The hospital inputs their data into Epic medical software. The home care agency tracks their data in an 80,000-line Excel spreadsheet (less than 8,000,000, which is good, right?). My mother copies down the name and other personal identifiers like insurance numbers from the Excel spreadsheet, counts (with the end of a pen on the screen) the number of billable visits, and enters this by hand onto a printed form which receives minor changes as you noted. She then collates these forms into stacks for various insurance agencies, and faxes the piles to the appropriate numbers. She's an RN, has 20 years of experience, and this is what they pay her to do?
Oh, and her password for remote login to do this from home was (until last week when she told me because I was talking to my sister about password strength) literally abc123. This was the default set by the IT department about 2 years ago.
I will never work in medical IT due to real-life horror stories like this.