title: Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes.
abstract: OBJECTIVE
  There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes.
  
  
  METHODS
  Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures.
  
  
  RESULTS
  Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups.
  
  
  CONCLUSIONS
  Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover.
  
  
  CONCLUSIONS
  Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology.
authors.affiliation: Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA. rantzm@missouri.edu
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Rantz
authors.forename: Lanis
authors.initials: L
authors.lastname: Hicks
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Petroski
authors.forename: Richard W
authors.initials: RW
authors.lastname: Madsen
authors.forename: Greg
authors.initials: G
authors.lastname: Alexander
authors.forename: Colleen
authors.initials: C
authors.lastname: Galambos
authors.forename: Vicki
authors.initials: V
authors.lastname: Conn
authors.forename: Jill
authors.initials: J
authors.lastname: Scott-Cawiezell
authors.forename: Mary
authors.initials: M
authors.lastname: Zwygart-Stauffacher
authors.forename: Leslie
authors.initials: L
authors.lastname: Greenwald
mesh_terms: D057179:Advanced Practice Nursing / Q000458:organization & administration; D003365:Costs and Cost Analysis; D057286:Electronic Health Records / Q000191:economics*; D006801:Humans; D008923:Missouri; D009735:Nursing Homes; D010561:Personnel Staffing and Scheduling; D019095:Point-of-Care Systems; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care