology, especially at the point of
care, is often considered as a way to
improve care coordination and quality
(1). Mobile technology, such as tablet
computers and personal digital
assistants, represents an opportunity to
gather information at the point of care.
Collection of information at the care site
would be especially important in home
health and hospice care, where care is
provided predominantly at the patient’s
home rather than in an institutional
setting (2,3). If the agency also has an
electronic health record for the patient,
any information collected at the point of
care through mobile technology has the
potential to be integrated into the
electronic health record, making the
information available across provider
locations. Having this information
visible across all locations of care
supports timely decision making and
documentation. For example, having the
capability to view test results at the
point of care enables the provider to use
these results to make timely decisions
about treatment. Similarly, having the
capability to order medications,
treatments, or tests at the point of care
eliminates a time lag in both ordering
and documenting the treatment. Linkage
of the information gathered through
mobile technology to the electronic
health record may facilitate timely
decisions and concordance of patient
information across locations of care.
However, the utility of having both
electronic health records and mobile
technology is dependent on both
technologies having the same
functionalities and the ability to share
information.
Although the adoption of each type
of health information technology has
been examined independently (4–6),
little information is available on the
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Page 2 National Health Statistics Reports n Number 66 n May 20, 2013
adoption of multiple types of health
information within one agency and the
agency characteristics associated with
adoption of multiple types. This report
builds on previous work and presents
data on co-use of electronic health
records and mobile technology by home
health and hospice care agencies, and on
agency characteristics associated with
adoption. Estimates are also presented
for the functionalities most often used in
mobile technology and electronic health
records, and among providers with both
technologies.
Methods
Estimates in this report are based on
data from the 2007 National Home and
Hospice Care survey (NHHCS),
conducted by the Centers for Disease
Control and Prevention’s (CDC)
National Center for Health Statistics
(NCHS). The 2007 NHHCS is one in a
series of nationally representative,
cross-sectional sample surveys of U.S.
home health and hospice care agencies.
It is designed to provide descriptive
information on these agencies, their staff
members, the services they provide, and
the people they serve. NHHCS was first
conducted in 1992 and was repeated in
1993, 1994, 1996, 1998, 2000, and
2007.
Information on NHHCS sampling,
design, and other methodology is
available in the Technical Notes at the
end of this report, as well as in other
reports (7) and online at http://
www.cdc.gov/nchs/nhhcs/nhhcs_
questionnaires.htm.
Data analysis
Bivariate (bivariate cross-tabulation)
and multivariate (multivariate logistic
regression) analyses were conducted to
examine home health and hospice care
agencies’ adoption of electronic health
records and mobile technology. The
following mutually exclusive variables
were created for the analyses:
+ Agencies that adopted both electronic
health records and mobile technology.
+ Agencies that adopted only electronic
health records.
+ Agencies that adopted neither
electronic health records nor mobile
technology.
The sample size for agencies that
adopted only mobile technology was too
small to create reliable estimates. Thus,
no analyses were conducted to identify
the factors associated with adoption of
only mobile technology, and these
agencies were excluded from the
bivariate and multivariate analyses.
Bivariate cross-tabulations were
used to determine the unadjusted
percentages of agencies that adopted
both electronic health records and
mobile technology, agencies that
adopted only electronic health records,
and agencies that adopted neither
technology, by selected agency
characteristics (Table 1). Adjusted
percentages controlling for agency
characteristics were calculated using
three multivariate logistic regression
models. The first model produces the
adjusted percentage of agencies that
adopted both technologies; the second
produces the adjusted percentage of
agencies that adopted only electronic
health records; and the third model
produces the adjusted percentage of
agencies that adopted neither
technology. In each model, agencies that
adopted only mobile technology were
excluded from the analyses.
Control variables in the models
include type of care offered, total
number of services offered, percentage
of revenue from Medicare, total number
of patients, administrator or director
tenure at the agency, joint ownership,
agency type, and chain affiliation. These
variables were chosen because in
previous research they were found to be
associated with adoption of electronic
health records (4–6). The regression
models are then used to predict marginal
probabilities (adjusted percentages) for
the average provider of home health or
hospice care, or both, with a given
characteristic (e.g., for-profit agencies)
and with the specific technology
adoption status (e.g., adoption of only
electronic health records), while
controlling for other variables in the
model.
