Factors affecting electronic health record adoption in long-term care facilities

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.

Hospitals' Adoption of Mobile-Based Personal Health Record Systems and Patients' Characteristics: A Cross-Sectional Study Analyzing National Healthcare Big Data

Insufficient information exists on the associations between hospitals' adoption of mobile-based personal health record (mPHR) systems and patients' characteristics. This study explored the associations between patients' characteristics and hospitals' adoption of mPHR systems in Korea. This cross-sectional study used 316 hospitals with 100 or more beds as the unit of analysis. Previously collected data on mPHR adoption from May 1 to June 30, 2020 were analyzed. National health insurance claims data for 2019 were also used to analyze patients' characteristics. The dependent variable was mPHR system adoption (0 vs 1) and the main independent variables were the number of patients, age distribution, and proportions of patients with cancer, diabetes, and hypertension among inpatients and outpatients. The number of inpatients was significantly associated with mPHR adoption (adjusted odds ratio [aOR]: 1.174; 1.117-1.233, P < .001), as was the number of outpatients (aOR: 1.041; 1.028-1.054, P < .001). The proportion of inpatients aged 31 to 60 years to those aged 31 years and older was also associated with hospital mPHR adoption (aOR: 1.053; 1.022-1.085, P = .001). mPHR system adoption was significantly associated with the proportion of inpatients (aOR: 1.089; 1.012-1.172, P = .024) and outpatients (aOR: 1.138; 1.026-1.263, P = .015) with cancer and outpatients (aOR: 1.271; 1.101-1.466, P = .001) with hypertension. Although mPHR systems are useful for the management of chronic diseases such as diabetes and hypertension, the number of patients, younger age distribution, and the proportion of cancer patients were closely associated with hospitals' introduction of mPHR systems.

State of the practice of health information systems: a survey study amongst health care professionals in intellectual disability care

BACKGROUND

Care for people with an Intellectual Disability (ID) is complex: multiple health care professionals are involved and use different Health Information Systems (HISs) to store medical and daily care information on the same individuals. The objective of this study is to identify the HISs needs of professionals in ID care by addressing the obstacles and challenges they meet in their current HISs.

METHODS

We distributed an online questionnaire amongst Dutch ID care professionals via different professional associations and care providers. 328 respondents answered questions on their HISs. An inventory was made of HIS usage purposes, problems, satisfaction and desired features, with and without stratification on type of HIS and care professional.

RESULTS

Typical in ID care, two types of HISs are being used that differ with respect to their features and users: Electronic Client Dossiers (ECDs) and Electronic Patient Dossiers (EPDs). In total, the respondents mentioned 52 unique HISs. Groups of care professionals differed in their satisfaction with ECDs only. Both HIS types present users with difficulties related to the specifics of care for people with an ID. Particularly the much needed communication between the many unique HISs was reported a major issue which implies major issues with inter-operability. Other problems seem design-related as well.

CONCLUSION

This study can be used to improve current HISs and design new HISs that take ID care professionals requirements into account.

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.

Evaluating the relationship between health information technology and safer-prescribing in the long-term care setting: A systematic review

BACKGROUND

The prevalence of health information technology (HIT) as an adjunct to increase safety and quality in healthcare applications is well known. There is a relationship between the use of HIT and safer-prescribing practices in long-term care.

OBJECTIVE

The objective of this systematic review is to determine an association between the use of HIT and the improvement of prescription administration in long-term care facilities.

METHODS

A systematic review was conducted using the MEDLINE and CINAHL databases. With the use of certain key terms, 66 articles were obtained. Each article was then reviewed by two researchers to determine if the study was germane to the research objective. If both reviewers agreed with using the article, it became a source for our review. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

The researchers identified 14 articles to include in a group for analysis from North America, Europe, and Australia. Electronic health records and electronic medication administration records were the two most common forms of technological interventions (6 of 14, 43%). Reduced risk, decreased error, decreased missed dosage, improved documentation, improved clinical process, and stronger clinical focus comprised 92% of the observations.

CONCLUSIONS

HIT has shown beneficial effects for many healthcare organizations. Long-term care facilities that implemented health information technologies, have shown reductions in adverse drug events caused by medication errors overall reduced risk to the organization. The implementation of new technologies did not increase the time nurses spent on medication rounds.

