A national report of nursing home information technology: year 1 results

What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol

INTRODUCTION

The number of Canadians 75 years and older is expected to double over the next 20 years, putting continuing care systems such as long-term care (LTC) homes under increasing pressure. Health information technology (IT) has been found to improve the quality, safety and efficiency of care in numerous clinical settings and could help optimise LTC for residents. However, the level of health IT adoption in Ontario's LTC homes is unknown and, as a result, requires an accurate assessment to provide a baseline understanding for future planning.

METHODS AND ANALYSIS

We will use a cross-sectional design to investigate the level of IT maturity in Ontario's LTC homes. IT maturity will be assessed with the LTC IT Maturity Instrument, a validated survey examining IT capabilities, the extent of IT use and degree of internal/external IT integration across the domains of resident care, clinical support and administrative activities. All LTC homes in Ontario will be invited to participate. The Director of Care for each home will be directly contacted for recruitment. The survey will be distributed online (or by paper, if preferred) to LTC homes and completed by a staff member designated by the LTC to be knowledgeable about its IT systems. Analyses will consist of descriptive statistics characterising IT maturity across LTC homes and inferential statistics to examine the association between key facility-level characteristics (size, ownership, rurality) and IT maturity.

ETHICS AND DISSEMINATION

This study was reviewed by the Ottawa Health Science Network Research Ethics Board and was exempt from full ethics review. Findings will be disseminated through peer-reviewed publication and presentations to the scientific community and stakeholders. Dissemination of our findings will not only inform provincial planning for harnessing the potential of technology in LTC but may also enable quality improvement initiatives in individual LTC homes.

The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents

Urinary tract infections (UTIs) are the most common infections among nursing home (NH) residents. Antibiotics are often misused when a UTI is suspected. Using sophisticated information technology (IT) could help in appropriate UTI prevention, diagnosis, and treatment. This repeated cross-sectional study explored relationships between IT maturity and UTI prevalence among long-stay NH residents. Data were from (1) four annual surveys 2013-2017 measuring IT maturity in a random sample of Medicare-certified NHs, (2) Minimum Data Set assessments for resident characteristics, and (3) Certification and Survey Provider Enhanced Reporting data for facility characteristics. In multivariate regressions using NH fixed effects, controlling for resident and NH characteristics, Administrative IT maturity in NHs was associated with decreased odds of UTI (AOR: 0.906, 95% CI: 0.843, 0.973). These results were robust in all sensitivity analyses. Using IT to relieve administrative burden may decrease UTIs.

A Report of Information Technology and Health Deficiencies in U.S. Nursing Homes

OBJECTIVE

The aim of the study was to investigate the impact of nursing home (NH) information technology (IT) sophistication on publically reported health safety deficiency scores documented during standard inspections.

METHODS

The sample included 807 NHs from every U.S. state. A total of 2187 health inspections were documented in these facilities. A national IT sophistication survey describing IT capabilities, extent of IT use, and degree of IT integration in resident care, clinical support, and administrative activities in U.S. NHs was used. The relationship between NH health deficiencies and IT sophistication survey scores was examined, using weighted regression.

RESULTS

Controlling for registered nurse hours per resident day, deficiency scores decreased as total IT sophistication increased. Controlling for total IT sophistication score, deficiency scores decreased as registered nurse hours per resident day increased. Ownership status significantly influenced health deficiency scores.

CONCLUSIONS

These results highlight the necessity to understand benefits of implementing NH IT and demonstrating its impact on patient safety.

Evaluation frameworks for digital nursing technologies: analysis, assessment, and guidance. An overview of the literature

Background

The evaluation of digital nursing technologies (DNT) plays a major role in gaining knowledge about certain aspects of a technology such as acceptance, effectiveness, or efficiency. Evaluation frameworks can help to classify the success or failure of a DNT or to further develop the technology. In general, there are many different evaluation frameworks in the literature that provide overviews of a wide variety of aspects, which makes this a highly diverse field and raises the question how to select a suitable framework. The aim of this article is to provide orientation in the field of comprehensive evaluation frameworks that can be applied to the field of DNT and to conduct a detailed analysis and assessment of these frameworks to guide field researchers.

Methods

This overview was conducted using a three-component search process to identify relevant frameworks. These components were (1) a systematized literature search in PubMed; (2) a narrative review and (3) expert consultations. Data relating to the frameworks’ evaluation areas, purpose, perspectives, and success definitions were extracted. Quality criteria were developed in an expert workshop and a strength and weakness assessment was carried out.

Results

Eighteen relevant comprehensive evaluation frameworks for DNT were identified. Nine overarching evaluation areas, seven categories of purposes, five evaluation perspectives and three categories of success definitions could be identified. Eleven quality criteria for the strengths and weaknesses of DNT-related evaluation frameworks were developed and the included frameworks were assessed against them.

