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The bumpy journey to adopt HIT

November 8, 2011
by Tiankai Wang, PhD
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LTC providers share barriers to adoption
Tiankai wang, phd
Tiankai Wang, PhD


Health information technology (HIT) is not a new concept to the long-term care industry. Since the late 1990s, HIT functions have been integrated among providers.

1 Numerous papers have studied the potential benefits of using HIT in LTC facilities, such as reducing errors and improving quality of care. For example, WinterGreen Research, Inc.

2 states that providers can “achieve an increase of 37 percent in administrative productivity” by using HIT systems over time. However, the fact is that HIT adoption in long-term care lags behind other sectors in the healthcare industry.

A recent survey conducted by the author confirms the gap in HIT adoption among LTC facilities in Texas. More than 100 Texas facilities, representative of the population of Texas LTC facilities, participated in the survey. The survey shows that only 37.3 percent of facilities fully or partially implemented an HIT system (See figure). This survey aims to identify the barriers in HIT adoption in long-term care.

LTC HIT Implementation Status in Texas, 2011.

THE FINANCE FACTOR

As seen in the table below, the most significant barrier to HIT adoption is the finance factor. Forty-six percent of respondents state that the expensive initial investment is a burden. Some administrators commented that HIT “would be a great asset to our facilities. It would help us provide better care for our residents, but the cost of these systems is just entirely too expensive for small nursing homes.” Moreover, no sound evidence proves that financial benefits were generated by adopting HIT.

Table. Barriers slowing/preventing HIT implementation (Texas 2011)

Barriers

Survey Respondents (%)

Finance factors:

Lack of capital resources to invest

46%

Lack of proven financial benefit

15.3%

Product factors:

Difficulty finding HIT products that meet needs

20.4%

Too complex

7.3%

User interfaces are not user-friendly

16.1%

Inability to easily input historic med record data into software/technology system

27%

Management factors:

Insufficient time to select, contract, install software/technology

29.2%

Lack of HIT knowledge

12.4%

Fear of technology

8%

Lack of technical support staff

21.2%

Not part of the strategic planning

15.3%

Unclear need for change management

11.7%

It is necessary for administrators to access alternative financial methods, such as lobbying state or local governments and private or not-for-profit stakeholders, issuing revenue bonds, and so on. Finance is a complex topic. LTC administrators need to gain more financial management knowledge3,4 and may wish to pursue external expertise to conduct a professional cost-benefit analysis and budget preparation.

The immaturity of HIT products in long-term care also hinders adoption. As shown in the table, product factors include difficulty finding HIT products that meet needs, the products' complexity, unfriendly user interfaces and the inability to easily input historic records. In this survey, some respondents expressed their negative attitudes toward HIT, remarking that HIT offers “zero time saving … (needs) extra steps for simple tasks … lowers patient satisfaction … (and is) poor for healthcare.” One administrator stated that a HIT system had been used under a trial, but it did not show quality improvement or financial benefits. Finally, the system was abandoned.

Part of the reason for this negativity is because current HIT products focus more on acute and ambulatory care, and long-term care suffers from relative inattention. In fact, all the above negative comments were based on the respondents' observation in hospitals, instead of in LTC facilities. Information technology faces unique challenges in long-term care, such as addressing needs for facilitating preventive measures, the starting dosages and special reporting needs, etc.5 Therefore, vendors' “one size fits all” strategy does not work in the LTC HIT market. To solve the problem, better communication between vendors and LTC facilities is indispensible for more effective product design and development. That requires that administrators not only manage facilities' operations, but also have some knowledge of HIT. Consequently, administrators can clarify their specific needs during vendor negotiation.

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