Electronic Health Record Use in Swiss Nursing Homes and Its Association With Implicit Rationing of Nursing Care Documentation: Multicenter Cross-sectional Survey Study

BACKGROUND

Nursing homes (NHs) are increasingly implementing electronic health records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality, and efficiency, and whether EHR use might ease the burden of documentation, thereby reducing its implicit rationing.

OBJECTIVE

This study aims to describe nurses' perceptions regarding the usefulness of the EHR system and whether sufficient numbers of computers are available in Swiss NHs, and to explore the system's association with implicit rationing of nursing care documentation.

METHODS

This was a multicenter cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018. It includes a convenience sample of 107 NHs, 302 care units, and 1975 care workers (ie, registered nurses and licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system's usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability, and teamwork and safety climate. For analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.

RESULTS

Overall, the care workers perceived the EHR systems as useful; ratings ranged from 69.42% (1362/1962; guarantees safe care and treatment) to 78.32% (1535/1960; allows quick access to relevant information on the residents). However, less than half (914/1961, 46.61%) of the care workers reported sufficient computers on their unit to allow timely documentation. Half of the care workers responded that they sometimes or often had to ration the documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system's usefulness (β=-.12; 95% CI -0.17 to -0.06) and sufficient numbers of computers (β=-.09; 95% CI -0.12 to -0.06) were consistently associated with lower implicit rationing of nursing care documentation.

CONCLUSIONS

Both the usefulness of the EHR system and the number of computers available were important explanatory factors for care workers leaving care activities (eg, developing or updating nursing care plans) unfinished. NH managers should carefully select and implement their information technology infrastructure with greater involvement and attention to the needs of their care workers and residents. Further research is needed to develop and implement user-friendly information technology infrastructure in NHs and to evaluate their impact on care processes as well as resident and care worker outcomes.

Staff perspectives on the usability of electronic patient records for planning and delivering dementia care in nursing homes: a multiple case study

BACKGROUND

The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user's perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective.

METHODS

An exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added.

RESULTS

Staff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes.

CONCLUSIONS

EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.

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.

A framework for analysing learning health systems: Are we removing the most impactful barriers?

INTRODUCTION

Learning health systems (LHS) are one of the major computing advances in health care. However, no prior research has systematically analysed barriers and facilitators for LHS. This paper presents an investigation into the barriers, benefits, and facilitating factors for LHS in order to create a basis for their successful implementation and adoption.

METHODS

First, the ITPOSMO-BBF framework was developed based on the established ITPOSMO (information, technology, processes, objectives, staffing, management, and other factors) framework, extending it for analysing barriers, benefits, and facilitators. Second, the new framework was applied to LHS.

RESULTS

We found that LHS shares similar barriers and facilitators with electronic health records (EHR); in particular, most facilitator effort in implementing EHR and LHS goes towards barriers categorised as human factors, even though they were seen to carry fewer benefits. Barriers whose resolution would bring significant benefits in safety, quality, and health outcomes remain.LHS envisage constant generation of new clinical knowledge and practice based on the central role of collections of EHR. Once LHS are constructed and operational, they trigger new data streams into the EHR. So LHS and EHR have a symbiotic relationship. The implementation and adoption of EHRs have proved and continues to prove challenging, and there are many lessons for LHS arising from these challenges.

CONCLUSIONS

Successful adoption of LHS should take account of the framework proposed in this paper, especially with respect to its focus on removing barriers that have the most impact.

Contradictions in information technology mediated work in long-term care: An activity theoretic ethnographic study

BACKGROUND

The growing demand for aged care services coupled with a global shortage of skilled nursing staff has hindered long-term care facilities' ability to provide necessary services to their residents. Healthcare information technology is expected to mitigate this challenge by streamlining nursing work, while also improving quality of care and productivity.

OBJECTIVES

This study set out to examine how nurses and care workers work, the role of information technology (IT) in their work and what contradictions they face in their IT mediated work.

DESIGN

Ethnographic study informed by six components of activity theory: subject, object, tool, rule, community and division of labor.

SETTING

Eight care units in two long-term care facilities in Australia.

PARTICIPANTS

Eleven staff from two long-term care facilities including registered nurses (n = 2), endorsed enrolled nurses (n = 5) and personal care workers (n = 4) participated in this study.

METHODS

Participants were shadowed during morning shifts (6:30 am to 3:00 pm). A total of 24 morning shifts were observed over four months. Field notes were created based on observational data and informal interviews, in addition to document review.