Conclusion

Evaluators can use the concise information and quality criteria of this article as a starting point to select and apply appropriate DNT evaluation frameworks for their research projects or to assess the quality of an evaluation framework for DNT, as well as a basis for exploring the questions raised in this article. Future research could address gaps and weaknesses in existing evaluation frameworks, which could improve the quality of future DNT evaluations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00654-8.

Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review

BACKGROUND

People living with all stages of dementia should have the opportunity to participate in meaningful occupations. For those living in care homes, this may not always occur and residents may spend significant parts of the day unengaged, especially those living with more advanced dementia. Digital technologies are increasingly being used in health care and could provide opportunities for people living with dementia (PLWD) in care homes to engage in meaningful occupations and support care staff to provide these activities. With technology advancing at a rapid rate, the objective of this scoping review is to provide an up-to-date systematic map of the research on the diverse range of digital technologies that support engagement in meaningful occupations. In particular, focus will be given to barriers and facilitators to inform future intervention design and implementation strategies, which have not yet been clearly mapped across the full range of these digital technologies.

METHOD

A scoping review will be conducted to systematically search for published research using a comprehensive search strategy on thirteen databases. Published, peer-reviewed studies that focused on PLWD in the care home setting and assessed any form of digital technology that supported a meaningful occupation will be included. All methodologies which meet the criteria will be included. Data will be extracted and charted to report the range of digital technologies, underlying mechanisms of action, facilitators and barriers to implementation.

DISCUSSION

Mapping the range of technologies to support PLWD to engage in meaningful occupations will identify gaps in research. The systematic search will include a diverse range of technologies such as software to enhance care planning, tablets devices, smartphones, communication robots and social media platforms, rather than focussing on a specific design or interface. This will enable comparison between mechanisms of action, barriers and facilitators to implementation which will be useful for future research and intervention design.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/7UDM2.

Qualitative Validation of the Nursing Home IT Maturity Staging Model

The goal of the current study was to qualitatively explore issues of validity, specificity, and sensitivity regarding the nursing home (NH) information technology (IT) maturity survey and staging model. Participants who completed the NH IT maturity survey were recruited during pilot testing of the survey and staging model. Cognitive interviewing was used to collect qualitative data. Findings indicate the NH IT maturity survey and staging model is a straightforward and acceptable instrument. Every participant in our study agreed with the IT maturity stage assigned to their facility, based on their total score on the IT maturity survey. However, some participants were not sure how to answer some questions on the survey because they did not have in-depth knowledge of IT processes that took place outside of their NH facility and others experienced difficulty interpreting items because their NH facility was in a time of transition. The next step in development is quantitative psychometric testing and use of the instrument in a 3-year national study. [Journal of Gerontological Nursing, 46(7), 47-54].

Exploring Resident Care Information Technology Use and Nursing Home Quality

A wide array of sophisticated information technology (IT) systems are being used in nursing home (NH) resident care to improve quality. The purpose of the current study was to explore differences in NH IT sophistication, a comprehensive measure of adoption, used in resident care processes based on facility characteristics over 4 consecutive years and to examine the impact on select long-stay NH quality measures. Results indicate IT systems used in resident care are becoming increasingly sophisticated. NH bed size, type of ownership, and location were significant predictors of IT score in areas related to resident care. Results also suggest that as electronic clinical processes and documents increase (e.g., incident reporting, nursing flowsheets, care planning) in resident care, more falls with injury are detected. Continued assessments of NH IT sophistication are important as the impact of technology on quality continues to be evaluated. [Journal of Gerontological Nursing, 46(4), 15-20.].

Health Data Sharing in US Nursing Homes: A Mixed Methods Study

OBJECTIVES

(1) To understand the extent to which nursing homes have the capability for data sharing and (2) to explore nursing home leaders' perceptions of data sharing with other health care facilities and with residents and family members.

DESIGN

Exploratory, mixed-methods.

SETTING AND PARTICIPANTS

We conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 815) representing every state in the United States. Next, semistructured interviews were used to elicit rich contextual information from (n = 12) administrators from nursing homes with varying data-sharing capabilities.

METHODS

We used descriptive statistics along with Rao-Scott chi-square and logistic regression models to examine the relationship between health data-sharing capabilities and nursing home characteristics such as location, bed size, and type of ownership. Qualitative data were analyzed using content analysis.

RESULTS

Of the 815 nursing homes completing the survey, 95% had computerized (electronic) medical records, and 46% had some capability for health information exchange. Nursing homes located in metropolitan areas had 2.53 (95% confidence interval = 1.53, 4.18) times greater odds for having health information exchange capability compared with nursing homes in small towns. Perceived challenges to health data sharing with residents and family members and external clinical partners include variance in systems and software, privacy and security concerns, and organizational factors slowing uptake of technology. Perceived benefits of health data sharing included improved communication, improved care planning, and anticipating future demand.

