Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey

Abstract

Objective To measure US hospitals’ adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers. Materials and Methods In an online survey of a national, random sample of 797 US acute-care hospitals in 2018–2019, 479 (60.1%) responded. We calculated nationally representative measures of the percentages of hospitals with EHRs that include structured documentation of the 4Ms and exchange/communications functions. Results Structured EHR documentation of the 4Ms was fully implemented in at least 1 unit in 64.0% of hospitals and across all units in 41.5% of hospitals. Of the 4Ms, structured documentation was the highest for medications (91.3% in at least 1 unit) and the lowest for mentation (70.3% in at least 1 unit). All exchange/communication functions had been implemented in at least 1 unit in 16.2% of facilities and across all units in 7.6% of hospitals. Less than half of the hospitals had an EHR portal for long-term care facilities to access hospital information (45.4% in at least 1 unit), sent information electronically to long-term care facilities (44.6%), and had training for adults/caregivers on the patient portal (32.1%). Discussion Despite significant national investment in EHRs, hospital EHRs do not yet include key documentation, exchange, and communication functions needed to support evidence-based care for the older adults who comprise the majority of the inpatient population. Additional policy efforts are likely needed to promote the expansion of EHR capabilities into these high-value domains. Conclusions US acute-care hospital EHRs are lacking key functions that support care for older adults.

Selecting implementation strategies to drive Age‐Friendly Health System Adoption

“…There is little evidence, however, to guide efforts to disseminate and implement the AFHS model. [3][4][5] The field of implementation science provides two relevant insights: (1) The choice of implementation strategy can have a profound influence on implementation success, and (2) implementation "success" should be measured both in terms of the extent to which implementation was achieved, and whether this made a difference in patient outcomes. 6,7 For example, one of the most common frameworks used to evaluate implementation success, RE-AIM, includes five domains The IHI has chosen an implementation strategy that uses Action Communities to build engagement, paired with a prescribed approach to 4Ms measurement that allows systems to achieve "Age-Friendly" recognition.…”

Progress Toward Digital Transformation in an Evolving Post-Acute Landscape

“…Yet, health systems struggle to help patients achieve these benefits by meaningfully integrating family caregivers as part of the care team. Caregiver proxy access to patient record portals continues to grow, but evidence of appropriate and supported use has not ( 14 , 59 , 60 ). Increased experience with restricted visitation between older adult patients and their caregivers as a result of the COVID-19 pandemic may attract greater interest in proxy use.…”

“…They are also more likely to have family caregivers involved in their health and health care management, and may require accommodation for different levels of digital literacy and digital interest. As a result, digitally supported care for older adults requires not only that they benefit equitably from generalized investments already made in IT capabilities, but also that specific capabilities are designed and tailored to meet their unique needs ( 14 ). There is an urgent need to characterize and address current gaps where older adults could benefit more fully from digitally supported care.…”

Management and organization construction status and development suggestions of aged‐friendly medical institutions in mainland China

“…Since launching the first AHA Age‐friendly cohort in 2019, 12 participants in the AHA Age‐Friendly Health Systems Action Community have implemented the 4Ms framework in different care settings. However, a survey 13 of 479 hospitals found that while 4MS has been proposed and electronic medical records are well established in the United States, there is still a lack of records of elderly information based on the key functions of 4MS. People need to explore how to put 4MS into practical work.…”