RESULTS

Through the lens of activity theory, the work activity system of nurses and care workers in the long-term care facilities consisted of the subject (nurses and care workers), their object (resident care), tools used for work including IT, rules of work, community, and division of labor. These components interacted through work processes; therefore, a "process" component was added in the activity system. Special attention was given to the role of IT as the conduit of information in the work processes. Although IT helped track medication rounds, automated documentation and communication among the staff, it introduced contradictions. Seven contradictions involving IT were identified, including contradictions within the IT tool, between the IT tool and the object of work, between the subjects and documentation rules, between the work activity system using paper records and the system using IT, and between the activity system within the long-term care facility and the pharmacists' work activity system outside the facility.

CONCLUSIONS

Activity theory provided a theoretic framework to model the work activity system of nurses and care workers. Information technology played an important role in supporting information flow in this system, however it also caused contradictions.

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.

Electronic patient records as a tool to facilitate care provision in nursing homes: an integrative review

Objective: The electronic patient record (EPR) has been introduced into nursing homes with the aim of reducing time spent on documentation, improving documentation quality and increasing transferability of information, all of which should facilitate care provision. However, previous research has shown that EPR may be creating new burdens for staff. The purpose of this literature review is to explore how EPR is facilitating or hindering care provision in nursing homes. Methods: An integrative literature review was carried out using four electronic databases to search for relevant articles. After screening, 22 articles were included for thematic synthesis. Results: Thematic synthesis resulted in six analytical themes linked to care provision: time for direct care; accountability; assessment and care planning; exchange of information; risk awareness; and person-centered care. Conclusion: For EPR to facilitate care provision in nursing homes, consideration should be given to the type of device used for documentation, as well as the types of applications, the functionality, content, and structure of EPR. Further research exploring the experiences of end users is required to identify the optimal characteristics of an EPR system specifically for use in nursing homes.

The Heimdall Framework for Supporting Characterisation of Learning Health Systems

BACKGROUND

Learning Health Systems (LHS) can focus population medicine and Evidence Based Practice; smart technology delivering the next generation of improved healthcare described as Precision Medicine, and yet researchers in the LHS domain presently lack the ability to recognise their relevant works as falling within this domain.

OBJECTIVE

To review LHS literature and develop a framework describing the domain that can be used as a tool to analyse the literature and support researchers to identify health informatics investigations as falling with the domain of LHS.

METHOD

A scoping review is used to identify literature on which analysis was performed. This resolved the ontology and framework. The ontology was applied to quantify the distribution of classifications of LHS solutions. The framework was used to analyse and characterise the various works within the body of LHS literature.

RESULTS

The ontology and framework developed was shown to be easily applicable to the literature, consistently describing and representing the goals, intentions and solutions of each LHS investigation in the literature. More proposed or potential solutions are described in the literature than implemented LHS. This suggests immaturity in the domain and points to the existence of barriers preventing LHS realisation.

CONCLUSION

The lack of an ontology and framework may have been one of the causes for the failure to describe research works as falling within the LHS domain. Using our ontology and framework, LHS research works could be easily classified, demonstrating the comprehensiveness of our approach in contrast to earlier efforts.

Health IT Adoption in Nursing Homes: The Role of IT Vendors

Applying exploratory qualitative methodologies such as interviews and focus groups, we examine the role of IT vendors in health IT adoption in nursing homes in Texas. We identify three roles pertaining to IT vendors in various adoption stages — information sources and financiers, strategic consultants, and educators in the initiation, implementation, and the institutionalization phases, respectively. Thus, vendors could be a critical factor in the health IT adoption, but nursing home management must critically evaluate not only the services, but also the strategic partnerships offered by the vendors. This is because their business interests may not address nursing homes’ distinctive need, and may prevent integration and institutionalization of health IT. As such, this research has important implications for technology adoption by nursing facilities.

Caregivers’ Time Utilization before and after the Introduction of an Electronic Nursing Documentation System in a Residential Aged Care Facility

Background: Despite increasing research on caregivers’ interaction with technology, there has been no attempt to investigate how the introduction of an electronic system in a residential aged care facility (RACF) may affect caregivers’ use of their time.

Objective: To assess how caregivers use their time before and after the introduction of an electronic documentation system in an RACF.

Methods: An observational work sampling study was undertaken with caregivers at two months before, and at 3, 6, 12 and 23 months after the implementation of an electronic documentation system.

