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 
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
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 governmentowned, 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%).
National Health Statistics Reports n Number 66 n May 20, 2013 Page 5

NOTES: OASIS is Outcome and Assessment Information Set. Mobile technology was adopted by 30% of home health and 

hospice care agencies. Figure excludes cases with missing data. See Data Analysis section for details. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. Percent of agencies with mobile technology

77 

73 71 

62 

51 

25 23 

0 

20 

40 

60 

80 

100 

OASIS E-mail Scheduling 

appointments 

Electronic 

reminders 

for tests 

Clinical 

decision 

support 

system 

Computerized 

physician 

order entry 

Viewing 

test 

results 

Figure 2. Home health and hospice care agencies with mobile technology, by functionality

used: United States, 2007

NOTES: Electronic health records were adopted by 44% of home health and hospice care agencies. Figure excludes cases 

with missing data. See Data Analysis section for details. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. Percent of agencies with electronic health records 

99 

84 

58 

51 

23 21 

9 

0 

20 

40 

60 

80 

100 

Demographics Clinical 

notes 

Clinical 

decision 

support 

system 

Computerized 

physician 

order entry 

Electronic 

reminders 

for tests 

Viewing 

test 

results 

Sharing 

records 

with other 

agencies 

Figure 3. Home health and hospice care agencies with electronic health records, by

functionality used: United States, 2007

Functionalities most often

used in electronic health

records

The majority of agencies with

electronic health records (agencies

adopting both mobile technology and

electronic health records or only

electronic health records) used

functionalities for patient demographics

(99%), clinical notes (84%), clinical

decision support systems (58%), and

computerized physician order entry

(51%) (Figure 3). Approximately

one-fifth of agencies with electronic

health records used electronic reminders

for tests (23%) and viewed test results

electronically (21%). Nine percent of

agencies with electronic health records

used functionalities to share records

with other agencies.

Functionalities most often

used by home health and

hospice care agencies with

both electronic health

records and mobile

technology

Four functionalities included on the

2007 NHHCS were included in

questions on both electronic health

records and mobile technology: clinical

decision support systems, computerized

physician order entry, electronic

reminders for tests, and viewing of test

results. Among home health and hospice

care agencies with both technologies, of

these four functionalities, clinical

decision support systems was most

commonly used on both types (60%),

followed by computerized physician

order entry (49%). The agencies also

used both technologies for electronic

reminders for tests (21%) and for

viewing of test results (18%) (Figure 4).

Summary

In 2007, 28% of home health and

hospice care agencies had adopted both

electronic health records and mobile

technology, 16% had adopted only

electronic health records, 2% had

adopted only mobile technology, and

54% had adopted neither.
Page 6 National Health Statistics Reports n Number 66 n May 20, 2013

NOTES: Both electronic health records and mobile technology were adopted by 28% of home health and hospice care 

agencies. Figure excludes cases with missing data. See Data Analysis section for details. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. Percent of agencies with both electronic health records and mobile technology 

Clinical decision 

support system 

Computerized 

physician 

order entry 

Electronic 

reminders 

for tests 

Viewing 

test results 

60 

49 

21 

18 

0 

20 

40 

60 

80 

100 

Figure 4. Home health and hospice care agencies with both electronic health records and

mobile technology, by functionalities used in both technologies: United States, 2007

In bivariate (unadjusted) analyses,

adoption of both electronic health

records and mobile technology was

associated with all the variables

included in the analyses, whereas

adoption of neither technology was

associated with type of care, percentage

of revenue from Medicare, number of

services offered, agency type, and joint

ownership. Adoption of only electronic

health records was associated with type

of care offered, number of patients,

agency type, and joint ownership.

In adjusted analyses, adoption of

both electronic health records and

mobile technology was associated with

number of patients and agency type,

whereas adoption of neither technology

was associated with agency type and

joint ownership. However, adoption of

only electronic health records was not

associated with any of the variables

included in the model, suggesting that

factors not examined in this study may

be driving adoption of only electronic

health records. Agency type was

associated with adoption of both types

of technology and with adoption of

neither type of technology. Nonprofit

and government-owned agencies were

much more likely to adopt both types of

technology than for-profit agencies;

conversely, for-profit agencies were

much more likely to adopt neither

technology. The results also suggest that

a threshold of 50 patients is associated

with adoption of both types of health

information technology.

