Table 1

Results from the review of the literature

AuthorsFacilitatorsBarriers
Wolf et al4▸ Emerging payment methods could encourage EHR adoption
▸ ‘Quality Improvement Organizations’ may increase adoption because they provide technical support that many LTC facilities need
▸ HITECH incentives only focus on acute care and primary physicians
▸ Expanding the incentives to LTC facilities may be too costly
Wang and Biedermann5▸ Anticipating state and federal requirements
▸ Good communication between vendors and LTC facilities
▸ Education and training programmes
▸ Lack of initial investment resources
▸ No technical infrastructure
▸ Not enough time to implement the EHR
▸ Lack of space for the new system
Resnick, et al6▸ Error reduction
▸ Quality
▸ Efficiency
▸ Better health outcomes
▸ Cost
▸ Complex systems (implementation)
▸ No standards (external)
Davidson7▸ Comprehensive implementation planning
▸ Governmental initiatives
▸ Management and staff support
▸ Cost
▸ Privacy issues
▸ Incorrect vendor
Hamid and Cline8▸ EHR satisfaction increases when the users understand the benefits
▸ Supportive management
▸ Training programmes
▸ Cost
▸ Perceived lack of usefulness
▸ Time consuming
Alexander and Madsen9▸ Improve clinical decision-making
▸ Earlier intervention
▸ Time savings
▸ IT sophistication negatively correlated with detection of incontinence (implementation issue?)
Phillips et al10▸ Government financial incentives
▸ Reduced errors and adverse drug events
▸ Including users in the design and implementation process
▸ Adoption costs
▸ Efficiency outcomes were inconsistent
▸ Incongruent cost savings
▸ Lack of interoperability
▸ Fear of changing the facility culture
Wilkins11▸ Training and learning the system increases adoption
▸ Understanding the usefulness of the EHR technology
▸ Facility size
▸ Lack of change agents or leaders in the facility
▸ Lack of interoperability
▸ Cost
▸ Resistance to change
Filipova12▸ Federal and state government incentives or policy initiatives could offset financial barriers
▸ Aligning organisational strategic plans could also encourage adoption
▸ Financial barriers like no capital to implement an EHR and the cost of hardware and infrastructure
▸ Organisational barriers
▸ Legal and regulatory barriers
▸ Technological barriers
▸ Network barriers
Bezboruah et al13▸ Institutional pressure like anticipated regulations and competition pressures increase EHR adoption▸ Cost of the electronic system and projected upgrades
▸ Leaders perceiving staff's resistance to change
▸ Misunderstanding how EHRs could be useful or not having enough information to choose the right system
Cherry14▸ Fast-growing elder populations mean quality of care in LTC facilities must be addressed with EHRs
▸ A strong implementation plan within the facility that aligns with strategic plans
▸ Initial and follow-up training programmes
▸ A perception shift about the benefits of EHR adoption
▸ Cost and a lack of capital resources
▸ Lack of industry standards
▸ Complicated implementation processes
▸ Lack of technical support
▸ Not enough evidence to support EHR's proposed benefits
Grabenbaueret al15▸ Improved communication
▸ Patient data access and sharing
▸ Cost
▸ Reduced time with patients
▸ Currently EHRs do not impact population health
Cherry et al20▸ Rapid patient record retrieval
▸ Better document consistency, quality and accuracy
▸ Improvements in employee satisfaction and retention
▸ Better patient assessments, oversight and order processing
▸ Better time management
▸ Technology and maintenance problems like downtime or learning the new system.
▸ Residents thought providers were more focused on the computers than on them
Tabar23▸ Perceptions are changing in LTC; EHRs are becoming a cost of doing business▸ Most EHRs were built for acute care and LTC facilities had trouble finding a system that met the organisation's needs
Vendor group develops EHR code of conduct24▸ Cost reductions
▸ Improve patient outcomes
▸ State programmes could help fund a facility's EHR adoption
Yu et al25▸ Continuous training
▸ Open dialogue with vendors
▸ Balancing EHR accuracy with patient care
▸ Facilities should have all paper or all electronic systems
▸ Staff resisted the new system because personal perceptions about their age, lack of documentation skills or other reasons created limitations
▸ Information management became too difficult and documents lacked consistency
▸ Providers complained about spending less time with residents
Hamann and Bezboruah26▸ Non-profit facilities were 40% more likely to adopt EHRs
▸ Non-profits have more regulations, so may need the benefits of EHRs
▸ For-profit facilities lagged behind in EHR adoption rates
▸ Fewer regulations enable for-profit facilities to invest in cost-effective endeavours and avoid the expense of EHR implementation
Vest et al27▸ More EHR vendors
▸ Trends show electronic record use is on the rise
▸ Meaningful use makes EHRs more prevalent
▸ Lagging widespread EHR adoption
▸ Misaligned incentives
Weaver S28▸ Error reduction (quality)
▸ Improved efficiency
▸ Consumer (user) perceptions
▸ Improved health outcomes
▸ Difficulties transitioning from paper to EHR (implementation)
▸ Training becomes paramount
Gruber et al29▸ Strong implementation team
▸ Train and prepare all users
▸ Have ample space for training
▸ Communicate often and thoroughly
▸ Set goals, tasks and schedules for the implementation
▸ Reduced errors
▸ Improved documentation
▸ Minor increases in operating expenses
Holup et al30▸ Rapidly aging populations stresses the need to create interoperable, coordinated EHRs for LTC facilities▸ LTC EHRs are not as comprehensive as acute care EHRs
Holup et al31▸ Created better health outcomes
▸ Reduced extra costs
▸ Improved delivery and quality
▸ An increasing elder population makes implementing EHRs a necessity
▸ Nonprofits were more likely to utilise EHRs
▸ High initial investment means slower adoption in facilities that cannot afford the EHR system, which slows the rate of becoming better integrated with acute care
▸ Facility characteristics determine EHR adoption
  • EHR, electronic health record; HITECH, Health Information Technology for Economic and Clinical Health; LTC, long-term care.