Results: During the first 12 months after implementation, the proportion of time spent by personal carers on documentation increased, that on direct care reduced, and the proportion on communication remained unchanged. At 23 months, the proportion on documentation and direct care had returned to pre-implementation levels. The percentage of time spent on these activities by recreational activity officers remained unchanged at most measurement periods after implementation. Changes in proportions of time on other activities were not directly associated with the introduction of the electronic system.

Conclusion: It may take over a year for some caregivers in an RACF to integrate the use of a newly introduced electronic documentation system into their daily work. Organisations implementing such systems should develop strategies that support and accelerate the caregivers’ integration of the new documentation practice into their routine activities. The electronic documentation system may not however, replace the role of verbal communication between caregivers in aged care service.

Designing a Self-Management App for Young People With Type 1 Diabetes: Methodological Challenges, Experiences, and Recommendations

Background

Young people with type 1 diabetes often struggle to self-manage their disease. Mobile health (mHealth) apps show promise in supporting self-management of chronic conditions such as type 1 diabetes. Many health care providers become involved in app development. Unfortunately, limited information is available to guide their selection of appropriate methods, techniques, and tools for a participatory design (PD) project in health care.

Objective

The aim of our study was to develop an mHealth app to support young people in self-managing type 1 diabetes. This paper presents our methodological recommendations based on experiences and reflections from a 2-year research study.

Methods

A mixed methods design was used to identify user needs before designing the app and testing it in a randomized controlled trial. App design was based on qualitative, explorative, interventional, and experimental activities within an overall iterative PD approach. Several techniques and tools were used, including workshops, a mail panel, think-aloud tests, and a feasibility study.

Results

The final mHealth solution was “Young with Diabetes” (YWD). The iterative PD approach supported researchers and designers in understanding the needs of end users (ie, young people, parents, and health care providers) and their assessment of YWD, as well as how to improve app usability and feasibility. It is critical to include all end user groups during all phases of a PD project and to establish a multidisciplinary team to provide the wide range of expertise required to build a usable and useful mHealth app.

Conclusions

Future research is needed to develop and evaluate more efficient PD techniques. Health care providers need guidance on what tools and techniques to choose for which subgroups of users and guidance on how to introduce an app to colleagues to successfully implement an mHealth app in health care organizations. These steps are important for anyone who wants to design an mHealth app for any illness.

Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review

BACKGROUND

Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities.

OBJECTIVE

The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology.

METHODS

The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review.

RESULTS

Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs.

CONCLUSIONS

Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making.

Implementation of Electronic Health Records in US Nursing Homes

While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.

Adoption Factors of the Electronic Health Record: A Systematic Review

Background

The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures.

Objective

The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States.

Methods

Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012–09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity.

Results

Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues.

Conclusions

The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite incentives in the HITECH Act. Limited financial backing and outdated technology were also common barriers frequently mentioned during data review. Future public policy should include incentives commensurate with those in the HITECH Act to maintain strong adoption rates.

Assessment of eHealth capabilities and utilization in residential care settings

The US National Survey of Residential Care Facilities was used to conduct cross-sectional analyses of residential care facilities (n = 2302). Most residential care facilities lacked computerized capabilities for one or more of these capabilities in 2010. Lacking computerized systems supporting electronic health information exchange with pharmacies was associated with non-chain affiliation (p < .05). Lacking electronic health information exchange with physicians was associated with being a small-sized facility (vs large) (p < .05). Lacking computerized capabilities for discharge/transfer summaries was associated with for-profit status (p < .05) and small-sized facilities (p < .05). Lacking computerized capabilities for medical provider information was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), and for-profit status (p < .05). Lack of electronic health record was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), for-profit status (p < .05), and location in urban areas (p < .05). eHealth disparities exist across residential care facilities. As the older adult population continues to grow, resources must be in place to provide an integrated system of care across multiple settings.

Electronic Health Records in Long-Term Care: Staff Perspectives

As long-term post-acute care (LTPAC) settings continue to increase their adoption of electronic health records (EHRs), it is important to learn from end users currently working with the technology to identify clinical implications and opportunities to improve systems and surrounding processes. This study utilized one-on-one interviews of direct care nurses ( n = 20) in a Midwest United States LTPAC setting to describe patterns of use, and areas to improve. The majority of respondents evaluated the EHR as easy to use, with a positive impact on quality of care, through efficiencies gained in communication with the care team. Staff responses outline desired modifications to the software, including fixes to data fields for more accurate medication administration and accurate reports on bowel protocol follow-up. Recommendations for LTPAC organizations are made regarding improved staff training on the EHR, and modifications to the EHR and related processes to improve quality of care and staff retention.

