DATA MANAGEMENT
Breaking Down Walls
Uncovering hidden insights by unifying fragmented data
By Mike Brents
A home health patient, recently discharged after a cardiac event, steps on a connected weight scale and slips on a blood pressure cuff first thing in the morning. The data syncs to an app—a small but meaningful win in managing their condition at home. A few hours later, their home health nurse arrives. To prepare, the nurse opens her agency-issued tablet, launches the remote patient monitoring (RPM) app to review the latest vitals, jots down the numbers, closes that app and opens the electronic medical record (EMR) to manually re-enter the weight and blood pressure. If this patient later transitions to hospice care, documentation will often move to yet another software system—without easy access to the patient’s rich history.
This daily dance of switching between apps, devices and logins is the reality of fragmented data in home health. Patient information is trapped in digital silos—isolated systems that don’t communicate. This isn’t just an administrative headache; it’s a barrier to proactive, coordinated care. When a patient’s story is scattered across disparate platforms, it drives inefficiency, increases the risk of error and undermines the experience for both clinicians and the patients they serve.
Opportunity Cost of Disconnected Data
The cost of disconnected data is significant. It can lead to missed care opportunities, delayed interventions and medication errors because clinicians lack a single, comprehensive source of truth.
Operationally, it creates a mountain of manual work; clinicians can spend 20% or more of their time on documentation, the majority being redundant entries that could be automated. Financially, the friction shows up as delayed claims, missed billing opportunities and weaker evidence of outcomes for value-based partners. In my view, the fix is rarely a rip-and-replace of core systems; it’s wiring the systems you already have into a reliable, shared data layer.
Why Data Silos Exist in the First Place
- Separate Business-Line Systems: Many agencies offering both home health and hospice use different EMRs for each line of business, often due to acquisitions or varying regulatory/billing requirements. While each system may be strong for its niche, the lack of integration forces clinicians who work across lines to juggle devices and logins—creating friction and a real data silo.
- Care Transition Gaps: The handoff from hospital or skilled nursing to homecare frequently arrives as faxes, PDFs or unstructured text that must be keyed into the agency’s EMR. This is time-consuming, error-prone and delays the start of effective care.
- Proprietary Technology: Beyond the EMR, home health pulls data from scheduling, billing, telehealth, secure messaging and an expanding array of RPM devices. Many vendors operate closed, proprietary systems with limited data access, creating a “lock-in” effect that fragments the patient record.
Practical Strategies for Unifying Data
1. Conduct a data audit.
You can’t fix what you can’t see. Map every data source your agency uses. A simple data flow diagram from intake to billing will show where data moves smoothly and where it hits a manual wall (fax, PDF upload, copy-paste). This quickly reveals the most critical silos and helps you prioritize.
2. Establish a centralized data hub.
Create a single source of truth without throwing out your current systems. A modern data warehouse (with a basic semantic layer) can pull and aggregate information from EMRs, RPM, scheduling and billing. The hub becomes a cohesive repository for key patient, episode, meds, vitals, visit and claims data—so clinicians and leaders can trust what they’re seeing.
3. Prioritize standardized data collection.
A hub is only as useful as the consistency of inputs. Align on naming conventions, picklists and formats across departments and devices. Standardized terminology and predefined fields ensure that once data is centralized, it’s actually usable for analysis and care coordination.
4. Leverage integration technology.
Interoperability is the point. Use integration platforms and APIs (including HL7/FHIR where available) as bridges between systems. Start with high-value use cases—e.g., write RPM vitals directly into the EMR to eliminate re-entry, or connect the EMR to secure messaging to streamline provider communication. Quick wins build momentum.
5. Create a culture of data ownership.
Technology alone won’t sustain the change. Define roles for data governance and enlist “data champions” within clinical teams to model best practices, reinforce standards and support peers. When everyone understands their role in data quality, outcomes and efficiency follow.
6. Partner with trusted, vendor-agnostic advisors.
Data integration in home health isn’t generic information technology. Work with advisors who have hands-on experience across home health and hospice EMRs, RPM platforms, payer requirements and HHVBP. Look for: proven integration playbooks, security/governance rigor, change management with clinical workflow mapping and a bias for quick wins. Insist on knowledge transfer and clear key performance indicators so your team can sustain the stack after go-live. Avoid “strategy-only” partners—choose advisors who will get hands-on with your data and workflows and leave you stronger, not dependent.
Future Vision
Breaking down data silos isn’t just about speed; it transforms care. A unified data ecosystem enables clinicians to make informed decisions, respond faster and deliver holistic, coordinated care. With the walls down, agencies unlock:
- Predictive Analytics: Spot high-risk patients—like early signs of fluid overload—before a crisis by trending vitals, symptoms and utilization.
- Operational Efficiency: Automate scheduling and resource allocation based on real-time acuity and geography, reducing drive time and burnout.
- Demonstrable Value: Give payers and health systems clear, quantifiable evidence—quality outcomes, readmission rates, cost of care—to win and perform under value-based contracts.
This connected vision is within reach. It starts with pragmatic steps: make the current data landscape visible, standardize what flows into it and integrate two or three high-impact connections. The result is a safer, more efficient and more sustainable home health care system—without waiting years for a perfect, monolithic platform.
Mike Brents, PT, DPT, MHA, is the managing director of technology consulting at SimiTree. With 20+ years of experience, he leads a team of experts in post-acute electronic medical record systems and data analytics. A licensed physical therapist and former chief clinical officer and vice president of informatics, Brents holds diverse experience in home-based care. Drawing on his unique clinical, operational and technical expertise, he helps organizations leverage technology and data to improve quality and operational efficiency. Visit simitreehc.com.
