Case Studies of IT Sophistication in Nursing Homes

Information technology (IT) has become a crucial area of development in the US long-term care industry. Adoption and use of health IT and electronic health records is a high priority for nursing homes (NHs) because of technology’s potential to improve the safety, quality, and efficiency of NH care. In 2010, the federal government invested $25.8 billion to support the development of sophisticated, interfacing technological systems that would improve care quality by diminishing medical errors and improving patient safety. However, little is known about which IT applications best support communication and risk assessment practices to improve resident outcomes in NHs. To address this gap, researchers at the University of Missouri recently evaluated how differences in IT sophistication in NHs impact communication and use of technology. Their work is part of a $14.8 million grant from the Centers for Medicare and Medicaid Services meant to reduce avoidable re-hospitalizations among NH residents. One goal of the project is to improve staff communication and information exchange through the use of sophisticated technologies.

The study, published in the International Journal of Industrial Ergonomics, was based on case studies of two NH sites—one with high IT sophistication and one with low IT sophistication. Utilizing a mixed methods approach, the researchers specifically examined how differences in IT sophistication impacted communication and technology use related to skin care and pressure ulcers. Communication patterns of certified nursing assistants (CNAs) were documented using a structured observational field note guide of recommended evidence-based guidelines for pressure ulcer management. Data from these notes were used to create models of the social networks that CNAs were collaborating with to provide care. Focus groups with CNAs from both sites were also conducted.

Based on a combined total of 1,386 observations of CNA communication strategies, results indicated that direct interactions between CNAs and registered nurses or licensed practical nurses were more frequent and centralized (e.g., at the nursing station) in the low IT sophistication NH. Data from five focus groups with 21 CNAs supported these findings, suggesting that the high IT sophistication NH had more robust and integrated communication strategies allowing for more comprehensive communication throughout the facility, as well as less frequent face-to-face interactions among nursing staff. The authors note that while face-to-face interactions may be preferable in some circumstances, physically moving from one location to another to communicate information may increase inefficiencies and interruptions in workflow for nursing staff, further contributing to medical errors and reduced care quality. However, additional research is necessary to determine how decreased face-to-face communication affects clinical workflow, staff relationships, and quality of patient care.


Alexander GL, Steege LM, Pasupathy KS, et al. Case studies of IT sophistication in nursing homes: A mixed method approach to examine communication strategies about pressure ulcer prevention practices. International Journal of Industrial Ergonomics (2013),

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