Agencies that adopted only mobile

technology may differ from those

adopting only electronic health records

or both technologies. However, due to

the small sample size of agencies that

adopted only mobile technology in this

study, it was not possible to conduct

further analyses of these agencies.

Among agencies with electronic

health records (whether or not they also

had mobile technology), the most

commonly used functionalities were for

patient demographics and clinical notes.

Among agencies with mobile technology

(whether or not they also had electronic

health records), OASIS reporting,

e-mail, and appointment scheduling

were the most commonly used.

Functionalities included in the

questionnaire for both electronic health

records and mobile technology (clinical

decision support systems, computerized

physician order entry, viewing test

results, and electronic reminders for

tests) were used by similar proportions

in both types of technology. Among

agencies with both technologies, clinical

decision support systems and

computerized physician order entry were

used by at least one-half of agencies.

Functionalities such as clinical decision

support systems or computerized

physician order entry may lead to

improved coordination of care delivered

at the point of care among home health

and hospice care agencies by

incorporating information gathered

through mobile technology into the

electronic health record.

Several limitations should be

considered when interpreting the study

results. Because NHHCS is based on

self-report, interpretation of

functionalities may vary among

agencies. Agencies may have had

additional functionalities that were not

included as specific options on the

questionnaire. These would not have

been captured unless the agency

provided the specific functionality as a

write-in. (This occurred with clinical

documentation on mobile technology.

See Technical Notes, ‘‘Definition of

Terms.’’) An underlying assumption of

the potential benefits of co-use of

electronic health records and mobile

technology is that data can be

transferred within the agency between

different types of technology and that

the same software (e.g., for clinical

decision support systems) is available

for both technologies. Data to test this

assumption were not available from the

survey.

Proponents believe that health

information technology has the potential

to improve both quality and

coordination of care (1)—a major

concern in home health care (11).

Adoption of mobile technology and

electronic health records is increasing,

as is research on the impact of these

technologies on the quality and
National Health Statistics Reports

n Number 66n May 20, 2013	 Page7

coordination of care in home and

hospice (12–18).

References

1.	 Blumenthal D. Launching HITECH. N Engl J Med 362(5):382–5. 2010.

2.	 Trescone D. Success at the point of

care. Caring 25(7):40–2. 2006.

3.	 Sanchez I. Implementation ofa point

of care system in home health. Home

Healthc Nurse 227(10):623–9. 2009.

4.	 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. Available from:

http://www.cdc.gov/nchs/data/

databriefs/db45.pdf.

5.	 Philips national study on the future

of technology and telehealth in home

care. 2008. Available from:

http://www3.medical.philips.com/

resources/hsg/docs/en-us/custom/

PhilipsNationalStudyFullReport.pdf.

[Accessed 2010.]

6.	 Resnick HE, Alwan M. Use of health

information technology in home

health and hospice agencies:

United States, 2007.J Am Med

Inform Assoc 17(4):389–95. 2010.

7.	 Dwyer LL, Harris-Kojetin L,

Branden L, Shimizu IM. Redesign

and operation of the National Home

and Hospice Care Survey, 2007.

National Center for Health Statistics.

Vital Health Stat 1(53). 2010.

Available from: http://www.cdc.gov/

nchs/data/series/sr_01/sr01_053.pdf.

8.	 Park-Lee EY, Decker FH.

Comparison of home health and

hospice care agencies by

organizational characteristics and

services provided: United States,

2007. National health statistics

reports; no 30. Hyattsville, MD:

National Center for Health Statistics.

2010. Available from: http://www.

cdc.gov/nchs/data/nhsr/nhsr030.pdf.

9.	 SAS, release 9.2 [computer

software]. Cary, NC: SAS Institute.

2008.

10. SUDAAN, release 10.0 [computer

software]. Research Triangle Park,

NC: RTI International. 2008.

11. Boling PA. Care transitions and

home health care. Clin Geriatr Med

25(1):135–48, viii. 2009.

12. Stolee P, Steeves B, Glenny C,

Filsinger S. The use of electronic

health information systems in home

care: Facilitators and barriers. Home

Healthc Nurse 28(3):167–81. 2010.

13. Russell D, Rosenfeld P, Ames S,

Rosati RJ. Using technology to

enhance the quality of home health

care: Three case studies of health

information technology initiatives at

the Visiting Nurse Service of New

York.J Healthc Qual 32(5):22–9.