CONCLUSIONS AND IMPLICATIONS

As health data sharing becomes more ubiquitous in acute care settings, policy makers, nursing home leaders, and other stakeholders should prepare by working to mitigate barriers and capitalize on potential benefits of implementing this technology in nursing homes.

Advancing health information technology roadmaps in long term care

BACKGROUND

Our purpose is to provide evidence that health information technology should be a mainstay of all future health and social support services for older people globally, both within and across community and residential care services.

METHODS

This work was conducted in two phases. In phase I, the authors conducted a focused exploration by selecting a convenience sample of four long term care health information technology roadmaps, developed by members of four different long term care health information technology collaboratives in United States, Australia, United Kingdom, and New Zealand. During Phase II the research team carried out an extensive systematic review of existing literature sources (2000-2018) to support roadmap assumptions.

RESULTS

Using converging domains and content, we offer recommendations among five aged care roadmap domains: Strategy/Vision, Continuing Care Community, Services and Support Provided, External Clinical Support, and Administrative. Within these domains we provide recommendations in five content areas: Innovation, Policy, Evaluation, Delivery Systems and Human Resources. We recommend future strategies for LTC HIT roadmaps that include 61 emphasis areas in aged care in these content areas and domains.

CONCLUSIONS

The roadmap provides a navigation tool for LTC leaders to take a strategic and comprehensive approach as they harness the potential of health information technologies to address the challenges and opportunities of LTC in the future.

Exploring information technology (IT) sophistication in New South Wales residential aged care facilities

Objective The aim of this study was to determine baseline information technology (IT) sophistication in New South Wales (NSW), Australia, residential aged care facilities. Method IT sophistication measures IT capabilities, extent of IT use and IT integration in two domains, resident care and clinical support. A survey was administered to all NSW residential aged care facilities (n = 876) between February and May 2017. A 15% response rate was achieved (130/876). Facilities were organised by organisational type, total residential places and remoteness. Using post-stratification weights, estimates of IT sophistication scores for NSW were determined. Regression was used to examine whether there was a linear relationship between IT sophistication and the ratio of residents receiving high care. Results Participating facilities were similar to other NSW facilities in residential places and remoteness, but different in organisational type. IT sophistication was highest in IT capabilities and integration in resident care. IT sophistication was lowest in clinical support. Respondents had a mean of 1.2 years of IT experience. IT sophistication varied among aged care facilities. There was a linear relationship (P < 0.05) with the proportion of high-care residents and total IT sophistication Conclusion Routine reports of IT sophistication in aged care are not available. If data were available, determining the influence of IT sophistication on the quality care for residential aged care would be possible. What is known about the topic? Aged care settings that deliver care to the older population need to be contemporary in their approach to delivering high-quality and safe care. Health IT holds great potential for improving the quality and safety of care of older residents in aged care facilities. What does this paper add? This report provides a baseline assessment of IT capabilities, extent of IT use and IT integration, called IT sophistication, among aged care facilities with variable characteristics. What are implications for practitioners? Increasing IT sophistication has the potential to improve the quality of care delivered by aged care staff.

A National Report of Nursing Home Quality and Information Technology: Two-Year Trends

Health Information Technology is transforming healthcare delivery. This research report describes 2 year trends in technology adoption, called information technology sophistication, defined as capabilities, extent of use, and integration of technology. Trends are identified using a validated annual survey. In Year 1, 815 facilities participated in the survey; in Year 2, 484 nursing homes repeated the survey representing every US state. Statistically significant increases in information technology sophistication were found in resident care and total scores. Sample homes tended to be smaller and from small town/rural areas. There were more information technology gains than losses in technology sophistication over the 2 years in the sample. Significant correlations were identified between differences in information technology sophistication and 12 different quality measures.

Ternary Trends in Nursing Home Information Technology and Quality Measures in the United States

Nursing home information technology (NH IT) adoption trends are not measured regularly. Evidence indicates digital footprints are growing, but gaps about NH IT adoption and quality impacts remain. We hypothesize as NH IT adoption grows, quality improves. This research assessed ternary (2014-2017) trends in IT and quality measures using a primary survey of U.S. NHs. Survey measures included nine dimensions/domains and total IT sophistication. Administrators completed 815 Year 1 surveys. Each year mean total IT sophistication scores in nine dimensions/domains consistently increased. Eighteen significant correlations (r > .13, absolute value) between IT sophistication and quality measures existed. Regression shows that for every 10 units increase in administrative activity extent of IT use, a decrease of 1.3% occurs in the percentage of low-risk long-stay residents with bowel or bladder incontinence. Increases in NH IT sophistication positively impact quality. Estimating ongoing trends in NH IT sophistication provides new information that should be consistently available.

