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
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Article info
Publication history
Published online: June 07, 2010
Footnotes
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.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