"Striving for Excellence": Minimum Data Set Coordinators' Perceptions of Their Role in the Nursing Home

The purpose of the current study was to explore how Minimum Data Set (MDS) coordinators perceive their role and the assessment process. Eleven MDS coordinators from 10 geographically dispersed nursing homes (NHs) were interviewed between May and September 2013. Four broad themes emerged from content analysis: (a) information gathering, (b) interdisciplinary coordination, (c) role challenges, and (d) resources. The first two themes referred to key components and competencies in the MDS coordinators' role, the third theme dealt with certain challenges inherent in the role, and the fourth theme highlighted resources that helped address these challenges. The current study provides insight into how MDS coordinators perceive their role, as well as some of the challenges they face to successfully enact that role. The current findings can help inform NH management staff, such as directors of nursing and NH administrators, and policy makers, on how best to support MDS coordinators' work to enable efficient and accurate resident assessment processes.

Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada

Background

Osteoporosis is a major global health problem, especially among long-term care (LTC) facilities. Despite the availability of effective clinical guidelines to prevent osteoporosis and bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers.

Methods

We performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans.

Results

LTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences.

Conclusions

This qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.

Emerging ICT implementation issues in aged care

BACKGROUND

Demand for aged care services continues to soar as a result of an aging population. This increasing demand requires more residential aged care facilities and healthcare workforce. One recommended solution is to keep older people in their homes longer and support their independent life through the use of information and communication technologies (ICT). However, the aged care sector is still in the early stages of adopting ICT.

OBJECTIVE

The aim of this study was to identify the key issues that affect the adoption of ICT in the aged care sector.

METHODS

A systematic literature review was undertaken and involved four steps. The first two steps aimed to identify and select relevant articles. Data was then extracted from the selected articles and identified issues were analyzed and grouped into three major categories.

RESULTS

ICT adoption issues were categorized into different perspectives, representing older people, health professionals and management. Our findings showed that all three groups were mostly concerned with issues around behavior, cost and lack of technical skills.

DISCUSSION AND CONCLUSIONS

Findings reported in this study will help decision makers at aged care settings to systematically understand issues related to ICT adoption and thus proactively introduce interventions to improve use of ICT in this sector. On the basis of our findings, we suggest future research focus on the examination of aged care workflow and assessment of return on ICT investment.

Using diffusion of innovation theory to understand the factors impacting patient acceptance and use of consumer e-health innovations: a case study in a primary care clinic

Background

Consumer e-Health is a potential solution to the problems of accessibility, quality and costs of delivering public healthcare services to patients. Although consumer e-Health has proliferated in recent years, it remains unclear if patients are willing and able to accept and use this new and rapidly developing technology. Therefore, the aim of this research is to study the factors influencing patients’ acceptance and usage of consumer e-health innovations.

Methods

A simple but typical consumer e-health innovation – an e-appointment scheduling service – was developed and implemented in a primary health care clinic in a regional town in Australia. A longitudinal case study was undertaken for 29 months after system implementation. The major factors influencing patients’ acceptance and use of the e-appointment service were examined through the theoretical lens of Rogers’ innovation diffusion theory. Data were collected from the computer log records of 25,616 patients who visited the medical centre in the entire study period, and from in-depth interviews with 125 patients.

Results

The study results show that the overall adoption rate of the e-appointment service increased slowly from 1.5% at 3 months after implementation, to 4% at 29 months, which means only the ‘innovators’ had used this new service. The majority of patients did not adopt this innovation. The factors contributing to the low the adoption rate were: (1) insufficient communication about the e-appointment service to the patients, (2) lack of value of the e-appointment service for the majority of patients who could easily make phone call-based appointment, and limitation of the functionality of the e-appointment service, (3) incompatibility of the new service with the patients’ preference for oral communication with receptionists, and (4) the limitation of the characteristics of the patients, including their low level of Internet literacy, lack of access to a computer or the Internet at home, and a lack of experience with online health services. All of which are closely associated with the low socio-economic status of the study population.

Conclusion

The findings point to a need for health care providers to consider and address the identified factors before implementing more complicated consumer e-health innovations.

The effect of an electronic health record system on nursing staff time in a nursing home: a longitudinal cohort study

BACKGROUND

Nursing homes are increasingly introducing electronic health record (EHR) systems into nursing practice; however, there is limited evidence about the effect of these systems on nursing staff time.

