U.S. Department of Health and Human Services

Literature Review and Synthesis: Existing Surveys on Health Information Technology, Including Surveys on Health Information Technology in Nursing Homes and Home Health

Executive Summary

Angela Richard, MS, RN, Meg Kaehny, MSPH, Karis May and Andrew Kramer, MD

University of Colorado, Denver
Division of Health Care Policy and Research

February 2009

This report was prepared under contract #HHS-100-03-0028 between U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the University of Colorado. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Jennie Harvell, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Her e-mail address is: Jennie.Harvell@hhs.gov.

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.

In an effort to better understand the current use and adoption rates of electronic health records and other health information technology (HIT) applications within nursing homes, the Division of Health Care Policy and Research at the University of Colorado Denver has been contracted by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services (HHS) to develop survey instruments for use in long-term care provider settings. Although numerous survey instruments have been fielded to assess HIT use in nursing homes and long-term care settings, the lack of consistent definitions, terminology, item construction, sampling frames, and measurement criteria render it difficult to accurately gauge current HIT adoption. In this report, we review existing surveys for long-term care and other provider settings pertaining to current HIT use and adoption, barriers to adoption, and recommend issues to consider when developing survey questions to ascertain HIT adoption, use, and barriers to adoption and use in nursing homes.

Section I of the deliverable discusses current trends and policy initiatives in HIT for long-term care. Section II summarizes several existing surveys on HIT use and adoption in long-term care settings, compares key findings of the surveys, and discusses measurement issues affecting survey results. Surveys used to assess HIT use and adoption in home health and hospice organizations, ambulatory or physician practices, and hospitals are discussed in Section III to determine if survey items and techniques from other settings could be used in long-term care. The descriptions of survey characteristics and findings were drawn from published papers or web-accessible information. The comparison of survey findings presented in Section II and Section III highlights the assertion that lack of consistency with regard to data items and measurement methods hinders efforts to draw meaningful conclusions from published survey results.

Despite national support for widespread adoption of HIT across health care settings and growing recognition of its value in improving health care safety, quality, and efficiency, HIT adoption continues at a relatively slow pace. Recent efforts have been made to identify barriers contributing to the limited progress in HIT adoption and supply information to help guide the development of policies and incentives to promote more rapid HIT proliferation. In addition to the review of surveys on HIT adoption, we reviewed the literature on barriers to HIT adoption across provider settings. A brief synthesis of existing surveys and literature on barriers is found in Section IV.

Section V provides recommendations for future survey development for long-term care. To reliably ascertain HIT adoption, use, and barriers in nursing homes, two sets of survey questions are recommended: (1) a shorter, core set of questions for possible use in the National Nursing Home Survey sponsored by the National Center for Health Statistics; and (2) an expanded set of questions, which would be made available to industry stakeholder groups for survey administration. The creation of two sets of survey questions will provide both breadth and depth in the collection of information on the adoption of HIT applications in nursing homes. The core set of questions would provide an overview of HIT adoption that could be generalized to the industry as a whole. The expanded, longer set of questions keyed off of the core set of questions would provide in-depth, detailed data on the extent to which specific workflow and health information exchange processes are being adopted. Both sets of questions will provide valuable information to policy makers to assess movement toward the goal of promoting HIT adoption and make informed decisions about the policy actions that are needed to accelerate adoption. Our recommendations on the content and format for the survey questions will guide the remainder of this project.