Differences between the results of
bivariate (unadjusted) and adjusted
analyses are due to the significant
associations between the variables
included in the adjusted model. For
example, chain affiliation and type of
care offered are significantly associated
(8). Because significant associations
were seen among the control variables
included in the full models, additional
models were run. One set of models
included only the variables with
significant bivariate associations. In
another series of models, the variables
with the most correlations with other
variables were dropped sequentially, in
the following order: ownership, joint
ownership, percentage of revenue from
Medicare, and type of care offered. The
results of these additional models are
discussed but are not shown.
The percentages of agency adoption
of mobile technology and electronic
health record functionalities were
calculated for the following categories:
+ Agencies that adopted mobile
technology regardless of adoption of
electronic health records.
+ Agencies that adopted electronic
health records regardless of adoption
of mobile technology.
+ Agencies that adopted both
technologies.
The weighted percentages of
nonresponse (‘‘don’t know’’ and
‘‘refused’’) for all variables used in the
analyses were less than 10%. The
weighted percentage of cases with
missing data was less than 1% for
functionalities on electronic health
records and mobile technology; 1% for
total number of patients, joint
ownership, and total number of services
offered; 5% for whether the agency had
an electronic health record; 7% for
whether the agency had mobile
technology and for administrator or
director tenure at agency; and 8% for
the percentage of revenue from
Medicare. Agency type and type of care
offered had no cases with missing data.
Cases with missing information on any
of the variables used in the analyses
were dropped (67 cases were dropped,
resulting in a sample of 969 cases being
used in the analyses). This yielded a
adoption of multiple types of health
information within one agency and the
agency characteristics associated with
adoption of multiple types. This report
builds on previous work and presents
data on co-use of electronic health
records and mobile technology by home
health and hospice care agencies, and on
agency characteristics associated with
adoption. Estimates are also presented
for the functionalities most often used in
mobile technology and electronic health
records, and among providers with both
technologies.
Methods
Estimates in this report are based on
data from the 2007 National Home and
Hospice Care survey (NHHCS),
conducted by the Centers for Disease
Control and Prevention’s (CDC)
National Center for Health Statistics
(NCHS). The 2007 NHHCS is one in a
series of nationally representative,
cross-sectional sample surveys of U.S.
home health and hospice care agencies.
It is designed to provide descriptive
information on these agencies, their staff
members, the services they provide, and
the people they serve. NHHCS was first
conducted in 1992 and was repeated in
1993, 1994, 1996, 1998, 2000, and
2007.
Information on NHHCS sampling,
design, and other methodology is
available in the Technical Notes at the
end of this report, as well as in other
reports (7) and online at http://
www.cdc.gov/nchs/nhhcs/nhhcs_
questionnaires.htm.
Data analysis
Bivariate (bivariate cross-tabulation)
and multivariate (multivariate logistic
regression) analyses were conducted to
examine home health and hospice care
agencies’ adoption of electronic health
records and mobile technology. The
following mutually exclusive variables
were created for the analyses:
+ Agencies that adopted both electronic
health records and mobile technology.
+ Agencies that adopted only electronic
health records.
+ Agencies that adopted neither
electronic health records nor mobile
technology.
The sample size for agencies that
adopted only mobile technology was too
small to create reliable estimates. Thus,
no analyses were conducted to identify
the factors associated with adoption of
only mobile technology, and these
agencies were excluded from the
bivariate and multivariate analyses.
Bivariate cross-tabulations were
used to determine the unadjusted
percentages of agencies that adopted
both electronic health records and
mobile technology, agencies that
adopted only electronic health records,
and agencies that adopted neither
technology, by selected agency
characteristics (Table 1). Adjusted
percentages controlling for agency
characteristics were calculated using
three multivariate logistic regression
models. The first model produces the
adjusted percentage of agencies that
adopted both technologies; the second
produces the adjusted percentage of
agencies that adopted only electronic
health records; and the third model
produces the adjusted percentage of
agencies that adopted neither
technology. In each model, agencies that
adopted only mobile technology were
excluded from the analyses.
Control variables in the models
include type of care offered, total
number of services offered, percentage
of revenue from Medicare, total number
of patients, administrator or director
tenure at the agency, joint ownership,
agency type, and chain affiliation. These
variables were chosen because in
previous research they were found to be
associated with adoption of electronic
health records (4–6). The regression
models are then used to predict marginal
probabilities (adjusted percentages) for
the average provider of home health or
hospice care, or both, with a given
characteristic (e.g., for-profit agencies)
and with the specific technology
adoption status (e.g., adoption of only
electronic health records), while
controlling for other variables in the
model.