AIMS

To investigate the effect of introducing an EHR system on time spent on activities by nursing staff in a nursing home.

METHOD

An observational work sampling study was undertaken with nursing staff between 2009 and 2011 at two months before, and at 3, 6, 12, and 23 months after implementation of an EHR system at an Australian nursing home. An observer used pre-determined tasks to record activities of the nursing staff at nine-minute intervals.

RESULTS

There was no significant change in registered nurses and endorsed enrolled nurses' time on most activities after implementation. Personal carers' time on oral-communication reduced, and time on documentation increased at most measurement periods in the first 12 months after implementation. At 23 months, time on these activities had returned to pre-implementation levels. Nursing staff time on direct care remained stable after implementation. No considerable change was observed in time spent on other activities after implementation.

CONCLUSION

Findings suggest that successful introduction of an EHR system in a nursing home may not interfere with nursing staff time on direct care duties. However, there is scope for improving the support provided by EHR systems through incorporation of functions to support collaborative nursing care.

Electronic health records implementation: an evaluation of information system impact and contingency factors

OBJECTIVE

This paper provides a review of EHR (electronic health record) implementations around the world and reports on findings including benefits and issues associated with EHR implementation.

MATERIALS AND METHODS

A systematic literature review was conducted from peer-reviewed scholarly journal publications from the last 10 years (2001-2011). The search was conducted using various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and Medical Complete. This paper reports on our analysis of previous empirical studies of EHR implementations. We analysed data based on an extension of DeLone and McLean's information system (IS) evaluation framework. The extended framework integrates DeLone and McLean's dimensions, including information quality, system quality, service quality, intention of use and usage, user satisfaction and net benefits, together with contingent dimensions, including systems development, implementation attributes and organisational aspects, as identified by Van der Meijden and colleagues.

RESULTS

A mix of evidence-based positive and negative impacts of EHR was found across different evaluation dimensions. In addition, a number of contingent factors were found to contribute to successful implementation of EHR.

LIMITATIONS

This review does not include white papers or industry surveys, non-English papers, or those published outside the review time period.

CONCLUSION

This review confirms the potential of this technology to aid patient care and clinical documentation; for example, in improved documentation quality, increased administration efficiency, as well as better quality, safety and coordination of care. Common negative impacts include changes to workflow and work disruption. Mixed observations were found on EHR quality, adoption and satisfaction. The review warns future implementers of EHR to carefully undertake the technology implementation exercise. The review also informs healthcare providers of contingent factors that potentially affect EHR development and implementation in an organisational setting. Our findings suggest a lack of socio-technical connectives between the clinician, the patient and the technology in developing and implementing EHR and future developments in patient-accessible EHR. In addition, a synthesis of DeLone and McLean's framework and Van der Meijden and colleagues' contingent factors has been found useful in comprehensively understanding and evaluating EHR implementations.

Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research

Background

Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses’ experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process.

Methods

A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities.

Results

The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents’ records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude.

Conclusions

In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.

Electronic health records use and barriers and benefits to use in skilled nursing facilities

The purpose of this study was to determine the levels of automation for 21 clinical functions and the benefits and barriers to electronic health records use in skilled nursing facilities in one of the Midwestern states in the US. A cross-sectional design was implemented. Data were collected from nursing home administrators using a mail and online survey approach. A total of 156 usable questionnaires of 397 distributed were returned, for a 39.30% response rate. While many facilities reported fully automated Minimum Data Set assessments, licensed nurse clinical notes, and care plans, there remained a predominant reliance on paper for functions, such as diagnostic tests and consults. Although many facilities had advanced toward using automation to produce quality reports, they were lagging behind in the use of automated clinical decision support and summary reports. The top two barriers included the amount of capital needed and the cost for hardware and infrastructure. Facilities with paper records were more likely to identify those barriers for functions, such as clinical notes and assessments. The top three benefits were quality patient care monitoring, management control of performance, and anywhere/anytime easier access to clinical data. The study concludes with recommendations to nursing home leaders and other stakeholders.

A statewide assessment of electronic health record adoption and health information exchange among nursing homes

OBJECTIVE

To determine rates of electronic health record (EHR) adoption and health information exchange (HIE) among New York State (NYS) nursing homes.

DATA SOURCES/STUDY SETTING

Primary data collected from a novel survey administered between November 2011 and March 2012 to all NYS nursing homes.

