NCHS Data Brief ■ No. 45 ■ September 2010

u.s. department of health and human services

Centers for Disease Control and Prevention

National Center for Health Statistics

Electronic Medical Record Adoption and 

Use in Home Health and Hospice

Anita Bercovitz, Ph.D.; Manisha Sengupta, Ph.D.; and Patricia Jamison, M.P.H.

Key findings

Data from the National 

Home and Hospice Care 

Survey, 2007

•	 In 2007, about 5,900 of 

the 14,500 providers of home 

health or hospice care (41%) 

had electronic medical records 

(EMRs), and an additional 

2,200 (15%) planned to have 

EMRs within the next year. 

Providers who offered both 

hospice and home health care 

were more likely to have 

EMRs than providers offering 

only home health care, but did 

not differ from providers of 

hospice care only. 

•	 Among providers 

with EMRs, 98% used 

components for recording 

patient demographics and 

83% for clinical notes, and 

over one-half used clinical 

decision support systems or 

computerized physician order 

entry. 

•	 Nonprofit and government

providers, providers jointly 

owned or operated with other 

health care organizations, 

and providers with over 150 

patients were more likely to 

have EMRs.

To promote the use of electronic health records (EHRs), the American 

Recovery and Reinvestment Act (ARRA) included financial incentives for

meaningful users of EHRs (1). Although ARRA provisions and incentives 

apply primarily to physicians’ offices and hospitals, persons receiving home

health and hospice care also receive care from physicians and hospitals. 

Coordination of care across sites of care through exchange of clinical 

information is one priority of ARRA (2). The increase in use of home health 

care from 1999 through 2007 (3) suggests that care coordination among other 

health providers and home health care will become increasingly important.

Nationally representative data on electronic medical record (EMR) use by 

providers of home health and hospice care are limited. This report provides 

baseline estimates for EMR use by providers of home health or hospice care 

in 2007, prior to implementation of ARRA incentives. 

Keywords: health information technology • long-term care • electronic health 

records

Forty-one percent of all home health or hospice care 

providers had EMRs in 2007.





















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NCHS Data Brief ■ No. 45 ■ September 2010

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•	 Of the 14,500 providers of home health or hospice care in 2007, approximately 5,900 (41%) 

had EMRs (Figure 1) and an additional 2,200 (15%) had plans for acquiring EMRs within 

the next year. 

•	 About 63% of providers offering both home health and hospice care had EMRs compared 

with 37% of providers offering home health care only. Forty-nine percent of providers of 

hospice care only had EMRs. 

Among providers with EMRs, almost all used components for patient 

demographics, and more than one-half used components for clinical notes, 

clinical decision support systems, or computerized physician order entry.

•	 Of the 5,900 providers of home health or hospice care with EMRs, 98% used a component 

for patient demographics (Figure 2). 

•	 Eighty-three percent of providers with EMRs used components for clinical notes, 57% for 

clinical decision support systems (CDSS), and 52% for computerized physician order entry 

(CPOE). 

     

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NCHS Data Brief ■ No. 45 ■ September 2010

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•	 Approximately one-fifth of providers with EMRs used components for test reminders (23%)

and displaying test results (20%). 

•	 Nine percent of providers with EMRs used the component for sharing records electronically 

with other agencies. 

Over one-half of providers with electronic medical records used three or 

fewer components.

•	 Twenty-eight percent of providers with EMRs used one or two components, 28% used 

three components, 22% used four components, and 23% used five to eight components.

No significant differences were found among the percentages of providers using differing

numbers of components (Figure 3).

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NCHS Data Brief ■ No. 45 ■ September 2010

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Providers with EMRs varied by profit status, ownership, and size. 

•	 Nonprofit and government providers (68%) and providers that were jointly owned or

operated by other health care organizations (62%) were more likely to have EMRs (see

table).

•	 No significant differences existed in the proportion of providers with and without EMRs

by whether: the providers were part of a chain; had contracts with managed care providers, 

assisted living facilities, skilled nursing facilities, or hospitals; or were located in a 

metropolitan statistical area (see table). 

•	 A greater proportion of providers with more than 150 patients had EMRs (60%) than 

providers with all other patient sizes (see table). 