2010.

14. Buntin MB, Burke MF, Hoaglin MC,

Blumenthal D. The benefits of health

information technology:A review of

the recent literature shows

predominantly positive results.

Health Aff (Millwood) 30(3):464–71.

2011.

15. O’Malley AS, Grossman JM, Cohen

GR, Kemper NM, Pham HH. Are

electronic medical records helpful for

care coordination? Experiences of

physician practices.J Gen Intern

Med 25(3):177–85. 2010.

16. Wu RC, Straus SE. Evidence for

handheld electronic medical records

in improving care:A systematic

review. BMC Med Inform Decis

Mak 6:26. 2006.

17. Berner ES, Houston TK, Ray MN,

Alison JJ, Heudebert GR, Chatham

WW, et al. Improving ambulatory

prescribing safety witha handheld

decision support system:a

randomized controlled trial.J Am

Med Inform Assoc 13(2):171–9.

2006.

18. Feldman PH, Murtaugh CM, Pezzin

LE, McDonald MV, Peng TR.

Just-in-time evidence-based e-mail

‘‘reminders’’ in home health care:

Impact on patient outcomes. Health

Serv Res 40(3):865–85. 2005.
Page 8 National Health Statistics Reports n Number 66 n May 20, 2013

Table 1. Unadjusted percentages of home health care and hospice care agencies that have adopted both mobile technology and

electronic health records, electronic health records only, or neither, by agency characteristics: United States, 2007

Neither

Both electronic electronic

health records Electronic health records

and mobile health nor mobile

Selected characteristic technology records only technology

Total, n .................................. 3,600 2,100 7,100

Type of care offered

Home health care only ........................ 1

22 218 59

Hospice care only ........................... 1

35 14 51

Home health and hospice care ................... 1

60 6 133

Chain affiliation

Part of a chain ............................. 17 19 64

Not part of a chain ........................... 1

33 16 52

Adminstrator or director tenure at agency

24 months or less ........................... 26 21 53

25–70 months.............................. 17 19 65

71 months or more. . . . . . . . . . . . . . . . . . . . . . . . . . . 3

39 10 51

Total number of patients

49 or fewer ............................... 1

9 428 63

50–99................................... 32 10 58

100 or more ............................... 43 12 45

Percent of revenue from Medicare

51% or less ............................... 20 24 56

52%–87% ................................ 1

42 11 547

88% or more .............................. 16 17 66

Total number of services offered

9 or fewer ................................ 14 26 60

10–13................................... 27 11 6

62

14 or more. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

43 13 45

Agency type

For-profit ................................. 1

8 721 171

Voluntary nonprofit ........................... 67 7 26

Government and other ........................ 51 12 37

Joint ownership

Independent ............................... 1

18 819 162

Hospital ................................. 51 6 1

44

Health care system and other .................... 60 16 1

23

1

Significantly different from other categories at p < 0.05. 2

Significantly different at p < 0.05 from agencies offering both home health and hospice care. 3

Significantly different at p < 0.05 from administrator tenure of 25–70 months. 4

Significantly different at p < 0.05 from agencies with 50–99 patients. 5

Significantly different at p < 0.05 from agencies with 88% or more of revenue from Medicare. 6

Significantly different at p < 0.05 from agencies offering 14 or more services. 7

Significantly different at p < 0.05 from voluntary nonprofit agencies. 8

Significantly different at p < 0.05 from agencies owned jointly with a hospital.

NOTE: Percentages may not sum to 100 across rows because of rounding.

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
National Health Statistics Reports n Number 66 n May 20, 2013 Page 9

Table 2. Adjusted probabilities of home health and hospice care agencies that have adopted both mobile technology and electronic

health records, electronic health records only, or neither, by selected agency characteristics: United States, 2007

