Heart to Heart Hospice is a private provider of hospice care with more than 40 locations across Texas, Michigan and Indiana. Its mission is to provide compassionate end-of-life care while prioritizing the well-being of patients and clinicians alike.
THE CHALLENGE
Before implementing medication management technology, Heart to Heart Hospice grappled with several pressing challenges. Clinicians faced extensive documentation requirements during patient admissions, particularly during the start-of-care visit, when all medications currently in the home must be reviewed, reconciled and entered into the electronic health record.
This process alone could take upwards of an hour, making start-of-care visits significantly longer and more burdensome than routine encounters.
While lengthy visits are challenging in themselves, the sheer volume of documentation, especially around medications, detracts from direct patient interaction and contributes to clinician frustration and burnout. Time spent typing in medication names, dosages and instructions is time not spent building rapport with the patient and family, performing assessments or offering comfort.
In this way, more than the visit duration, administrative overload becomes the barrier to delivering high-quality, compassionate care, said Patrick McPherson, senior vice president of EMR operations at Heart to Heart Hospice.
"We also saw wide variability in how medications were documented across our clinicians, which introduced inconsistency and increased the risk of errors," he explained. "Without a standardized system to guide medication entry and care planning, our teams were left to make decisions independently at the point of care, adding cognitive load and opening the door to potential compliance gaps.
"These inefficiencies underscored our need for a scalable system that could streamline documentation, support clinical decision making and improve consistency across our multi-state operation," he added.
PROPOSAL
To address these challenges, the organization turned to the medication kit functionality embedded within its EHR, Homecare Homebase. This functionality allowed staff to create and implement a standardized, scalable system for medication selection and documentation, customized based on historical prescribing patterns, symptom-based care needs and formulary requirements.
"The proposal centered on building customizable medication kits – essentially pre-defined, editable templates of medications mapped to specific symptoms, conditions or levels of care," McPherson explained. "These kits would allow our clinicians to choose from commonly prescribed medications within a single workflow, reducing manual data entry, standardizing care and minimizing documentation errors.
"Crucially, we could tailor each kit's medications, dosages, frequencies and instructions while keeping space for clinician judgment and patient-specific customization," he continued.
By housing the kits within the EHR, clinicians could access them during any visit, not just admissions, though the greatest impact was expected during start-of-care visits, when entering all home medications is most time-consuming.
"We anticipated this would alleviate documentation burdens, speed up admissions, and provide clearer, care-planned medication records for surveyors and pharmacists alike," he said. "The kits also positioned us to manage costs more effectively by ensuring alignment with our pharmacy benefit manager and internal formulary."
MEETING THE CHALLENGE
Heart To Heart Hospice began its implementation by analyzing two years of prescribing data across the organization and extracting the top 500 most frequently ordered medications. After filtering for duplicates and non-formulary items, staff narrowed the list to around 250 medications.
These were reviewed in collaboration with the on-staff pharmacist, clinical leadership and executive medical directors to build the initial kit structure.
"Rather than base our kits solely on diagnoses, we chose to organize them around symptoms and levels of care, a decision that better aligned with how our clinicians approach care planning, and matched the patient-centered care plan framework in the EHR," McPherson noted. "We ultimately built 32 distinct medication kits covering categories such as cardiovascular, respiratory, GI, endocrine, general inpatient care, continuous care and pain, as well as symptom-specific categories like fever, dyspnea, nausea and secretions.
"The kits were designed to include both brand-name and generic options where appropriate, allowing clinicians to recognize and select familiar medications without risking duplication," he continued.
Once built in the Homecare Homebase back office, the kits were tested by clinical supervisors using real patient scenarios. Staff opted to pilot in multiple branches simultaneously, rather than a single test site, in order to collect broader feedback.
Training was conducted by the clinical leadership team, not just IT support, so field clinicians could hear directly from their peers on how and why the kits were built and how to apply them. Educational notes within each kit reminded clinicians to personalize the fields that could not be pre-filled, like start dates and medication understanding.
"From a systems perspective, the kits were integrated within the EHR's workflow and linked to our pharmacy benefit manager, Script Care," McPherson explained. "This alignment reduced the need for clinicians to reformat prescriptions manually within the PBM portal, as medication selections from the kits were pre-templated to match formulary and prescription standards.
"The process now supports smoother transitions from clinician selection to pharmacy fulfillment while reducing time and errors at each step," he added.
RESULTS
McPherson points to three major results that prove the success of the medication management effort.
"First, a 28.5-minute reduction in documentation time," he reported. "Since rolling out our medication kits, we've seen this average reduction in admission visit documentation time. This time savings is particularly impactful during high-acuity cases, like general inpatient care admissions, where medication reconciliation is especially complex.
"By removing the need to search for and build each medication from scratch, clinicians can move more efficiently through the EHR and focus their time on patient and family needs," he added.
Second, clinician satisfaction and adoption.
"Our staff of 800 nurses, including triage, admissions, case managers and on-call clinicians, have responded positively to the new system," he said. "Our current adoption rate stands at nearly 65%, and we've received only four support tickets specifically related to med kits since launch.
"This low error rate reflects both the thoughtful buildout of the templates and our field teams' comfort with the tool," he continued. "We've also seen an increase in communication between field clinicians and patient care managers, helping drive ongoing engagement and education."
And third, improved care planning and surveyor feedback.
"By aligning medications with our patient-centered care plan categories and including clear documentation fields, the technology has significantly improved our ability to care plan medications within the EHR," he said. "In fact, during one recent survey, an inspector noted she could tell our documentation practices had improved just by comparing a pre-kit chart to a newer one, calling out how clearly medications were planned.
"That kind of feedback speaks to the operational and compliance impact this tool has delivered beyond efficiency alone," he added.
ADVICE FOR OTHERS
If a provider organization is considering implementing medication management technology through customizable kits, be prepared to invest upfront in thoughtful planning and stakeholder collaboration, McPherson advised.
"This isn't a plug-and-play process," he said. "We started by analyzing two years of data, engaging our pharmacy and compliance teams, and having our clinical leaders drive decisions from the ground up. That investment in cross-functional design not only ensured our kits reflected real-world usage, it also helped drive clinician buy-in from day one.
"Also, don't underestimate the importance of education that speaks the clinician's language," he continued. "Our success hinged on having clinical leaders, not just tech trainers, deliver training and contextualize how the kits map to actual care planning and patient needs. Ensure that educational notes within the kits reinforce both regulatory requirements and patient safety goals."
And finally, prioritize integration with the PBM and EHR workflows to minimize manual entry and reduce documentation friction, he said.
"When the templates and back-end systems work in concert, it lifts a major administrative burden and lets clinicians focus on what matters most: caring for patients," he concluded.
Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
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