Electronic Health Record use among residential care facilities: National estimates

Residential care facilities (RCFs) included those serving adults in need of assistance with daily living, but not requiring skilled care such as is needed in nursing homes. Electronic Health Records (EHRs) provide a systematic approach to gather and maintain health information, which is critical for vulnerable populations using long-term care. We examined data from a recent nationally representative survey to ascertain the proportion of RCFs currently reporting an EHR, and factors associated with this use. We conducted a cross-sectional analysis of the National Survey of Residential Care Facilities (NSRCF) facility public use file (2010) from the National Center for Health Statistics. The unit of analysis was the facility (n=2,302). The dependent variable was the reported use of EHR for reasons other than accounting or billing. Facility characteristics included location (Metropolitan Statistical Area (MSA)), size characterized as small (4-10 beds), medium (11-25 beds), large (26-100 beds) and extra-large (over 100 beds); ownership; and affiliation (chain, group or multi-facility system versus other). Chi Square was used for bivariate comparisons and logistic regression for multivariable analysis. All analyses were weighted to adjust for the complex sampling frame of the survey. Across the US, an estimated 17.4% of RCFs employed an EHR in 2010. Bivariate analysis provided evidence of a relationship between the use of EHRs with location, facility size, ownership type and chain affiliation. Facilities lacking an EHR varied across location (78.2% for rural and 84.6% of urban), facility size (87.5% for small, 83.4% for medium, 76.1% for large and 71% for extra-large), ownership type (73.8% for non-profit and 84.4% for for-profits) and chain affiliation (85% for non-chains and 74.6% for facilities associated with chains). In multivariable analysis (adjusting for multiple facility characteristics), the following factors were associated with an increased likelihood in the odds that an RCF would report not using an EHR: lacking chain affiliation (OR=1.5, 1.2-2.0) small or medium sized (OR=2.2, 1.5-3.3; OR=1.9, 1.3-2.8 respectively), for-profit (OR=1.7, 1.3-2.2) and MSAs (OR=1.3, 1.005-1.8). Maintaining health and independence for vulnerable adults across the spectrum of care will call for increasing use of EHRs in managed living situations. In 2010, fewer than one in five RCFs had this capability. Smaller facilities and those not operated by chains face gaps in the use of EHRs. As the use of EHRs in the RCF settings expands, additional research will be needed to ensure that gaps do not persist or that particular populations are not disadvantaged.