Neither

Both electronic electronic

health records Electronic health records

and mobile health nor mobile

Selected characteristic technology records only technology

Total, n .................................. 3,600 2,100 7,100

Type of care offered

Home health care only ........................ 27 18 55

Hospice care only ........................... 22 18 65

Both home health and hospice care ................ 27 10 57

Chain affiliation

Part of a chain ............................. 26 16 60

Not part of a chain ........................... 26 18 55

Adminstrator or director tenure at agency

24 months or less ........................... 27 20 51

25–70 months.............................. 21 19 60

71 months or more. . . . . . . . . . . . . . . . . . . . . . . . . . . 28 13 58

Total number of patients

49 or fewer ............................... 1

12 25 59

50–99................................... 31 11 58

100 or more ............................... 32 15 50

Percent of revenue from Medicare

51% or less ............................... 22 22 54

52%–87% ................................ 27 17 56

88% or more .............................. 28 14 60

Total number of services offered

9 or fewer ................................ 21 21 53

10–13................................... 26 12 64

14 or more. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 18 53

Agency type

For-profit ................................. 1

10 19 169

Voluntary nonprofit ........................... 54 11 29

Government and other ........................ 50 15 36

Joint ownership

Independent ............................... 25 18 56

Hospital ................................. 25 9 65

Health care system and other .................... 33 23 2

38

1

Significantly different from other categories at p < 0.05.
 2

Significantly different at p < 0.05 from agencies jointly owned with a hospital.
 

NOTES: The adjusted probabilities (predicted marginals) represent the percentage of home health and hospice care agencies with a given characteristic, by adoption of electronic health records
 

and mobile technology, while controlling for other variables in the logistic regression model. The variables controlled for in the model are type of care offered, chain affiliation, administrator or
 

director tenure at agency, total number of patients, percent of revenue from Medicare, total number of services offered, agency type, and joint ownership. Percentages may not sum to 100 across
 

rows because of rounding.
 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
 
Page 10 National Health Statistics Reports n Number 66 n May 20, 2013

Technical Notes

Data source and methods

Data from the 2007 NHHCS were

used for these analyses. The survey used

a stratified, two-stage probability design.

The first stage was the selection of

home health and hospice care agencies

from the sampling frame of over 15,000

agencies 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.

Data collection

Data for the 2007 NHHCS were

collected through personal interviews

with agency directors and staff who

used administrative records to answer

questions about the agency, staff,

services, and programs. Interviews were

complete for 1,036 agencies. The

unweighted response rate was 71%. The

response rate weighted by the inverse of

the probability of selection was 59%. A

detailed description of the sampling

design, data collection, and response

rates for NHHCS is provided elsewhere

(7) and online at http://www.cdc.gov/

nchs/nhhcs/nhhcs_questionnaires.htm.

Estimation

Because NHHCS statistics are based

on a sample, they will differ somewhat

from the data that would have been

obtained if a complete census had been

taken using the same definitions,

instructions, and procedures. However,

the probability design of NHHCS

permits the calculation of sampling

errors. The standard error of a statistic is

primarily a measure of sampling

variability that occurs by chance

because only a sample, rather than the

entire population, is surveyed. The

standard error also reflects part of the

variation that arises in the measurement

process but does not include any

systematic bias that may be in the data

or any other nonsampling error. The

chances are about 95 in 100 that an

estimate from the sample differs from

the value that would be obtained from a

complete census by less than twice the

standard error. More information on

estimation is available at http://www.

cdc.gov/nchs/data/nhhcsd/NHHCS_

NHHAS_web_documentation.pdf.

Estimates are considered reliable if

they are based on 60 or more sample

cases and the relative standard error

(RSE) is less than 30%. Estimates based

on 30–59 cases, or based on more than

59 cases but with an RSE exceeding

30%, are indicated as unreliable in the

text, tables, and figures.

Definition of terms

Adoption of mobile technology—Based

on agency self-report at the time of

interview and defined by a ‘‘yes’’

response to the question, ‘‘Does this

agency’s staff use any system for

Electronic Point of Care

Documentation? Include PDAs (Personal

Digital Assistants), Notebook PCs, or

other portable handheld devices.’’

Mobile technology functionalities—

Based on agency self-report of use of

specific functionalities at the time of

interview and defined by a ‘‘yes’’

response to the question, ‘‘Are these

devices used for any of the following?’’

Options were ‘‘yes’’ or ‘‘no’’ for each

functionality. Functionalities included

computerized physician order entry for

prescriptions or pharmacy, laboratory

work, or tests; viewing of test results;

electronic reminders for tests; clinical

decision support systems or reference

systems; e-mail communication with

agency staff or other staff; scheduling

appointments or visits; OASIS reporting;

and other. Based on write-in responses

to the Other category, clinical

documentation was added as a

functionality; however, the estimate is

unreliable due to small sample size and

is not presented in this report.

