Caregivers and Computers: Key Lessons From the Adoption and Implementation of EMR in New York State Nursing Homes

This chapter presents an overview of our evaluation of the introduction of electronic medical records (EMR) in 20 nursing homes located in the New York City region. These organizations were part of an EMR demonstration project cosponsored by the for-profit segment of the nursing home industry in the region and 1199SEIU United Health Care Workers East, the union that represented frontline staff in these organizations. We report central lessons from our evaluation, which took place over the course of four years and included multiple data sources. The primary purpose of our research was to examine the effects of EMR adoption on employment and labor relations in the participating organizations. Findings are based on a longitudinal study of EMR adoption in 15 of the 20 organizations that received the EMR technology and five “control” organizations, which did not receive the technology, employing a mixed methodological design with both quantitative and qualitative data collection methods. Results from our research inform the existing EMR adoption discussion in two ways. First, we find mixed evidence associated with EMR implementation. The adoption of this new technology enhances certain organizational outcomes, but it seems to hinder others. Second, findings from our research highlight the importance of preexisting organizational factors as predictors of EMR-associated outcomes. EMR-associated outcomes, positive or negative, are likely to be contingent on key organizational characteristics and on managerial adoption strategies. Our study's findings imply that the meaningful use of EMR needs to take into account not only the technical specifications of EMR but also the organizational characteristics of the physician practices and healthcare facilities adopting the technology. Healthcare organizations vary in their capacity and ability to make optimal use of health information technology, which should be incorporated into public policy and organizational practices designed to increase adoption.