Building consensus toward a national nursing home information technology maturity model

OBJECTIVES

We describe the development of a nursing home information technology (IT) maturity model designed to capture stages of IT maturity.

MATERIALS AND METHODS

This study had 2 phases. The purpose of phase I was to develop a preliminary nursing home IT maturity model. Phase II involved 3 rounds of questionnaires administered to a Delphi panel of expert nursing home administrators to evaluate the validity of the nursing home IT maturity model proposed in phase I.

RESULTS

All participants (n = 31) completed Delphi rounds 1-3. Over the 3 Delphi rounds, the nursing home IT maturity staging model evolved from a preliminary, 5-stage model (stages 1-5) to a 7-stage model (stages 0-6).

DISCUSSION

Using innovative IT to improve patient outcomes has become a broad goal across healthcare settings, including nursing homes. Understanding the relationship between IT sophistication and quality performance in nursing homes relies on recognizing the spectrum of nursing home IT maturity that exists and how IT matures over time. Currently, no universally accepted nursing home IT maturity model exists to trend IT adoption and determine the impact of increasing IT maturity on quality.

CONCLUSIONS

A 7-stage nursing home IT maturity staging model was successfully developed with input from a nationally representative sample of U.S. based nursing home experts. The model incorporates 7-stages of IT maturity ranging from stage 0 (nonexistent IT solutions or electronic medical record) to stage 6 (use of data by resident or resident representative to generate clinical data and drive self-management).

A National Assessment of Access to Technology Among Nursing Home Residents: A Secondary Analysis

Background

According to the National Center for Health Statistics, there are over 1.7 million nursing home residents in the United States. Nursing home residents and their family members have unique needs and stand to benefit from using technology empowering them to be more informed and engaged health care consumers. Although there is growing evidence for benefits of patient-facing technologies like electronic patient portals on patient engagement in acute and outpatient settings, little is known about use of this technology in nursing homes.

Objective

The purpose of this study was to report findings from a secondary analysis of data from a national nursing home study of information technology (IT) adoption, called IT sophistication. We describe the extent to which nursing homes (n=815) allow residents or their representatives to access technology including electronic health records, patient portals, and health information-exchange systems as well as the ability of the residents or representatives to self-report data directly into the electronic health record.

Methods

We used descriptive statistics and regression techniques to explore relationships between information technology adoption (IT sophistication) and residents’ or their representatives’ access to technology. Covariates of location, bed size, and ownership were added to the model to understand their potential influence on the relationship between IT sophistication and resident access to technology.

Results

Findings revealed that resident access to technology was a significant predictor of the nursing home IT sophistication (P<.001). The inclusion of covariates—nursing home location, bed size, and ownership—with their interactions produced a nonsignificant effect in the model. Residents’ or their representatives’ use of electronic health records and personal health records were both significant predictors of overall IT sophistication (P<.001).

Conclusions

As nursing homes continue to progress in technological capabilities, it is important to understand how increasing IT sophistication can be leveraged to create opportunities to engage residents in their care. Understanding the impact of health information technology on outcomes and which technologies make a difference will help nursing home administrators make more informed decisions about adoption and implementation.

Adoption of Health Information Technology Among US Nursing Facilities

OBJECTIVES

Nursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption.

DESIGN

Cross-sectional survey.

SETTING & PARTICIPANTS

We surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations' health information technology usage and characteristics.

MEASUREMENTS

Using questions adopted from existing instruments, the survey measured nursing home's EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for 8 determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources, and slack resources. A series of regression models estimated the association between potential determinants and technology adoption.

RESULTS

84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39, 95% confidence interval = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%).

CONCLUSIONS/IMPLICATIONS

An organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policy makers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities.

Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training

Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation.

Nursing Information Flow in Long-Term Care Facilities

OBJECTIVE

Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making.

METHODS

This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis.

RESULTS

Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or "sticky" notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed.

CONCLUSION

This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information technology (HIT) developers to consolidate the design of HIT solutions for LTC, and serve as a communication tool between nurses and information technology (IT) staff to refine requirements and support further LTC HIT research.

Analyzing Change in Nursing Home Information Technology Sophistication: A 2-Year Survey

Nursing home (NH) health information technology (IT) is becoming more prevalent across the country. Currently, a national sample of NHs is being surveyed for 3 consecutive years to determine trends in NH IT sophistication (e.g., measures of IT capabilities, extent of IT use, IT integration with internal and external stakeholders). IT sophistication is measured in resident care, clinical support, and administrative activities. The current article provides details of the differences in NH IT sophistication reported by administrators completing Year 1 and Year 2 surveys. IT in clinical support (i.e., laboratory, pharmacy, and radiology) had the greatest differences. This difference is expected because these areas typically require external contracts, making it dificult to fit IT with existing workflows, which is important for sustained adoption. [Journal of Gerontological Nursing, 43(1), 17-21.].