STUDY DESIGN

We used a cross-sectional study design to assess level of EHR implementation, automation of key functionalities, participation in HIE, and barriers to adoption.

DATA COLLECTION/EXTRACTION METHODS

We used descriptive statistics to characterize rates of EHR adoption and participation in HIE and logistic regression to identify nursing home characteristics associated with EHR adoption and HIE.

PRINCIPAL FINDINGS

We received responses from 375 of 632 nursing homes (59.3 percent). Of respondents, almost one in five (n=66, 18.0 percent) reported having a fully implemented and operational EHR and a majority (n=192, 54.4 percent) reported electronically exchanging information. Nursing homes with 100-159 beds were significantly less likely than other facilities to have implemented or be in the process of implementing an EHR (p=.011).

CONCLUSIONS

Our findings present an important systematic look at EHR adoption and HIE by NYS nursing homes. Although the nursing home sector has been reported to lag in health information technology adoption, our results are encouraging. However, they suggest much room for growth and highlight the need for targeted initiatives to achieve more widespread adoption in this important health care sector.

Health Care Provider Adoption of eHealth: Systematic Literature Review

Background

eHealth is an application of information and communication technologies across the whole range of functions that affect health. The benefits of eHealth (eg, improvement of health care operational efficiency and quality of patient care) have previously been documented in the literature. Health care providers (eg, medical doctors) are the key driving force in pushing eHealth initiatives. Without their acceptance and actual use, those eHealth benefits would be unlikely to be reaped.

Objective

To identify and synthesize influential factors to health care providers’ acceptance of various eHealth systems.

Methods

This systematic literature review was conducted in four steps. The first two steps facilitated the location and identification of relevant articles. The third step extracted key information from those articles including the studies’ characteristics and results. In the last step, identified factors were analyzed and grouped in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT).

Results

This study included 93 papers that have studied health care providers’ acceptance of eHealth. From these papers, 40 factors were identified and grouped into 7 clusters: (1) health care provider characteristics, (2) medical practice characteristics, (3) voluntariness of use, (4) performance expectancy, (5) effort expectancy, (6) social influence, and (7) facilitating or inhibiting conditions.

Conclusions

The grouping results demonstrated that the UTAUT model is useful for organizing the literature but has its limitations. Due to the complex contextual dynamics of health care settings, our work suggested that there would be potential to extend theories on information technology adoption, which is of great benefit to readers interested in learning more on the topic. Practically, these findings may help health care decision makers proactively introduce interventions to encourage acceptance of eHealth and may also assist health policy makers refine relevant policies to promote the eHealth innovation.

Utilization of technology by long-term care providers: comparisons between for-profit and nonprofit institutions

OBJECTIVE

We examine ownership differences in the use of technology in long-term care facilities.

METHOD

We analyze two nationally representative surveys of administrators collected by the Centers for Disease Control (CDC): the 2004 National Nursing Home Survey and the 2010 National Survey of Residential Care Facilities.

RESULTS

We find that nonprofit nursing homes are more likely to use some computerized administrative functions and digital laboratory reports, and report use rates similar to for-profit organizations in other areas of health IT. Nonprofit residential care facilities are more likely to use electronic medical records and information exchange systems than their for-profit counterparts. In addition, nonprofit residential care facilities are more likely than for-profit facilities to digitize more types of information and use larger health information exchange networks.

DISCUSSION

The reasons for which nonprofit long-term care organizations report higher levels of some types of technology utilization are explored, and future research is recommended.

Use of electronic documentation for quality improvement in hospice

Little evidence exists about the use of electronic documentation (ED) in hospice and its relationship to quality improvement (QI) practices. The purposes of this study were to (1) estimate the prevalence of ED use in hospice, (2) identify organizational characteristics associated with use of ED, and (3) determine whether quality measurement practices differed based on documentation format (electronic vs nonelectronic). Surveys concerning the use of ED for QI practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of ED were able to monitor a wider range of quality-related data than users of non-ED. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of ED. Use of ED may help hospices monitor quality and compliance.

Does the introduction of an electronic nursing documentation system in a nursing home reduce time on documentation for the nursing staff?

PURPOSE

To determine whether the introduction of an electronic nursing documentation system in a nursing home reduces the proportion of time nursing staff spend on documentation, and to use this information in evaluating the usefulness of the system in improving the work of nursing staff.

