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Nana and a Belief in Informatics within the Nursing Home

February 27, 2013
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Nana, the name I call my grandmother, has been in a nursing home for several years. Truth be told, it’s painful.

Don’t get me wrong, I’m happy that my grandmother is still with us, but it’s hard because she doesn’t recognize anyone in my family or possibly even herself. She winces in pain while sleeping and doesn’t seem to be interested in eating. She doesn’t even talk. Every time I see her, it seems she has slipped further away from the genial, soft-spoken lady whose house I loved sleeping at as a kid, and who took me to the movies and made sure I was eating healthy.

Anyone who has ever watched a loved one spend the last few years of their life in a nursing home can probably relate. They know that a smile or a hand grab is usually the best you can hope to get during a trip to the home.  

One thing I cherish from those trips, besides the occasional smile or hand grab, are the nurses at the home. The ones I’ve seen at my grandmother’s home do great work.

I’d like to think the nurses at Briarwood in Needham, Mass. are typical of the industry, but I’m guessing that’s not the case. Various studies have linked poor staff communication and coordination of care to low quality of care in nursing homes, even patient neglect.  It doesn’t seem to be a secret that these are issues every nursing home faces, possibly even at the one I just mentioned.

Yet, according to one enthusiastic researcher, there seems to be a possible solution to this industry-wide problem: information technology.Greg Alexander, Ph.D., an associate professor in the University of Missouri School of Nursing, recently conducted research on how differences in IT sophistication in nursing homes would impact communication and use of technology related to skin care and pressure ulcers among nursing home staff members.  

Alexander and his team of researchers looked at nursing homes with a high level of IT adoption (i.e. electronic health records, nursing documentation systems, clinical decision support) and compared them to nursing homes that had low levels of IT adoption. What they found, when looking at nursing facilities across Missouri, was that not only can IT improve communication and quality of care, but it can even protect patient privacy.

I recently spoke with Dr. Alexander, wanting to know how IT could actually better protect patient privacy, when often it seems the opposite is true. He told me that in the nursing homes they studied without a high adoption of IT, the staff communicated on a patient’s condition by posting photos or magnets of the patient’s health hazards on their door. “You can tell a lot about a person’s health status by the things around them,” he notes.

As Alexander says, in this environment, this private information is being exposed to the various people who are moving in and out of the facility. With IT, that protected health information (PHI) is kept under a password. Yes, he knows it could get hacked. But it’s far less exposed with an electronic safeguard than being out in the open.

It’s more than just this privacy element. IT in the nursing home brings the nurses and other practitioners closer to the bedside, Alexander told me, where they can conduct better documentation, rather than “just checking boxes” on a quality care measure to do list. It also allows for earlier interventions, with more information on hand at the point-of-care.  Lastly, more IT meant less face-to-face interactions between the various nurses and additional practitioners, which meant less time was needed to verify orders or report on a patient status. It’s important to additionally note, at low IT adoption homes, there was more of a centralized meeting point, which was typically the nursing station.

Like all careful researchers, Alexander would like to see more studies conducted. He wants to get a clearer picture of how the decreased face-to-face communication affects clinical workflow, staff relationships, and ultimately quality of patient care. He wants to use Meaningful Use, to further expand research on how IT systems can improve communication and quality-of-care measures at nursing homes.

No single study is definitive, although there have been other studies in support of Alexander’s hypothesis. The point is it seems clear to me that IT in the nursing home can make a difference.

And as Nana and I know, in the nursing home environment, this can make all the difference in the world.

Please feel free to respond in the comment section below or on Twitter by following me at @HCI_GPerna



My tweet was to short to capture my thoughts

I am a huge advocate and a strong believer in the power of healthIT to improve the quality of care and communication (and my first job in health IT was for the largest provider of EHRs to nursing homes )but I wonder if this study really just shows that EHR's are in implemented in facilities that already have high quality and realize that this is a powerful tool.

What we need are before and after studies but again I am fairly sure that those facilities that either the resources to implement an EHR or the pre-existing commitment to quality would adopt them first? IE they are both a marker and a tool.

What would be interesting to do is to implement them in a facility that has the commitment but lacks the financial resources and see what happens?

Hi Sherry,

Thanks for commenting. More research in this area needs to be done, there is no doubt, this is something Dr. Alexander stressed to me in our interview. I love your idea. Any nursing home who has already implemented an established set of health IT tools, as was the case in this study, probably had high quality to begin with. I'd love to see an EHR, health IT adoption before and after, as you say, for a nursing home in an underserved area, that doesn't have the same resources. See how it affects care at that kind of place. Perhaps, there is some kind of government or other organization-funded grant? I'm not sure.

Anyway, thanks again for the response.


There is definitely an underlying "chicken or egg" question here; as with acute-care hospitals, those nursing homes with the most advanced information technology also tend to be the ones with the most advanced care management practices. That's not surprising, since such patient care organizations inevitably have the most innovative, progressive executives, managers, and clinician leaders. It will be fascinating to see how this phenomenon evolves forward in the next decade, as nursing homes modernize along multiple dimensions.