The HITECH Act’s $25 billion investment in health information technology had several omissions in the continuum of care. For one, it excluded providers of long-term care from getting EHR incentive payments. Because nursing homes did not receive the same level of investment in technology as hospitals, there has been less research about the impact of technology on patient care in that sector.
But a research team from the University of Missouri has found a correlation between increasing IT sophistication and improvements in healthcare quality measures. By overlaying survey data about IT sophistication with already published quality scores, they are able to see where technology appears to be enabling nursing homes to overcome previously recognized deficiencies. Results of their early research, “A national report of nursing home information technology adoption and quality measures,” were published in the Journal of Nursing Care Quality.
Despite the lack of federal incentives, it does appear that nursing homes are starting to invest in clinical IT systems, even if they do lag behind those in the acute-care settings. “From this national survey we conducted, there appears to be a stronger presence of IT in resident care now,” said Greg Alexander, professor in the Sinclair School of Nursing. “Before most of the strength was in administration, because that was where billing and the business office was. There used to be little emphasis on clinical areas like lab tests and pharmacy, but I do sense that it is increasing.”
To understand the relationship between IT sophistication and quality measures in health care, Alexander and his team, Richard Madsen, a statistician with the medical research office in the MU School of Medicine and project staff Erin Miller and Keely Wise, are assessing national trends in IT adoption every year over a three-year period using an IT Sophistication Survey. The assessment provides scores based on IT capabilities, extent of IT use and IT integration, and how they are used in resident care, clinical support and administrative activities.
“We found that as IT sophistication increases in resident care, there appears to be a positive impact on quality measures,” he said. “This finding means that if nursing home staff have access to the right technological tools and are using them to facilitate resident care, quality of care can and should improve.”
Alexander said there also is a push in the industry for nursing homes and acute-care providers to share more data electronically, especially to reduce hospital re-admissions. “Those facilities more likely to adopt and integrate technology will have a much greater ability to connect with other people in the network, which is what Meaningful Use wanted,” he said. But the problem is that there are 16,000 nursing homes and a lot fewer hospitals. How are those networks going to be built and maintained? “It is a system that has been built relying on fax numbers and paper transfers with EMS people going back and forth. The culture of exchange that exists is a paper exchange,” he added. “Building a network of trust requires technological savvy, and you have to have some resources dedicated to building those networks. But I think it will catch on. Those in post-acute care realize they must do this, and I think hospitals do, too. They are looking for people they can connect with and who have the resources to do it.”
Alexander recently received a Fulbright U.S. Scholar program grant to Australia from the U.S. Department of State and the J. William Fulbright Foreign Scholarship Board. The grant will be used to study informatics in nursing homes. He will be researching IT sophistication and quality measures in nursing homes at Macquarie University as part of a project to improve patient care in Australia’s nursing homes.