Health Care Information Technology, Work Organization, and Nursing Home Performance

Abstract

The authors investigate whether electronic medical record (EMR) systems are associated with higher levels of nursing home performance. Their difference-in-differences analysis is based on a survey of health care information technology (HIT) use in approximately 304 New York State nursing homes, combined with regulatory data from the Center for Medicaid and Medicare Studies (CMS) Nursing Home Compare database and the New York State RHCF-4 financial reports. For nursing home owners, the authors find a positive effect of EMR-system implementation, on the order of 1% higher productivity, 3% greater efficiency, but approximately 2.7% higher cost. They also find that EMR systems amplify the returns to modern workplace organization. Facilities that are one standard deviation higher on a work-organization scale—composed of practices that encourage employee collaboration, decision making, suggestions, and problem solving—have no adverse cost impact of adoption of HIT, and adoption of HIT is associated with a productivity increase of 1.5% or more. They find no evidence of an impact on health care quality.