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

Abstract

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.

Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development

“…The context varied in our sample with for example different nursing tasks in home care and nursing homes, differences in size, location, and distance to hospitals. We also found variation in access to reliable networks and communication with GPs in home care and nursing homes that sometimes challenged the staffs and managers work, in line with previous research [19]. However, our results are consistent with previous research showing that one of the greatest leadership challenge is to prepare and facilitate processes for organizational change [20,21].…”

Nursing staff’s evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study

“…The managers' level of engagement and active involvement in the implementation of WNCSs appears to be higher in this study than in previous studies of health information technology implementation in residential care facilities, which reported a lack of involvement as well as lack of systematic planning and decision-making from managers [29,31,32,35]. The care providers' evaluation of the managers' efforts supported the effect of an implementation strategy adopted by all care facilities; that the unit managers had learned to use the WNCS and taken an essential role for driving the implementation [57].…”

“…This complexity should be accounted for and attended to in order to facilitate successful implementation, and develop new knowledge and practice. Within this complexity, factors that affect implementation processes include the physical environment and infrastructure, availability of time and resources, availability of staff training, availability of support, receptiveness of organizational culture, involvement of all stakeholders, demonstrable benefits of the change and empowering leadership [34][35][36][37][38][39].…”

“…Within the window of time from the outset of the implementation until the survey was undertaken, the care providers had gained experience from using the WNCS devices. Most of them had acquired skills and increased their knowledge about the WNCSs through structured trainingsessions, which is a recommended implementation strategy [35,52,62]. They could easily understand instructions given by their manager and communicate about the WNCS and the implementation.…”

Conditions and ethical challenges that could influence the implementation of technologies in nursing homes: A qualitative study

“…In their literature review, combined with qualitative findings, Ko, Wagner, and Spetz () found that NHs faced many challenges in technology implementation. For example, many did not use a systematic implementation process or lacked the appropriate infrastructure to support the use of technology.…”