Article

Information Technology Sophistication in Nursing Homes

Sinclair School of Nursing, University of Missouri, Columbia, MO 65101, USA.
Journal of the American Medical Directors Association (Impact Factor: 5.3). 08/2009; 10(6):398-407. DOI: 10.1016/j.jamda.2009.02.001
Source: PubMed

ABSTRACT There is growing recognition that a more sophisticated information technology (IT) infrastructure is needed to improve the quality of nursing home care in the United States. The purpose of this study was to explore the concept of IT sophistication in nursing homes considering the level of technological diversity, maturity and level of integration in resident care, clinical support, and administration.
Twelve IT stakeholders were interviewed from 4 nursing homes considered to have high IT sophistication using focus groups and key informant interviews. Common themes were derived using qualitative analytics and axial coding from field notes collected during interviews and focus groups.
Respondents echoed the diversity of the innovative IT systems being implemented; these included resident alerting mechanisms for clinical decision support, enhanced reporting capabilities of patient-provider interactions, remote monitoring, and networking among affiliated providers.
Nursing home IT is in its early stages of adoption; early adopters are beginning to realize benefits across clinical domains including resident care, clinical support, and administrative activities. The most important thread emerging from these discussions was the need for further interface development between IT systems to enhance integrity and connectivity.
The study shows that some early adopters of sophisticated IT systems in nursing homes are beginning to achieve added benefit for resident care, clinical support, and administrative activities.

0 Bookmarks
 · 
157 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND The role of nursing home (NH) information technology (IT) in quality improvement has not been clearly established, and its impacts on communication between care givers and patient outcomes in these settings deserve further attention. OBJECTIVES In this research, we describe a mixed method approach to explore communication strategies used by healthcare providers for resident skin risk in NH with high IT Sophistication (ITS). METHODS Sample included NH participating in the statewide survey of ITS. We incorporated rigorous observation of 8- and 12-hour shifts, and focus groups to identify how NH IT and a range of synchronous and asynchronous tools are used. Social network analysis tools and qualitative analysis were used to analyze data and identify relationships between ITS dimensions and communication interactions between care providers. RESULTS Two of the nine ITS dimensions (resident care-technological and administrative activities-technological) and Total ITS were significantly negatively correlated with number of unique interactions. As more processes in resident care and administrative activities are supported by technology, the lower the number of observed unique interactions. Additionally, four thematic areas emerged from staff focus groups that demonstrate how important IT is to resident care in these facilities including providing resident-centered care, teamwork and collaboration, maintaining safety and quality, and using standardized information resources. CONCLUSION Our findings in this study confirm prior research that as technology support (resident care and administrative activities) and overall ITS increases, observed interactions between staff members decrease. Conversations during staff interviews focused on how technology facilitated resident centered care through enhanced information sharing, greater virtual collaboration between team members, and improved care delivery. These results provide evidence for improving the design and implementation of IT in long term care systems to support communication and associated resident outcomes.
    International Journal of Medical Informatics 08/2014; 83(8). DOI:10.1016/j.ijmedinf.2014.05.001 · 2.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper addresses key barriers to implementing a clinical information system (CIS) in a Hong Kong nursing home setting, from a healthcare specific socio-technical perspective. Data was collected through field observations (n = 12) and semi-structured individual interviews (n = 18) of CIS stakeholders in a Hong Kong nursing home, and analyzed using the immersion/crystallization approach. Complex interactions relevant to our case were contextualized and interpreted within the perspective of the Sittig-Singh Healthcare Socio-Technical Framework (HSTF). Three broad clusters of implementation barriers from the eight HSTF dimensions were identified: (a) Infrastructure-based barriers, which relate to conflict between government regulations and system functional needs of users; lack of financial support; inconsistency between workflow, work policy, and procedures; and inadequacy of hardware-software infrastructural and technical support; (b) Process-based barriers, which relate to mismatch between the technology, existing work practice and workflow, and communication; low system speed, accessibility, and stability; deficient computer literacy; more experience in health care profession; clinical content inadequacy and unavailability; as well as poor system usefulness and user interface design; and (c) Outcome-based barriers, which relate to the lack of measurement and monitoring of system effectiveness. Two additional dimensions underlining the importance of the ability of a CIS to change are proposed to extend the Sittig-Singh HSTF. First, advocacy would promote the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and second, adaptability would ensure the ability of the system to adjust to emerging needs. The broad set of discovered implementation shortcomings expands prior research on why CIS can fail in nursing home settings. Moreover, our investigation offers a knowledge base and recommendations that can serve as a guide for future implementation strategies and policies in CIS initiatives.
    Journal of Medical Systems 09/2014; 38(9):99. DOI:10.1007/s10916-014-0099-9 · 1.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices. This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents. We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis. Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility's electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers. Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.
    Applied Clinical Informatics 01/2011; 2(4):420-36. DOI:10.4338/ACI-2011-07-RA-0043 · 0.39 Impact Factor

Full-text (2 Sources)

Download
17 Downloads
Available from
Aug 14, 2014