METHODS

An observational work sampling study was conducted in 2009 and 2010, 2 months before, and 3, 6 and 12 months after the introduction of an electronic nursing documentation system. An observer (ENM) used a work classification tool to record documentation activities being performed using paper and with a computer by nursing staff at particular times for periods of 5 days.

RESULTS

Three hundred and eighty three (383) activities were recorded before implementation of the electronic system, 472 activities at 3 months, 502 at 6 months, and 338 at 12 months after implementation. There was no significant difference between the proportion of time nursing staff spent on documentation 2 months before and 3 months after the implementation of the electronic system. Six months after implementation, the proportion of time on documentation increased significantly and after 12 months, settled back to original levels that were recorded in the paper-based system. Over half of the proportion of time on documentation at 6 and 12 months after implementation was spent on paper documentation tasks.

CONCLUSION

Introduction of an electronic nursing documentation system did not reduce the proportion of time nursing staff spent on documentation. This may in part have been a result of the practice of documenting some information items on paper and others on a computer. To reduce the use of paper documentation or to achieve a paper-free documentation environment in this setting, an in-depth understanding of nursing staff's information needs, and documentation workflow is necessary.

Assessing organizational readiness for electronic health record adoption in long-term care facilities

Methods to support long-term care (LTC) providers to successfully implement electronic health records (EHR) are vital as they move to leverage the potential for improvements in quality, efficiency, and effectiveness through EHRs. This article reports the development of a readiness assessment tool to allow LTC facilities to measure their capacity for successful EHR implementation. The LTC Readiness Assessment Tool for EHR Implementation was developed through a literature review and qualitative study to establish content validity, followed by the current study to assess the tool's internal reliability. The tool was mailed to administrators or directors of nursing at 600 LTC facilities in Texas with instructions for survey completion. Ninety-three surveys were returned. Item means ranged from 2.72 to 5.07 on a 7-point scale (1 = strongly disagree to 7 = strongly agree), with the category of state regulatory support receiving the lowest mean and physical plant requirements receiving the highest. Internal reliability was supported with a Cronbach's alpha coefficient of 0.95.

Experiences with electronic health records: early adopters in long-term care facilities

BACKGROUND

: Electronic health records (EHRs) are becoming a required technology across the health care sector. Long-term care (LTC) facilities have lagged other settings in adopting health information technologies but represent an area where significant care coordination benefits might be realized. Nevertheless, managers face many of the same challenges implementing EHRs that exist in other environments when implementing enterprise-wide systems.

PURPOSES

: This study was conducted to provide a description of the early users' experiences with EHRs in LTC facilities.

METHODOLOGY

: Semistructured interviews were conducted. The 10 sites were all the "freestanding" LTC facilities using an EHR as of July 2008 in Texas. The interview respondents included administrators, nursing managers, nurses, certified nurse aides, and other system users. Semistructured interviews across multiple stakeholders were used to assess constructs critical to EHR adoption and implementation.

FINDINGS

: The LTC facility employees who work with EHR systems on a daily basis were positive about their experiences. In particular, operational improvements were achieved through increased access to resident information, cost avoidance, increased documentation accuracy, and implementation of evidence-based practices.

PRACTICE IMPLICATIONS

: Overall, administrators believed that the systems improved care quality and employee satisfaction and were cost effective and that the EHR made a positive return on investment. Electronic documentation led to both increases in charge capture related to resource utilization group documentation, significant savings in pharmacy waste, and reductions in nursing overtime as medical record management became more automated. Quality improvement came from computer-aided monitoring of the certified nurse aide's attendance to residents' activities of daily living.

Hospital information technology systems' impact on nurses and nursing care

OBJECTIVE

We conducted a review of the literature to determine the impact of health information technologies (HITs) on nurses and nursing care.

BACKGROUND

Nurses' effective use of HIT has the potential to produce a positive impact on nursing-sensitive patient outcomes, patient safety, and quality of care.

METHODS

A review of the literature produced 564 unique references of which 74 were selected for review.

RESULTS

Findings suggest that (1) HIT improves the quality of nursing documentation; (2) HIT reduces medication administration errors; (3) nurses are generally satisfied with HIT and have positive attitudes about it; and (4) nurse involvement in all stages of HIT design and implementation, and effective leadership throughout these processes, can improve HIT.

CONCLUSION

HIT has had positive influences on nurse satisfaction and patient care. Effective nursing leadership can positively influence the effective development, dissemination, and use of HIT.