Table. Percentage of providers of home health or hospice care with selected provider characteristics, by 

whether had electronic medical records: United States, 2007 

Characteristic Had EMR1 No EMR1

Total2 41 55

Is provider part of a chain?

Yes 33 65

No 45 50

Is provider independent or owned by other organization?3

Independent 34 61

Owned or operated by other organization4 62 38

Is provider nonprofit or for profit?3

Nonprofit or government owned 68 29

For profit 26 68

Does provider have a contract to provide services to:

Managed care providers 49 47

Assisted living facilities 49 47

Skilled nursing facility 52 45

Hospital 45 51

Is provider located in a metropolitan statistical area?

Yes 40 54

No5 44 55

Total number of current patients6

0–50 34 62

51–100 39 57

101–150 33 66

151 or more 60 34

1

At time of 2007 National Home and Hospice Care Survey. 2

Providers missing information on EMR are included in the denominator for calculating percentages. Percentages may not sum to 100 across rows due to 

missing data and rounding.

3

Significant difference among providers with EMRs by characteristic at p < 0.05. 4

Includes joint ownership or operation with outpatient medical or surgical center, managed care organization, hospital, skilled nursing facility, or other health care 

system.

5

Includes micropolitan statistical area and other.

6

Significant difference among providers with EMRs at p < 0.05 between providers with 151 or more current patients and all other patient categories.

NOTE: EMR is electronic medical record.
NCHS Data Brief ■ No. 45 ■ September 2010

■  5  ■

•	 No differences were found in whether providers had EMRs by their source of revenue, 

whether Medicare, Medicaid, private insurance, or patient out-of-pocket payments (results 

not shown).

Summary

Overall, 41% of providers of home health or hospice care had EMRs in 2007 and an additional 

15% planned to obtain EMRs within the next year. This proportion was greater than the 35% of 

office-based physicians with EMRs in 2007 (4,5). Nonprofit and government providers, providers

owned or operated with other health care organizations, and providers with over 150 patients 

were more likely to have EMRs. The association between size and having EMRs is similar to 

other studies among office-based physicians, hospitals, and nursing homes and a previous study

of providers of home health or hospice care (5–8). Similarly, the association between joint 

ownership or operation and having an EMR is similar to other studies among physician groups 

jointly owned by other providers (9). 

Of providers with EMRs, virtually all used a component for patient demographics (98%), 83% 

used components for clinical notes, 57% used CDSS, and 52% used CPOE. Over one-half (56%) 

of providers with EMRs used three or fewer components.

All EMR components included in this study are considered essential in achieving the 

improvements in quality and efficiency posited by use of EMRs, as highlighted in the proposed

definition of meaningful use (2). However, less than one-half of providers of home health or

hospice care had EMRs, and less than 10% of providers with EMRs used the component of 

sharing records with other agencies. To meet the ARRA priority to improve care coordination by 

electronic exchange of clinical information among providers across the spectrum of health care, 

EMR use among providers of home health or hospice care would need to increase significantly.

Definitions

EMRs and EHRs: Often used interchangeably to refer to electronic records of health-related 

information. However, one formal definition of an EMR is an electronic record based within one

health care organization, while an EHR is interoperable and thus can be used by more than one 

health care organization (10).

Having an EMR: Based on agency self-report at time of the National Home and Hospice Care 

Survey (NHHCS) and is defined by a “yes” response to: “Does this agency currently have an

Electronic Medical Records system? This is a computerized version of the patient’s medical 

information used in the management of the patient’s health care. Exclude electronic records 

used only for billing purposes and required documentation such as OASIS files.” If respondents

answered “no” they were then asked, “Does this agency have plans to obtain an Electronic

Medical Records System within the next year?”

Components of electronic medical records: Based on agency self-report of use of specific

components at time of NHHCS. Specific component use is defined by a “used” response

to: “With this agency’s current Electronic Medical Records system, please indicate for each

component listed below, whether it is used, available but not used, or not available.” Components

included CPOE for prescriptions, labs, and tests; test results (chest x-rays, labs, etc.); patient 

demographics; electronic reminders for tests (labs, imaging, etc.); CDSS for contraindications, 
NCHS Data Brief ■ No. 45 ■ September 2010

■  6  ■

allergies, guidelines, etc.; clinical notes; public health reporting (notifiable diseases); and sharing

medical records electronically with other agencies. One agency (of the 1,036 that participated in 

the survey) reported having an EMR, but that all the components were not used although they 

were available.

