Improving Quality of Care Through Health Tech Adoption in US Nursing Homes

An article published in Public Policy & Aging Report discusses the current state of health information technology (HIT) adoption in US nursing homes (NHs), highlighting the barriers and limitations that exist and the need for future policies to promote widespread adoption to improve care outcomes for residents. 

The US long-term care system currently consists of many nursing homes with high occupancy rates and a primary workforce of nurses. However, the adoption of HIT in nursing homes has been limited due to outdated technologies, poor infrastructure, and reduced incentives, leading to longer resident stays and potential harm. Researchers are increasing efforts made to address this issue and achieve widespread HIT adoption in nursing homes as recommended by the National Academies of Medicine Engineering and Science. 

“Health information technology is a key input to improving nursing home quality of care,” wrote authors.  

Various barriers to the adoption of nursing home HIT include lack of training, poor adaptation to work processes, and inadequate restructuring of teams, which have resulted in lower adoption rates. The current system's failure to adopt HIT and electronic health records (EHRs) in nursing homes is causing disparities in structure and resident outcomes. A lack of federal support and incentives for NHs has led to differences in digital maturity compared to other healthcare sectors, hindering the adoption of HIT. Inadequate infrastructure, limited interoperability, and a lack of workforce readiness contribute to the challenges NHs face in implementing and managing HIT systems. 

Federal policies have been implemented to support the adoption of NH HIT to improve clinical assessments, patient safety, quality monitoring, and workforce development. The Improving Medicare Post-Acute Care Transformation Act of 2014 mandated standardized clinical data for bidirectional information exchanges between post-acute care providers. The Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 transitioned the Medicare EHR Incentive Program to the Merit-Based Incentive Payment Program, which includes criteria for electronic information exchange. The 21st Century Cures Act focused on advancing HIT interoperability and defined interoperability as the exchange of accessible health information. The CMS's Data Element Library and other projects support interoperability and encourage information sharing between providers and patients. However, there is a need for federal incentives and timelines to promote EHR adoption and ensure NHs have the necessary resources and support. 

Goal 7 of the National Academies of Medicine Engineering and Science’s Report (NASEM) made recommendations such as providing financial incentives for nursing homes to adopt certified EHRs and developing criteria for health information exchanges (HIEs). The report also suggests measuring HIT adoption and interoperability in nursing homes and providing financial support for workforce training in HIT. Additionally, the report encourages funding rigorous evaluation studies to examine the use of HIT to improve resident outcomes and address disparities in adoption and use. These recommendations aim to improve resident outcomes, enhance care coordination, and increase staff productivity by adopting HIT in nursing homes. 

The current system of financing, delivering, and regulating care in nursing home settings in the US is deemed ineffective, inefficient, fragmented, and unsustainable by experts. 

“One hope for improved quality of NH care is use of HIT, but barriers to adoption that have long been enacted need to change. The time for change is now,” said researchers.  

Reference  

Alexander GL & McMullen T.  Probing into federal policies and national academies’ recommendations to adopt health information technology in all U.S. nursing homes. Public Policy & Aging Report. 2023;33(1):S28–S34. doi:10.1093/ppar/prac026