Differences between the results of
bivariate (unadjusted) and adjusted
analyses are due to the significant
associations between the variables
included in the adjusted model. For
example, chain affiliation and type of
care offered are significantly associated
(8). Because significant associations
were seen among the control variables
included in the full models, additional
models were run. One set of models
included only the variables with
significant bivariate associations. In
another series of models, the variables
with the most correlations with other
variables were dropped sequentially, in
the following order: ownership, joint
ownership, percentage of revenue from
Medicare, and type of care offered. The
results of these additional models are
discussed but are not shown.
The percentages of agency adoption
of mobile technology and electronic
health record functionalities were
calculated for the following categories:
+ Agencies that adopted mobile
technology regardless of adoption of
electronic health records.
+ Agencies that adopted electronic
health records regardless of adoption
of mobile technology.
+ Agencies that adopted both
technologies.
The weighted percentages of
nonresponse (‘‘don’t know’’ and
‘‘refused’’) for all variables used in the
analyses were less than 10%. The
weighted percentage of cases with
missing data was less than 1% for
functionalities on electronic health
records and mobile technology; 1% for
total number of patients, joint
ownership, and total number of services
offered; 5% for whether the agency had
an electronic health record; 7% for
whether the agency had mobile
technology and for administrator or
director tenure at agency; and 8% for
the percentage of revenue from
Medicare. Agency type and type of care
offered had no cases with missing data.
Cases with missing information on any
of the variables used in the analyses
were dropped (67 cases were dropped,
resulting in a sample of 969 cases being
used in the analyses). This yielded a
National Health Statistics Reports n Number 66 n May 20, 2013 Page 3
weighted sample size of 13,100 cases
(91% of the total weighted sample).
Weights that take into account the
sample stages with adjustments for
nonresponse were used to produce
national estimates of agencies providing
home health and hospice care.
Differences between subgroups were
evaluated with chi-square tests at the
p = 0.05 level for differences in
percentages and percent distributions.
All comparisons reported in the text are
statistically significant unless otherwise
indicated. Comparisons not mentioned
may or may not be statistically
significant. Data analyses were
performed using the statistical packages
SAS, version 9.2 (9) and SUDAAN,
version 10.0 (10). Because estimates
were rounded to the nearest hundred,
individual estimates may not sum to
totals.
Results
Adoption of electronic health
records and mobile
technology
Twenty-eight percent of home
health and hospice care agencies have
adopted both electronic health records
and mobile technology (Figure 1).
Slightly over one-half (54%) of the
agencies had neither an electronic health
record nor mobile technology. Sixteen
percent adopted only electronic health
records, whereas 2% (an unreliable
estimate) adopted only mobile
technology. In other words, 44% of
agencies adopted electronic health
records (16% only electronic health
records and 28% both technologies),
whereas 30% adopted mobile
technology (2% only mobile technology
and 28% both technologies).
Agency characteristics
associated with adoption of
both electronic health
records and mobile
technology
In unadjusted analyses (Table 1),
agency adoption of both electronic
health records and mobile technology
was associated with all the variables
Electronic health
records only
(n = 2,100)
16%
Mobile technology only
(n = 300)
2%*
Both electronic health
records and mobile
technology
(n = 3,600)
28%
Neither electronic health
records nor mobile
technology
(n = 7,100)
54%
* Estimate is unreliable.
NOTES: A weighted total of 13,100 agencies were analyzed. Figure excludes cases with missing data. See Data Analysis
section for details.
SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
Figure 1. Home health and hospice care agencies’ adoption of electronic health records
and mobile technology: United States, 2007
included in the analyses. Agencies were
more likely to adopt both technologies if
the agency offered both home health
and hospice care, was not part of a
chain, had administrators with a tenure
of 71 or more months (rather than
25–70 months), had 50 or more patients,
had revenue from Medicare in the
middle tertile (52%–87%) of total
revenues, offered 14 or more services,
were either nonprofit or government-
owned, or were jointly owned by either
a hospital or a health care system. The
largest effect was for agency type:
where 8% of agencies that were
for-profit adopted both technologies, in
contrast to voluntary nonprofits (67%)
and government agencies (51%). Total
number of patients and joint ownership
had effects of similar magnitude. Among
agencies with fewer than 50 patients,
9% adopted both technologies, but there
was no difference in adoption between
agencies with 50–99 patients (32%) and
those with 100 or more patients (43%).