Adoption of an electronic health

record system—Based on agency

self-report at the time of interview and

defined by a ‘‘yes’’ response to the

question, ‘‘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.’’

Electronic health record

functionalities—Based on agency

self-report of use of specific

functionalities at the time of interview

and defined by a ‘‘used’’ response to the

following: ‘‘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.’’ Functionalities included

computerized physician order entry for

prescriptions, laboratory work, and tests;

viewing of test results (e.g., chest

x-rays); patient demographics; electronic

reminders for tests (e.g., laboratory tests

and imaging); clinical decision support

systems of contraindications, allergies,

guidelines, etc.; clinical notes; public

health reporting (notifiable diseases);

and sharing medical records

electronically with other agencies. Of

the 1,036 agencies that participated in

the 2007 NHHCS, one agency reported

having an electronic health record

system but that none of the

functionalities were used, although they

were available. Because the question

about mobile technology asks about the

use of the functionality, only ‘‘used’’

responses for electronic health record

functionalities are included, to allow

clear comparison with mobile

technology functionality use.

Type of care offered—Indicates

whether the agency offered home health

care only, hospice care only, or both

home health and hospice care.

Chain affiliation—Indicates whether

the agency was part of a chain
National Health Statistics Reports

n Number 66n May 20, 2013 Page 11

of two or more agencies under one

ownership or operation.

Administrator or director tenure at

agency—Based on responses to the

question at the time of interview,

‘‘About how long has he/she been the

Director/Administrator at this agency?’’

Administrator tenure was converted

from continuous variables toa

categorical variable with three levels:

24 months or less, 25–70 months, and

71 months or more

Total number of patients—Refers to

the number of patients receiving care

from the agency at the time of

interview. For agencies providing both

home health and hospice care, the total

number of patients included both types

of patients. The total number of patients

was converted toa categorical variable

with three levels: 49 or fewer patients,

50–99 patients, and 100 or more

patients.

Percentage of revenue from

Medicare—Based on the agency’s

estimate of what percentage of its

overall patient care revenue was from

Medicare. This variable was divided into

three categories: 51% or less, 52%–

87%, and 88% or more.

Total number of services

offered—Calculated as the sum of

‘‘yes’’ responses when the agency was

asked whether they offereda specified

service. Services included

complementary and alternative medicine,

dietary and nutritional services,

enterostomal therapy, IV therapy,

physician services, podiatry services,

skilled nursing services, wound care,

durable medical equipment, pharmacy

services, occupational therapy, physical

therapy, respiratory therapy, speech

therapy or audiology, companion

services, continuous home care,

homemaker services, Meals on Wheels,

assistance with activities of daily living,

transportation services, volunteer

services, pastoral services, mental health

services, referral services, respite care,

medical social services, ethical issues

counseling, grief or bereavement

counseling, and other. The number of

services was converted froma

continuous variable toa three-level

categorical variable:9 or fewer services,

10–13 services, and 14 or more services.

Agency type—This variable has three

categories: for-profit, voluntary

nonprofit, and government and other

(e.g., city, county, state, or federal

government, and Department of Veterans

Affairs).

Joint ownership—This variable was

collapsed into three categories:

independent, jointly owned with

hospital, and jointly owned with health

care system and other. Other includes

outpatient medical or surgical center,

managed care organization, and skilled

nursing facility.
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782

FIRST CLASS MAIL
 

POSTAGE & FEES PAID
 

CDC/NCHS
 

PERMIT NO. G-284
 

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

National Health Statistics Reports n Number 66 n May 20, 2013

Suggested citation

Bercovitz AR, Park-Lee E, Jamoom E.

Adoption and use of electronic health records

and mobile technology by home health and

hospice care agencies. National health

statistics reports; no 66. Hyattsville, MD:

National Center for Health Statistics. 2013.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., Acting Director

Jennifer H. Madans, Ph.D., Associate Director

for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.
 

For questions or general information about NCHS: Tel: 1–800–CDC–INFO (1–800–232–4636) • TTY: 1–888–232–6348
 

Internet: http://www.cdc.gov/nchs • Online request form: http://www.cdc.gov/cdc-info/requestform.html
 

DHHS Publication No. 2013–1250 • CS239260