Adoption and Utilization of Electronic Health Record Systems by Long-Term Care Facilities in Texas

摘要

Long-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs.A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities. Key words: electronic health record, long-term care, health information technology, survey, utilization, technology adoptionBackgroundThe aging of the US population and the projected growth of the oldest age bracket (85 years and older) will have a major effect on the demand for and supply of long-term care (LTC) services and on the resources needed to provide those services.~(1) Seniors themselves consume more than 50 percent of total healthcare services and dollars in this country.~(2) LTC providers care for the fastest-growing segment of the population and account for a high proportion of the healthcare dollars spent. The patients in LTC experience frequent transitions, which may create gaps in quality and opportunities for errors.~(3)~(,)~(4)An electronic health record (EHR) system has the potential to reduce errors, improve quality of care, and deliver healthcare more efficiently.~(5)~(,)~(6) LTC providers can “achieve an increase of 37 percent in administrative productivity” by using EHR systems over time.~(7) Although health information technology (HIT) applications that positively affect both quality of care and patient safety currently exist, they are not widely used in current LTC settings.~(8) LTC facilities lag in EHR adoption, compared to the other sectors of healthcare.~(9) Part of the reason for this is that current HIT agendas and strategies focus more on acute and ambulatory care, and LTC suffers from relative inattention.~(10) Chaudhry et al. summarized the impact of EHRs on the quality, efficiency, and cost of medical care from 74 journal articles at four benchmark institutes; however, none of the studies included a LTC setting.~(11) Furthermore, most EHRs are intended primarily for acute care facilities, so LTC facilities face unique challenges in using EHRs, such as different documentation needs for facilitating preventive measures, different starting doses of medications, and special reporting needs. Utilization of EHRs in LTC facilities does not initially save time for clinicians.~(12) LTC settings are often intensely interdisciplinary and holistic in their approach to their patients and residents. Therefore, the challenges and opportunities for promoting EHR adoption and utilization in LTC facilities are greater than ever.~(13)Policy makers need reliable and valid data on EHR adoption rates in LTC facilities to assess movement toward the goal of promoting EHR adoption.~(14) If national cross-sectional data were available, we could have a “big picture” of national EHR adoption and utilization status in LTC facilities. If time-series data in a state were available, we could analyze the trend of EHR adoption and utilization status in LTC facilities in that state. However, information on EHR adoption in LTC facilities is relatively scarce.~(15) In January 2010, the US Department of Health and Human Services (HHS) developed two survey instruments on EHR adoption and use in nursing homes. Unfortunately, no further report was published. Consequently, no national cross-sectional data are available. Several regional surveys, including a 2008 report from Minnesota and a 2007 report from California, are the only EHR adoption and utilization data sources related to LTCs.~(16)~(,)~(17) No regional survey has been conducted more than one time to provide time-series data. On the positive side, each of the state surveys contributed a piece of puzzle to the “big picture” of national EHR adoption and utilization status, and set a baseline for these states. Because EHR adoption and utilization has been proposed for decades, no state has the first-mover advantage in EHR adoption. Therefore, we have reasons to assume that EHR adopt