Independent agencies were less likely to
adopt both technologies (18%),
compared with agencies jointly owned
with a hospital (51%) or a health care
system (60%).
In adjusted analyses (Table 2),
agency adoption of both electronic
health records and mobile technology
was associated with the number of
current patients served and with
ownership. Agencies that had 50 or
more patients and were either nonprofit
or government-owned were more likely
to adopt both technologies, compared
with all other agencies that had adopted
only electronic health records or adopted
neither technology, while controlling for
other variables. Twelve percent of
agencies with fewer than 50 patients
weighted sample size of 13,100 cases
(91% of the total weighted sample).
Weights that take into account the
sample stages with adjustments for
nonresponse were used to produce
national estimates of agencies providing
home health and hospice care.
Differences between subgroups were
evaluated with chi-square tests at the
p = 0.05 level for differences in
percentages and percent distributions.
All comparisons reported in the text are
statistically significant unless otherwise
indicated. Comparisons not mentioned
may or may not be statistically
significant. Data analyses were
performed using the statistical packages
SAS, version 9.2 (9) and SUDAAN,
version 10.0 (10). Because estimates
were rounded to the nearest hundred,
individual estimates may not sum to
totals.
Results
Adoption of electronic health
records and mobile
technology
Twenty-eight percent of home
health and hospice care agencies have
adopted both electronic health records
and mobile technology (Figure 1).
Slightly over one-half (54%) of the
agencies had neither an electronic health
record nor mobile technology. Sixteen
percent adopted only electronic health
records, whereas 2% (an unreliable
estimate) adopted only mobile
technology. In other words, 44% of
agencies adopted electronic health
records (16% only electronic health
records and 28% both technologies),
whereas 30% adopted mobile
technology (2% only mobile technology
and 28% both technologies).
Agency characteristics
associated with adoption of
both electronic health
records and mobile
technology
In unadjusted analyses (Table 1),
agency adoption of both electronic
health records and mobile technology
was associated with all the variables
Electronic health
records only
(n = 2,100)
16%
Mobile technology only
(n = 300)
2%*
Both electronic health
records and mobile
technology
(n = 3,600)
28%
Neither electronic health
records nor mobile
technology
(n = 7,100)
54%
* Estimate is unreliable.
NOTES: A weighted total of 13,100 agencies were analyzed. Figure excludes cases with missing data. See Data Analysis
section for details.
SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
Figure 1. Home health and hospice care agencies’ adoption of electronic health records
and mobile technology: United States, 2007
included in the analyses. Agencies were
more likely to adopt both technologies if
the agency offered both home health
and hospice care, was not part of a
chain, had administrators with a tenure
of 71 or more months (rather than
25–70 months), had 50 or more patients,
had revenue from Medicare in the
middle tertile (52%–87%) of total
revenues, offered 14 or more services,
were either nonprofit or government-
owned, or were jointly owned by either
a hospital or a health care system. The
largest effect was for agency type:
where 8% of agencies that were
for-profit adopted both technologies, in
contrast to voluntary nonprofits (67%)
and government agencies (51%). Total
number of patients and joint ownership
had effects of similar magnitude. Among
agencies with fewer than 50 patients,
9% adopted both technologies, but there
was no difference in adoption between
agencies with 50–99 patients (32%) and
those with 100 or more patients (43%).
Independent agencies were less likely to
adopt both technologies (18%),
compared with agencies jointly owned
with a hospital (51%) or a health care
system (60%).
In adjusted analyses (Table 2),
agency adoption of both electronic
health records and mobile technology
was associated with the number of
current patients served and with
ownership. Agencies that had 50 or
more patients and were either nonprofit
or government-owned were more likely
to adopt both technologies, compared
with all other agencies that had adopted
only electronic health records or adopted
neither technology, while controlling for
other variables. Twelve percent of
agencies with fewer than 50 patients
Page 4 National Health Statistics Reports n Number 66 n May 20, 2013
adopted both technologies, compared
with 31% of agencies with 50–99
patients and 32% of agencies with 100
or more patients. Ten percent of
for-profit agencies adopted both
technologies, compared with 54% of
voluntary nonprofit agencies and 50% of
government agencies.
