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3 types of technology support for hospice and palliative physicians and nurse practitioners

While physicians have the same direct care role within hospice and palliative organizations—as compared to those in ambulatory and acute environments—they often lack the tools found in the latter care settings. The biggest reason for this gap is the lack of EMR-integrated and hospice-specific applications for technology solutions that have been present in other care settings for more than a decade. This problem impacts all areas of an organization—from intake to revenue cycle—which is why an evolution of technology support for hospice and palliative physicians and nurse practitioners (NP) is imperative as the payment and regulatory landscape continues to evolve.

As hospice and palliative care physicians have the same pressures and requirements as their peers in other care settings, the aforementioned technology gap creates broken workflows and disparate connectivity, resulting in inefficient and error-prone processes that can affect patient care. Here, we discuss three integrated technologies that support workflows for hospice and palliative physicians and NPs that need to be part of every organization’s integrated toolkit.

1. Electronic prescribing

One piece of technology support for hospice and palliative care that some hospice physicians and NPs already use is electronic prescribing, which has been around since 2003. While many larger hospices already leverage this technology, smaller organizations continue to work directly with pharmacies by paper, phone, or other manual processes. But with the regulatory landscape changing around controlled substance reporting, all hospice organizations will be obliged to use an ePrescribing application or another electronic reporting tool. While ePrescribing solutions without an EMR integration may meet regulatory needs, it will also create an administrative nightmare with manual entry into multiple disparate applications. An integrated solution will not only help meet reporting requirements, but it will also help create a more efficient clinical operation. In fact, adopting an integrated ePrescribing tool is both a clinical and administrative win:

  • ePrescribe solution preloads with a reconciled medication profile.
  • Prescriptions can send directly to the pharmacy and integrate back into the EMR with one action.
  • ePrescribing eliminates the need to place phone calls with the pharmacy.
  • Using an ePrescribe tool helps to reduce manual data entry errors.
  • Physicians can rely on a single system for medication entry.

With the dynamics in today’s marketplace, integrating an ePrescribing solution directly into an EMR is no longer simply a want; it is a universal need within the hospice industry. Hospice and palliative care providers need an ePrescribing tool not only to meet controlled substance reporting requirements but also to streamline their organization and keep their teams happy. In short, ePrescribe is a must-have for hospices in 2021. Organizations that elect not to adopt an integrated ePrescribing tool may introduce risks and increase administrative overhead.

2. Voice to text

The second piece of technology support for hospice and palliative care physicians and nurse practitioners is voice-to-text and narrative entry. Similar to electronic prescribing, voice-to-text and narrative entry of information have also been around for years, but once again, have been primarily focused on acute and ambulatory providers. Similar to ePrescribe, existing solutions are rarely specific for hospice and palliative provider needs and are not clinical flow integration. Unfortunately, the barriers to voice-to-text adoption in post-acute settings are also financial, as most voice-to-text solutions are not priced at a level where many organizations can rationalize an investment. We would like to remove these barriers to support hospice and palliative providers.

Physicians in hospice settings are responsible for significant narrative documentation, and the content of their clinical observation is used by the rest of the hospice organization to care for the patient. To properly support the patient, the narrative documentation captured by physicians must be thorough, which is a time-consuming process even for the most accomplished typists. Voice-to-text solutions—long in use in other care settings like radiology—allow for more efficient narrative entry because people can talk up to 50% faster than their typing speeds. In addition, when users are speaking, their narrative becomes richer—while capturing more words in place of typing. A richer narrative means a more accurate view of the patient’s condition, ensuring the best possible care decisions can be made.

To fully realize the value of a voice-to-text solution, like ePrescribe, it must be integrated. Having a voice-to-text option available at key points of an assessment or other narrative entries ensures the tool is used to the fullest extent. Integrated technology also helps avoid unnecessary clicks or taps, which can make a process feel inefficient and create a barrier to adoption. Once an organization has implemented a voice-to-text option for their physicians and NPs, opportunities to improve patient care through more thorough documentation can be realized.

3. Direct messaging

The third piece of technology support for hospice and palliative care is provider-to-provider communication over the Direct Trust Network which is another technology advantage seen in ambulatory and acute care, but often absent in hospice and palliative settings. Whether communicating within your different locations or a community of organizations working together, care needs to be coordinated and transitioned easily through the proper implementation of technology. Palliative care physicians and NPs have an especially challenging time, as they need to communicate their documentation back to the patient’s primary care physician, specialist, and possible acute care provider. This burden often falls on clinical support staff and leads to mistakes that happen when relying on fax or in-person delivery (a mode made difficult since the onset of COVID-19).

An additional scenario for palliative organizations is that often physicians and NPs are documenting in external EMRs used by the hospital or outpatient clinic. This information needs to make its way back to their organization’s EMR to meet health record and revenue cycle requirements. In many cases, this is supported by outdated standards of communication like faxes or in-person exchange—methods that are inefficient and error-prone.

Much like ePrescribe and voice-to-text technologies, without this functionality integrated into your hospice or palliative EMR, the full potential cannot be realized. The capabilities must be easily accessible and embedded into the patient health record.

Direct messaging is an essential tool for coordinating complex palliative and post-acute referrals without adding work to the administrative flow. Through technology embedded directly into an EMR, providers can share medical records, visit/encounter notes, new advanced directives, and more. Interoperability is an ongoing conversation effort between providers across the care continuum, and using the right tools to facilitate communication can have a tremendous impact on efficiency and quality. Hospice and palliative physicians and NPs can benefit greatly from strong workflows built on Direct Secure Messaging, and organizations should move quickly to adopt them.

How do we move forward?

It’s clear that, for many reasons, hospice and palliative physicians and providers often lack key technologies that their counterparts have in other care settings. Fortunately, opportunities to adopt and normalize these technologies in hospice and palliative care settings are becoming more frequent. The best path forward is to begin assessing how expanded technology solutions can solve different problems:

  • Identify the right partner. Whether that is your EMR or an external solution, ensure you feel comfortable in the partnership and demand integrated solutions.
  • Determine an ROI. Not every solution has a direct monetary ROI; assess for problems solved, not just efficiencies gained.
  • Start small. Adopt a solution with a core group of power users. If the solution is right for your organization, your key users can bring everyone else on board.
  • Engage your partner providers. Interoperability is a dialogue between providers, not just data connectivity. Demonstrate your value as a partner by engaging to build strong communication flows supported by technology.

Adopting established healthcare technology to support physicians and NPs will pay dividends with the right solutions and workflows. To survive the ever-changing environment of hospice and palliative care, organizations must take action to get the tools they need to thrive as quickly as possible.

Want to learn more? Let’s connect!


Chris Pugliese
Chris Pugliese

Chris Pugliese is a Senior Product Manager of Integration and Interoperability for MatrixCare. Chris has spent the last decade working with post-acute technology and EMRs, and the last 5 years focused on interoperability. His strength is enabling technology, as well as educating on the growing importance of interoperability and its benefits to the post-acute care settings. In a short time, Chris has become a leader, spearheading integration and interoperability initiatives within and outside of MatrixCare. Recent industry committee roles and responsibilities include: Leadership Team Member for the Post Acute Interoperability Work Group (PACIO), Technical Lead for the Functional Status Subgroup for the PACIO initiative – developing FHIR Profiles for Functional Status, CommonWell Health Alliance Use Case Committee member, CommonWell Health Alliance Specification Workgroup member


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