The bumpy journey to adopt HIT

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.


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)


Survey Respondents (%)

Finance factors:

Lack of capital resources to invest


Lack of proven financial benefit


Product factors:

Difficulty finding HIT products that meet needs


Too complex


User interfaces are not user-friendly


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


Management factors:

Insufficient time to select, contract, install software/technology


Lack of HIT knowledge


Fear of technology


Lack of technical support staff


Not part of the strategic planning


Unclear need for change management


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.


Besides the finance and product factors, LTC administrators have to take a major responsibility for lagging in adopting HIT. The second biggest barrier, “insufficient time,” sounds like an excuse. Some administrators clearly stated that HIT is not part of the strategic plan, and some did not realize the need for change management. Some comments reveal another cause for the situation. An administrator mentioned, “Owners do not feel they have found a HIPAA-compliant system.” Another asked, “How can I ensure security features are available?” These comments show that some, if not many, administrators do not keep abreast of current HIT development. In the official Certification Commission for Health Information Technology (CCHIT) website (, there is updated information about the certificated EHRs, all of which are HIPAA-compliant systems, including security features. Administrators need proper training in HIT to become familiar with the updated federal regulations and those certified products.

In this survey, the author noticed another astonishing situation-only 44.5 percent of LTC facilities have websites. In today’s information technology (IT) world, having a website makes it easier for existing and prospective customers to easily access facility features, staffing and other information. As compared to print media, a website can offer a cost-effective option for advertising and marketing, and it is easier and cheaper to update.

LTC administrators whose facilities have no website may disagree with the above statements. They would claim that seniors are technophobic and do not like the Internet, and that LTC service is mainly local with word of mouth the conventional advertising approach. In fact, “seniors are now one of the fastest growing groups of new Web users.”

6 All the evidence from studies that report on the online activities of seniors suggests that they do much the same online as most other age groups-that is, communication and information searches as well as using online services.

7 Furthermore, health was seniors’ most searched online topic.

8 Under the current Web 2.0 frame, a website not only acts as a portal to broadcast the business, but also functions as a multidimensional platform by providing more value-added services, such as self-service mediums and customer feedback. The suggestion is that for those that do not have a website, it is necessary to launch one immediately, and for those having existing websites, better design and more functions should be scheduled to maximize the benefits.

It will be a long journey to achieve HIT adoption and full utilization in long-term care. Administrators need to comply with federal regulations and master the updated IT and related management knowledge, such as finance and project management. Proper education and training is part of the solution to the issue.


The purpose of the study, “Adoption and Utilization of Electronic Health Record System by Long Term Care Facilities in Texas,” was to assess EHR adoption and utilization status in LTC facilities in Texas, identify the barriers in EHR adoption and help policymakers assess movement toward the goal of promoting EHR adoption. A survey instrument was mailed to all Texas LTC facilities from October 2010 to March 2011. The survey found that in Texas 39.5 percent of LTC facilities have fully or partially implemented EHRs and 15 percent of LTC facilities have no plans to adopt EHRs yet. Authors: Tiankai Wang and Sue Biedermann. Funding for the study was provided by the Texas Long Term Care Institute.

Tiankai Wang, PhD, is an Assistant Professor at the Health Information Management Department, Texas State University-San Marcos. Dr. Wang has published a book on public finance and two book chapters. His research articles have appeared in the

Journal of AHIMA, Journal of Public Affairs Education and

Chinese Public Administration Review. Dr. Wang can be reached at


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Long-Term Living 2011 November;60(11):34-37

Topics: Articles , Facility management , Leadership , Technology & IT