title: Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.
abstract: OBJECTIVE
  Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs.
  
  
  METHODS
  We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs.
  
  
  RESULTS
  In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption.
  
  
  CONCLUSIONS
  Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in RCFs.
authors.affiliation: Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN 38152, United States; Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States. Electronic address: sbhuyan@memphis.edu.
authors.forename: Soumitra S
authors.initials: SS
authors.lastname: Bhuyan
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States.
authors.forename: He
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States.
authors.forename: Aastha
authors.initials: A
authors.lastname: Chandak
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States.
authors.forename: Jungyoon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States.
authors.forename: Jim P
authors.initials: JP
authors.lastname: Stimpson
mesh_terms: D003199:Computer Systems; D003695:Delivery of Health Care / Q000458:organization & administration*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D009936:Organizational Innovation; D012112:Residential Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States
keywords: Electronic health record; Long-term care; Residential care facility; Service innovation