EHR adoption – and use of health IT in general – is growing slowly every year. But adoption is not happening at the same rate across different types of healthcare settings. A recent data brief by the ONC has revealed that skilled nursing facilities (SNF) are lagging behind acute care centers (like clinics and hospitals) in EHR use. About 64% of SNFs use EHRs while 18% use both an EHR and a state/regional health information organization (HIO)1. Those numbers are encouraging but there is still a gap between these facilities and acute care settings.
Why is there such a gap between long-term facilities and acute care settings? There are a few reasons for this disparity.
- Lack of incentives encouraging EHR use
Unlike most medical practices and hospitals, skilled nursing facilities are not eligible to receive financial incentives under the various federal programs. Purchasing and deploying any EHR is an investment that will pay off handsomely in the long-term. But the reality is that nursing facilities have to set aside quite a chunk of financial resources at the outset. Without any financial incentives coming their way, it is no wonder that they find it difficult to justify health IT purchases.
- Focus on standards
Many federal and state level programs for the healthcare industry focus on common standards for data exchange. Standards are important to ensure that the data being sent and received is in a readable format for all entities involved in the process. However there needs to be a greater emphasis on the timely exchange of data, especially when the patient is transitioning to a different care setting. It is all too common for a patient to reach the nursing facility while their data is still languishing in the hospital. It causes interruptions in patient care that are preventable for the most part.
- User perception
EHR adoption will not go up if end-users like doctors, nurses and others refuse to use it daily. Training, awareness and user perception are important factors that determine if a practice gets the most value out of an EHR. Unfortunately the reaction of users has been a mixed bag in acute care settings.
This means that many people in skilled nursing facilities perceive EHRs as cumbersome, complicated and not worth the effort. Word-of-mouth and user testimonials are much more powerful than marketing and advertising efforts. It means that people who have heard horror stories about EHRs are less likely to view them in a positive light when their own facility deploys one. This initial hesitation translates into lower satisfaction which in turn hinders effective use.
Implementation problems are a dime a dozen when it comes to EHRs. Depending on the size of the organization, the EHR implementation can be a multiyear project with several different deadlines, budgets and targets. The bigger the project, the higher the probability of running into obstacles. It is no different with nursing facilities that try to deploy EHRs. Training users, digitizing data and customizing the software to suit individual needs can take quite a while.
Larger SNFs have access to in-house experts, outside consultants and other resources. Unfortunately smaller organizations continue to struggle with implementation problems. This is reflected in the fact that integration of patient information from external sources is much higher by larger SNFs than medium-sized ones.
Some of the barriers to EHR use in skilled nursing facilities are similar to what hospitals faced a few years before. Others are unique to the particular type of organization. The adoption of health IT remains a priority for most states. So it won’t be long before long-term care settings catch up with their colleagues in this respect.