JAMDA
Volume 11, Issue 7 , Pages 485-493, September 2010

Cost, Staffing and Quality Impact of Bedside Electronic Medical Record (EMR) in Nursing Homes

  • Marilyn J. Rantz, PhD, RN, FAAN

      Affiliations

    • Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO
    • Corresponding Author InformationAddress correspondence to Marilyn J. Rantz, PhD, RN, FAAN, Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO.
    • ,
  • Lanis Hicks, PhD

      Affiliations

    • Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO
    • ,
  • Gregory F. Petroski, PhD

      Affiliations

    • School of Medicine, University of Missouri, Columbia, MO
    • ,
  • Richard W. Madsen, PhD

      Affiliations

    • Department of Statistics, University of Missouri, Columbia, MO
    • ,
  • Greg Alexander, PhD, RN

      Affiliations

    • Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO
    • ,
  • Colleen Galambos, PhD

      Affiliations

    • Department of Social Work, University of Missouri, Columbia, MO
    • ,
  • Vicki Conn, PhD, RN, FAAN

      Affiliations

    • Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO
    • ,
  • Jill Scott-Cawiezell, PhD, RN, FAAN

      Affiliations

    • College of Nursing, University of Iowa, Iowa City, IA
    • ,
  • Mary Zwygart-Stauffacher, PhD, RN, FAAN

      Affiliations

    • University of Wisconsin, Eau Claire, WI
    • ,
  • Leslie Greenwald, PhD

      Affiliations

    • RTI International, Research Triangle Park, NC

published online 07 June 2010.

Objective

There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes.

Methods

Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures.

Results

Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups.

Discussion

Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover.

Conclusions

Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology.

Keywords: EMR, costs, quality indicators, nursing homes, advanced practice nurse

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 Evaluation activities were supported by the Centers for Medicare & Medicaid Services (CMS) for work completed for the project funded in response to RFP-CMS-03–001/DB. Opinions are those of the authors and do not necessarily represent CMS.

PII: S1525-8610(09)00413-7

doi:10.1016/j.jamda.2009.11.010

JAMDA
Volume 11, Issue 7 , Pages 485-493, September 2010

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