5 Questions With Nick Knowlton, ResMed VP of Strategic Initiatives

Almost all doctors and hospitals say they’re more likely to refer patients to a post-acute care provider that can support electronic data sharing, according to a recent report Brightree and MatrixCare. The biannual Interoperability and Engagement Research Report surveyed more than 130 hospital and physician entities that refer patients for post-acute care (PAC) services, plus over 300 PAC providers including home health, hospice, home medical equipment, pharmacy, home infusion and skilled nursing facilities.  

It is the third iteration of the report and the first to include data from home medical equipment (HME) providers. It found that 99% of referrers surveyed said they’d be more likely to choose PAC providers who can support their interoperability needs—up from 74% in 2021 and 60% in 2019.  

Some of the other findings included:  

• 98% of home health care and hospice providers said interoperability is important to their referral sources, up from 85% in 2021 and just 34% in 2019. 
• 99% of referring entities said they’d be more likely to send referrals to HME, pharmacy and home infusion providers who can receive orders electronically. 
• Only 20% of HME providers and pharmacies said they receive referrals via electronic data exchange most of the time. 

You can click here to see the full data for home health and hospice or here for HME, pharmacy and home infusion.  

HomeCare talked with Nick Knowlton, vice president of Strategic Initiatives at ResMed (the parent company of Brightree and MatrixCare) to find out more about the results and the latest in interoperability.  

HomeCare: How did you start doing the survey in the first place?  
Knowlton: I’ve been part of the Brightree family for about eight years, since the home health and hospice product rolled up under that brand name and came into ResMed through the acquisition. When I first came over to the company, I was talking with a bunch of my old electronic health record customers from when I was in the physician world. And we asked them “What do you think of post-acute care?” And they gave me all sorts of anectodal answers like: “It’s the black hole of care delivery. We lose patients once they go into post-acute, we don’t know what happens there, and this is going to become a lot more important in the future.” They had other problems they felt were more pressing, but as we started getting closer to more referral sources that were saying “This is of increasing importance,” we thought, these anecdotes are one thing but let’s actually try to bring some data to the conversation about what the market is telling us and telling provider organizations so that everyboy understands how important that is. That was really the intent for doing the survey.  

HomeCare: Did you find anything surprising about the results this time?  
Knowlton: I wouldn’t say that the results are surprising per se. It was more about how much more seriously referral sources and post-acute providers in general are taking the topic of interoperability. Out of the gate, in 2019, 60% (of primary care providers) said they would switch (away from a post-acute provider that did not interoperable access to patient data)…. And in 2019, only roughly a third of providers thought interoperability was important to their referral sources, and now 98% of them recognize it. You know, the first step is recognizing “Hey, we need to do something here,” and step two is doing something about it.  

When it comes to the first-year data on HME—there are a lot of similarities there. The referral sources expect to be able to connect just the same way they do with other care settings. But also, (it’s good to see) the level of opportunity that’s there in terms of improvement for the percent of orders that get passed electronically. And also the number of organizations that say they’re going to invest more heavily in these types of technologies in the near future—that’s great!  

HomeCare: When you talk about interoperability from an HME perspective, are you talking about e-prescribing?

Knowlton: E-prescribe is a great example of interoperability. When we talk specifically about orders transitioning electronically, that would be e-prescribe, but there are other opportunities to interoperate with referral sources outside of that. We see a lot of different things from HME customers now about wanting to report back on observations about patients with referral sources. If you think about it, the HME can be the first one in the patient’s home—maybe they’re dropping off an oxygen concentrator, and they might call up that referral source and say “We dropped of Nick’s concentrator, but he’s in a wheelchair, he has no access to food and no wheelchair ramp at his house.” We all know he’s going to readmit in 24 hours. So, thinking about the broader opportunities for interoperability, I think HMEs can play a much bigger role; they’re very interested in doing everything they can to be a better partner with their referral sources along those lines. 

HomeCare: Do the referrers—the physicians or the health systems etc.—do they still have that original perception of post-acute care as a black hole? Is that changing?  
Knowlton: So, it would probably be good for us to ask some survey questions about this in the future. But I am definitely starting to feel the love for our industry with regards to playing an increasingly important role in helping patients manage chronic disease in their own home. I absolutely believe that our industry’s making traction in terms of representing that value. By freeing up some of the data and some of the insights, our providers are becoming much better partners to their referral sources and achieving quadruple-aim type goals for the patient populations that those referral sources are serving.  

HomeCare: Are there any trends or maybe things that are on the cutting edge that we should be looking at in terms of interoperability in general?  
Knowlton: I don’t think interoperability should just be limited to referral sources. As patients have become much better consumers over the course of the past few years—everything from high deductible health plans to people getting digital experiences when trying to interact with providers during the pandemic—the level of expectation for not just patients, but also for family caregivers to interact with provider organizations has really become more important. I think we’re only going to see that level of interest from patients as consumers and family caregivers increase. Also, if you look at the information blocking rules that have been released at a steady cadence over the course of the past several years, making sure patients can get access to their data and interact with care team members is definitely of increasing importance.