Chances are, if you’ve seen a medical professional recently, they’ve entered your information into a laptop or a tablet rather than on the traditional paper chart. It’s called electronic health records, or EHR. But it’s likely a nursing home or other long-term care facility is still using paper records.
Studies of EHR adoption in long-term care facilities nationwide all say the same thing, said Majd Alwan, who is senior vice president of technology for LeadingAge, a Washington, D.C., nonprofit organization on aging services, and also executive director of the Center for Aging Services Technologies. “All these studies, generally, show lower adoption levels among long-term and post-acute care provider than physician offices and hospitals,” he said.
In particular, nonprofit facilities show higher adoption rates than for-profit ones, because they are less focused on the bottom line, Alwan said. In addition, rural facilities and smaller facilities that are not affiliated with larger organizations also show lower rates of adoption – also likely to be a factor in Idaho, he said. This is primarily due to lower economies of scale and revenues, as well as to EHR’s requirements for broadband connectivity, he explained.
“Most facilities have some type of electronic system,” said Robert Vande Merwe, executive director of the Idaho Health Care Association, a Boise-based association for long-term care facilities. “But it’s not used nearly as much as in doctors’ offices or hospitals.”
One reason is that the more than 15,000 long-term facilities in the U.S., which provide care for about 1.5 million Medicare and Medicaid patients, were not eligible for funding that the federal government offered to other medical offices as an incentive to adopt EHR. That program, called “meaningful use,” is a carrot-and-stick approach. Since 2009, when the program was implemented, medical facilities have received $34 billion in incentives to adopt EHR, according to Bloomberg; penalties can also be imposed if medical organizations fail to meet standards and deadlines.
But long-term care facilities have thus far not been included in the meaningful use program, Vande Merwe said. “There were no financial incentives, and no extra funds to help in the implementation, cost, or training,” he said. “It had to come out of your own bottom line. That’s the No. 1 reason.”
The Centers for Medicare & Medicaid Services have been working for a year on 403 pages of proposed rules to provide for such incentives for long-term care facilities. That rule is in the rulemaking process, and the center is not able to comment otherwise on the issue while it is in the rulemaking process, said Lindsey O’Keefe, public affairs specialist for the organization.
Vande Merwe said EHR seems safer than paper. “There’s much better data of what’s happening with patients,” he said. “There’s so much more with the click of a mouse than with a hundred charts sitting on the wall. It’s easier to track quality and improve quality than by pulling all the charts once a month to try to track where the infections were. With an electronic system, you can find that out very quickly.”
But nurse regulators for the Bureau of Facilities Standards, the statewide office that inspects long-term care facilities statewide, prefers paper records to electronic ones, said Vande Merwe, formerly an administrator of a skilled nursing facility in Eastern Idaho. “The nurses who do the inspections were not trained on EHR,” he said. “They can’t easily thumb through a chart and find what they’re looking for. They have to hunt and peck on a computer screen.” Some of them have specifically said they don’t like electronic records, that they’re not good for patient care, and even that they’re harming patients, he said.
At the same time, the federal government is pushing long-term care facilities in that direction, though there isn’t yet funding for it, Vande Merwe said. “We’re caught between one regulatory body that wants it, and one that doesn’t want it.”
There are exceptions.
“We are pretty much totally there,” said Sayle’ Panopolos Kruse, health information management director for the Good Samaritan Society Boise Village, a 92-bed facility that is one of four similar facilities in Idaho. The other three are located in Idaho Falls, Moscow, and Silverton. All four, which are owned by the nonprofit Good Samaritan Society, use EHR, a transition that started in 2014. When the organization receives paper from a doctor or hospital, it’s scanned into a repository so it becomes electronic she said.
And “we are converting,” said Bonnie Sorenson, administrator for Countryside Care & Rehabilitation, a 46-bed Minidoka County-owned facility in Rupert. Material that is already electronic includes pharmaceuticals and administration, while nurse charting will be the last function converted, she said. “It’s been a slow conversion process, a little bit at a time,” she said. “It gives people time to learn a little bit at a time rather than have to swallow all of it at once.”
Different facilities’ systems are not necessarily compatible with each other. Many Idaho physician offices are owned by or partnered with a hospital, so they use the same system, Vande Merwe said. And several of the long-term care facilities that do have EHR are connected with a hospital, particularly in rural areas, he said. But most nursing homes are not owned by or partnered with a hospital, so even if they had EHR, chances are it wouldn’t easily be able to exchange information with an EHR system from a doctor or a hospital.
“That’s the Holy Grail,” Vande Merwe said. “If we can have a common system that would talk to each other, that would be awesome. It wouldn’t matter how much they cost.”