Models in which ownership, joint
ownership, percentage of revenue from
Medicare, and agency type were
dropped sequentially from the full
model were also run. When ownership
was dropped, adopting both technologies
was associated with joint ownership,
administrator tenure, number of patients,
and chain membership. Percentage of
revenue from Medicare, number of
patients, administrator tenure, and chain
membership were significant when joint
ownership was also removed from the
model. When percentage of revenue
from Medicare was also removed, type
of care provided, number of patients,
administrator tenure, and chain
membership were significant. When all
four of the most closely associated
variables (ownership, joint ownership,
percentage of revenue from Medicare,
and type of care provided) were
removed from the model, the number of
services offered, number of patients,
administrator tenure, and chain
membership were all associated with
adopting both types of technology. (Data
not shown.)
Agency characteristics
associated with adoption of
only electronic health
records
In unadjusted analyses, adoption of
only electronic health records was
associated with type of care offered by
the agency, number of patients, agency
type, and joint ownership (Table 1).
Compared with all other agencies,
agencies that adopted only electronic
health records were more likely to offer
home health care only (18%) rather than
both home health and hospice care
(6%); to have fewer than 50 patients
(28%) rather than 50–99 patients (10%);
to be for-profit (21%) rather than
voluntary nonprofit (7%); or to be
independent (19%) rather than jointly
owned with a hospital (6%).
In adjusted analyses (Table 2), an
agency’s adoption of only electronic
health records (compared with adopting
both or neither technology) was not
associated with any of the variables
used in the analyses.
Adjusted analyses that included
only the four variables with significant
bivariate associations (type of care
offered by the agency, number of
patients, agency type, and joint
ownership) did not improve the overall
fit compared with the full model.
Similarly, when ownership, joint
ownership, percentage of revenue from
Medicare, and type of care offered were
dropped sequentially, none of those
models improved the fit. (Data not
shown.)
Agency characteristics
associated with adoption of
neither electronic health
records nor mobile
technology
In unadjusted analyses, agency
adoption of neither type of technology
was associated with type of care offered,
percentage of revenue from Medicare,
number of services offered, agency type,
and joint ownership (Table 1). Agencies
were more likely to adopt neither
technology if they provided either home
health care only or hospice care only
rather than both types of care; if their
percentage of revenue from Medicare
was in the highest tertile (88% or more)
of total revenues rather than the middle
tertile (52%–87%); if they offered
10–13 services rather than 14 or more;
if they were for-profit rather than
nonprofit or government-owned; and if
they were independent or jointly owned
with a hospital rather than jointly owned
with a health care system and other. The
largest effects were seen with agency
type, where 71% of for-profit agencies
adopted neither technology, compared
with 26% of voluntary nonprofits and
37% of government-owned agencies.
Joint ownership also showed strong
effects, with 62% of independent
agencies adopting neither technology,
compared with 44% of agencies
affiliated with a hospital and 23%
affiliated with a health care system.
In adjusted analyses, agency
adoption of neither type of technology,
rather than both or electronic health
records only (Table 2), was associated
with agency type and joint ownership.
Agencies that were for-profit and were
independent or jointly owned with a
hospital were more likely to have
adopted neither type of technology than
to have adopted both technologies or
only electronic health records.
In adjusted analyses, which
included only the variables with
significant bivariate associations with
adoption of neither technology (type of
care offered, percentage of revenue from
Medicare, number of services offered,
agency type, and joint ownership), the
same variables found significant in the
full model (agency type and joint
ownership) were significant in the
smaller model. The adjusted percentages
from this smaller model were very
similar to the adjusted percentages in
the full model. When ownership, joint
ownership, and percentage of revenue
from Medicare were dropped
sequentially, none of the remaining
variables were significant. However,
when type of care offered was dropped
as well, then the number of services
offered became significant. Adoption of
neither technology was associated with
offering 10–13 services, compared with
13 or more. (Data not shown.)
Functionalities most often
used in mobile technology
Most agencies with mobile
technology (agencies adopting both
mobile technology and electronic health
records or just mobile technology) used
functionalities related to the Outcome
and Assessment Information Set
(OASIS) (77%), e-mail (73%),
appointment scheduling (71%), clinical
decision support system (62%), and
computerized physician order entry
(51%) (Figure 2). Approximately
one-quarter used mobile technology for
viewing test results (25%) or for
electronic reminders for tests (23%).
adopted both technologies, compared
with 31% of agencies with 50–99
patients and 32% of agencies with 100
or more patients. Ten percent of
for-profit agencies adopted both
technologies, compared with 54% of
voluntary nonprofit agencies and 50% of
government agencies.
