“HIT: Benefits, Dissemination and Noticeable Absence in U.S. Nursing Homes” by Lilly Gerrity
Texas Insight writer Lilly Gerrity examines the incorporation of Health IT into U.S. hospitals and the comparative lack thereof in our nursing homes.
The American Hospital Association states that, America’s hospitals have been pioneers in harnessing IT to improve patient care, quality and efficiency and share the vision of a health care system where widespread use of interoperable electronic health records (EHRs) supports improved clinical care, better coordination of care, fully informed and engaged patients, and improved public health. The benefits of Health Information Technology have been well-documented, but its diffusion throughout the U.S. has all but missed a rather critical faction of society: the residents of nursing homes and long-term care facilities.
What is Health Information Technology (HIT)?
HIT is reported to have numerous benefits for the U.S. healthcare system that include efficiency, quality, error-reduction, cost-effectiveness, etc. The term encompasses a number of different technologies whose function is to store, share, and analyze health information. These include:
- Electronic Health Records (EHRS): electronic systems that store your health information. These make it easier for your physician to access your medical records and share them with relevant parties, such as a specialist or consulting physician, etc.
- Personal Health Records (PHRs): similar to an EHR with the exception that you control the information contained in those records, and if you want, can include information about your life outside of doctor’s visits.
- E-Prescribing: allows physicians to communicate directly with your pharmacy rather than having to deal with paper trails.
- Personal Health Tools: can include digital mental health platforms, smartphone applications, text reminders, etc. to help you keep track of your health for yourself.
- Online Communities: communities you can join for information-sharing and support.
Why is it important?
In truth, the real-world cost-effectiveness of HIT depends entirely on how its implementation impacts the structure of a given organization or entity. Additionally, while various reports have shown a steady increase in HIT adoption, its impacts have been mixed. However, it has very tangible benefits—the most important of which may be the reduction of medical errors.[NCBI] “Clinical HIT systems may make a substantial impact on medical quality and safety by integrating relevant automated decision making and knowledge acquisition tools into the practices of medical providers, thereby reducing errors of omission that result from gaps in provider knowledge or the failure to synthesize and apply that knowledge in clinical practice.”[NCBI] In the ambulatory healthcare environment, Health IT offers a number of other notable advantages:
- Improving the efficiency “[and] financial health” of that environment;
- Using EHRs to monitor and improve clinical quality;
- e-prescribing may improve the safety and efficiency of prescribing practices; and
- Widespread implementation of Health IT can allow for information-exchanges among providers in the same organization, between different organizations, and ultimately, “nationwide.”
Health IT in the U.S.
Funding for HIT was an important chunk of the American Reinvestment and Recovery Act, which allotted significant funds to advancing health IT “to improve quality, safety, efficiency in health care while also reducing health disparities.”[SD] Hospitals, however, received more investment in technology than nursing homes, leading to a poor or limited understanding of the relationship between advanced IT and patient care in nursing homes. According to Greg Alexander, professor in the Sinclair School of Nursing, “Approximately 16,000 nursing homes exist in the United States, and more than one million older Americans depend on nursing homes for their care…Yet despite the significant role nursing homes play in health care, nursing homes do not receive the same financial incentives to upgrade their IT systems as hospitals.” [SD]
Why not nursing homes?
Information on the implementation of HIT in nursing homes is unfortunately limited and often outdated. However, there are several specific barriers discussed in a report from the Agency for Healthcare Research and Quality. These include a lack of computer skills among LTC staff, a lack of proven benefit or clarity regarding return on investment, lack of capital resources, no reimbursement for using health IT, potential consequences of new State and Federal requirements, difficulties finding appropriate products, and a shortage of professional health IT staff. Building on that, a report published last year by the Journal of Post-Acute and Long-Term Care Medicine discussed the characteristics of individual nursing homes and how those characteristics influenced the adoption of HIT. Their findings were:
|Nursing homes with licensed nursing staff levels above the state average were 20% more likely to adopt computer-provided order entry (CPOE) than homes with licensed nursing staff below average. Resident resources (more Medicare-paid patients and fewer Medicaid patients) were positively correlated to health IT adoption, particularly to a clinical data repository (CDR), clinical decision support systems (CDSS), and an order entry (OE) system. Other characteristics, including chain affiliation, ownership, and market competition, are also related to some health IT adoption within nursing homes.|
To Err is Human
Countless entities feel that HIT is an inevitability in healthcare centers all over the U.S., because it will dramatically reduce the potential for simple, normal, often inescapable human error to have a negative effect on a patient. Additionally, the ability to share medical records and other information across channels in a fast and efficient manner can be critical to getting a patient the treatment they need when they need it. The AHRQ reported that a health information structure supporting an EHR system could have numerous benefits for long-term care/nursing home settings, including:
- Reduced medical errors and increased resident and patient safety.
- Valuable information available at the point of care.
- Enhanced communication and information exchange between varied entities, such as physicians, staff, residents, families of residents, pharmacies, and others.
- Improved regulatory compliance.
- Improved provider efficiency and satisfaction.
All of these suggest that implementing HIT in more nursing homes across the U.S. would not only improve their efficiency, but could greatly improve the overall health, and quality of life of their residents.