Data source and methods

Data from the 2007 NHHCS were used for these analyses. The 2007 NHHCS used a stratified

two-stage probability sample design. The first stage was the selection of home health and

hospice care agencies from the sampling frame representing the universe of agencies providing 

home health and hospice care services in the United States. Agencies affiliated with hospitals,

government entities, retirement centers, or similar institutions where the agencies maintained 

financial and patient records independent of the larger institution were included in the frame.

The primary sampling strata of agencies were defined by agency type and metropolitan statistical

area status. Within these sampling strata, agencies were sorted by census region, ownership,

certification status, state, county, ZIP Code, and size (number of employees). For the 2007

NHHCS, 1,545 agencies were sampled with probability proportional to size. The unweighted 

response rate was 71%. The response rate weighted by the inverse of the probability of selection 

was 59% (11).

Differences among subgroups were evaluated using chi-square and t tests. All significance tests

were two-sided using p < 0.05 as the level of significance. All comparisons reported in the text

are statistically significant unless otherwise indicated. Data analyses were performed using the

statistical packages SAS version 9.1 (SAS Institute, Cary, N.C.) and SUDAAN version 9.0 

(Research Triangle Institute, Research Triangle Park, N.C.). Because estimates were rounded to 

the nearest hundred, individual estimates may not sum to totals. 

About the authors

Anita Bercovitz and Manisha Sengupta are with the Centers for Disease Control and Prevention’s 

(CDC) National Center for Health Statistics (NCHS), Division of Health Care Statistics. Patricia 

Jamison is with CDC’s NCHS, Office of the Center Director.
NCHS Data Brief ■ No. 45 ■ September 2010

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References

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for Health Information Technology. HealthIT.hhs.gov information related to the American 

Recovery and Reinvestment Act of 2009. Available from: http://healthit.hhs.gov/portal/server.

pt?open=512&objID=1233&parentname=CommunityPage&parentid=9&mode=2&in_hi_

userid=10741&cached=true [Accessed 6/10/10].

2. U.S. Department of Health and Human Services. Medicare and Medicaid Programs; 

Electronic Health Record Incentive Program Final Rule. Federal Register 75(144):44314–588. 

2010.

3. Ng T, Harrington C, Kitchener M. Medicare and Medicaid in long-term care. Health Aff 

29(1):22–88. 2010.

4. Hsiao CJ, Beatty PC, Hing ES, et al. Electronic medical record/electronic health record use 

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emr_ehr.htm [Accessed 6/24/10].

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6. Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, et al. Use of 

electronic health records in U.S. hospitals. N Engl J Med 360(16):1628–38. 2009. 

7. Pearson WS, Bercovitz AR. Use of computerized medical records in home health and hospice

agencies: United States, 2000. National Center for Health Statistics. Vital Health Stat 13(161). 

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8. Resnick HE, Manard BB, Stone RI, Alwan M. Use of electronic information systems in 

nursing homes: United States, 2004. J Am Med Inform Assoc 16(2):179–86. 2009.

9. Burt CW, Sisk JE. Which physicians and practices are using electronic medical records?

Health Aff 24(5):1334–43. 2005.

10. The National Alliance for Health Information Technology. Report to the Office of the

National Coordinator for Health Information Technology on defining key health information

technology terms. 2008. Available from: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS

_0_10741_848133_0_0_18/10_2_hit_terms.pdf [Accessed 6/10/10].

11. Dwyer LL, Harris-Kojetin LD, Branden L, Shimizu IM. Redesign and operation of the 

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NCHS Data Brief ■ No. 45 ■ September 2010

Suggested citation

Bercovitz A, Sengupta M, Jamison P. 

Electronic medical record adoption and use 

in home health and hospice. NCHS data 

brief, no 45. Hyattsville, MD: National 

Center for Health Statistics. 2010.

Copyright information

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source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

 Director for Science

Division of Health Care Statistics

Jane E. Sisk, Ph.D., Director

U.S. Department of

Health & Human Services

Centers for Disease Control and Prevention

National Center for Health Statistics

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