Models in which ownership, joint
ownership, percentage of revenue from
Medicare, and agency type were
dropped sequentially from the full
model were also run. When ownership
was dropped, adopting both technologies
was associated with joint ownership,
administrator tenure, number of patients,
and chain membership. Percentage of
revenue from Medicare, number of
patients, administrator tenure, and chain
membership were significant when joint
ownership was also removed from the
model. When percentage of revenue
from Medicare was also removed, type
of care provided, number of patients,
administrator tenure, and chain
membership were significant. When all
four of the most closely associated
variables (ownership, joint ownership,
percentage of revenue from Medicare,
and type of care provided) were
removed from the model, the number of
services offered, number of patients,
administrator tenure, and chain
membership were all associated with
adopting both types of technology. (Data
not shown.)
Agency characteristics
associated with adoption of
only electronic health
records
In unadjusted analyses, adoption of
only electronic health records was
associated with type of care offered by
the agency, number of patients, agency
type, and joint ownership (Table 1).
Compared with all other agencies,
agencies that adopted only electronic
health records were more likely to offer
home health care only (18%) rather than
both home health and hospice care
(6%); to have fewer than 50 patients
(28%) rather than 50–99 patients (10%);
to be for-profit (21%) rather than
voluntary nonprofit (7%); or to be
independent (19%) rather than jointly
owned with a hospital (6%).
In adjusted analyses (Table 2), an
agency’s adoption of only electronic
health records (compared with adopting
both or neither technology) was not
associated with any of the variables
used in the analyses.
Adjusted analyses that included
only the four variables with significant
bivariate associations (type of care
offered by the agency, number of
patients, agency type, and joint
ownership) did not improve the overall
fit compared with the full model.
Similarly, when ownership, joint
ownership, percentage of revenue from
Medicare, and type of care offered were
dropped sequentially, none of those
models improved the fit. (Data not
shown.)
Agency characteristics
associated with adoption of
neither electronic health
records nor mobile
technology
In unadjusted analyses, agency
adoption of neither type of technology
was associated with type of care offered,
percentage of revenue from Medicare,
number of services offered, agency type,
and joint ownership (Table 1). Agencies
were more likely to adopt neither
technology if they provided either home
health care only or hospice care only
rather than both types of care; if their
percentage of revenue from Medicare
was in the highest tertile (88% or more)
of total revenues rather than the middle
tertile (52%–87%); if they offered
10–13 services rather than 14 or more;
if they were for-profit rather than
nonprofit or government-owned; and if
they were independent or jointly owned
with a hospital rather than jointly owned
with a health care system and other. The
largest effects were seen with agency
type, where 71% of for-profit agencies
adopted neither technology, compared
with 26% of voluntary nonprofits and
37% of government-owned agencies.
Joint ownership also showed strong
effects, with 62% of independent
agencies adopting neither technology,
compared with 44% of agencies
affiliated with a hospital and 23%
affiliated with a health care system.
In adjusted analyses, agency
adoption of neither type of technology,
rather than both or electronic health
records only (Table 2), was associated
with agency type and joint ownership.
Agencies that were for-profit and were
independent or jointly owned with a
hospital were more likely to have
adopted neither type of technology than
to have adopted both technologies or
only electronic health records.
In adjusted analyses, which
included only the variables with
significant bivariate associations with
adoption of neither technology (type of
care offered, percentage of revenue from
Medicare, number of services offered,
agency type, and joint ownership), the
same variables found significant in the
full model (agency type and joint
ownership) were significant in the
smaller model. The adjusted percentages
from this smaller model were very
similar to the adjusted percentages in
the full model. When ownership, joint
ownership, and percentage of revenue
from Medicare were dropped
sequentially, none of the remaining
variables were significant. However,
when type of care offered was dropped
as well, then the number of services
offered became significant. Adoption of
neither technology was associated with
offering 10–13 services, compared with
13 or more. (Data not shown.)
Functionalities most often
used in mobile technology
Most agencies with mobile
technology (agencies adopting both
mobile technology and electronic health
records or just mobile technology) used
functionalities related to the Outcome
and Assessment Information Set
(OASIS) (77%), e-mail (73%),
appointment scheduling (71%), clinical
decision support system (62%), and
computerized physician order entry
(51%) (Figure 2). Approximately
one-quarter used mobile technology for
viewing test results (25%) or for
electronic reminders for tests (23%).
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