Serving the home health, home care and hospice industry since 1999.

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by Darcey Trescone, RN, BSN

Healthcare at Home, The Rowan Report staff put out a survey to its subscribers to gather industry insider input regarding satisfaction with software systems overall and specifically about vendor implementation services to home health, home care, and hospice provider agencies. Areas asked about were sales process, achieved vs promised ROI, implementation planning and execution, timely regulatory updates, vendor innovation and the amount of agency internal resources required to provide end user support and on-going training needs. 

The seventy agencies that responded ranged in number of locations, field staff and overall census. 72 percent of survey responses pertained to software implementations occurring after the year 2010, with 40 percent of those occurring between 2015-2018. 

Below is a breakdown summary of respondent type:

Number of locations:

1 56.5%
2-5 30.4%
6-10 5.7%
11-25 1.4%
More than 25 5.7%


Number of field staff:

0-50 58%
50-100 12%
100-200 9%
200-500 14%
500-1000 4%
1000+ 3%


Average Daily Census:

0-50 19%
50-100 26%
100-200 10%
200-500 16%
500-1000 13%
1000-2000 10%
2000-3000 4%
3000+ 2%


Year software was implemented:

2000-2005 10%
2005-2010 18%
2010-2015 32%
2015-2018 40%


Nurse with Computer

Sales and Implementation Results:

The success of any EMR in an agency begins with selecting the right tool and ensuring it is implemented appropriately. Internal processes and utilization of the system to support the needs of the agency is critical. Once a contract is signed it is the responsibility of both the vendor and the agency to ensure the system is successful.

74 percent of all respondents were satisfied with the overall sales process when purchasing an EMR system. The overall theme from respondents not satisfied centered around the vendor not delivering what was promised during the sales process and feeling they were over-sold.

68 percent were satisfied with their vendor’s implementation process overall and felt the vendor partnered with their internal team to deploy the system. 77 percent of the respondents did report having a dedicated internal resource to oversee the implementation and work with the vendor.

32 percent were not satisfied with the vendor’s implementation process and 23 percent did not have a dedicated internal resource to work with the vendor. Having an agency internal resource to oversee and work with the vendor on implementation could have a correlation to overall system satisfaction.

Efficiencies Gained with EMR Results

An EMR system has multiple moving parts and efficiencies gained can correlate to financial savings and gains, if measured. Software vendors have multiple accountabilities to deliver on functionality that supports operational and clinical aspects of an agency, as well as regulatory updates and market changes. Overall, respondents report positive experiences in this area but it is unclear that consumer expectations are in line with vendor delivered ROI and innovation.

77 percent of respondents reported achieving improvements and efficiencies from a clinical and back-office perspective. 23 percent reported that their software system neither improved nor harmed costs and revenue.

Multiple respondents, while reporting having achieved improvements and efficiencies, did not feel they achieved their expected ROI with the purchase of their EMR system. This is interesting because improvements and efficiencies are typically what support achieving the desired ROI. In spite of this negative indication from a few, 82 percent of respondents feel their EMR software at least meets the daily operational needs of their agency. 

It is interesting to note that 14 percent report their EMR exceeds their expectations, 25 percent report their EMR keeps them efficient, and 43 percent of respondents reported that the EMR meets their operational needs "fairly well." 18 percent of respondents report their EMR does not meet their daily operational needs.

Other survey indicators

85% report their EMR software vendor delivers timely on regulatory needs but that number needs to be broken down:

  • 27.5% Always releases changes prior to regulatory deadline
  • 30.4% Always releases changes on or before regulatory deadline
  • 27.5% Releases changes on time but occasionally with errors
  • 4.3% Occasionally misses regulatory deadlines
  • 10.1% Appears not to make regulatory changes a priority

57 percent are of the opinion that they receive the innovation (new functionality) they expected from their EMR vendor; 43 percent are of the opinion that they do not. When asked to explain, many comments focused on basic, essential clinical or back office functionality being absent or cumbersome.


About ongoing support and training

The EMR systems in our industry are so much more than patient electronic medical records. They provide functionality for business development, staffing and scheduling, human resource management, clinical compliance, billing, payroll, reporting and more. Ongoing oversight of utilization, support and delivery of training after initial implementation is the responsibility of the agency that purchased the system. Respondents told us this about their training and support efforts.

  • 61 percent of responding agencies claim to have a dedicated internal resource to provide support to end users. 39 percent do not have a dedicated internal resource for end user support.
  • 62 percent of agencies responding claim to have a dedicated internal resource that provides training on updates/changes to their EMR. 
  • 28 percent rely on their vendor’s online training system.
  • Only 1 percent claimed to engage the vendor for on-going training.
  • 9 percent reported having no internal resource or engaging the vendor to train.
  • 32 percent of respondents claimed that part or all their staff does not engage in additional product training from their vendor on a yearly basis. 
  • 25 percent responded they engage in training once a year.
  • Overall, 57 pecent of all respondents are not engaging in additional product training from their vendor.

The health and success of an agency can be seen in how well they utilize their EMR system. Software selection, implementation, on-going support/training and marrying internal processes with the tool’s functionality is a shared duty. Both the seller (vendor) and buyer (agency) of a system in any industry are on the hook for achieving ROI and consumer satisfaction.  

Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at


©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.