Forecasting Content and Stage in a Nursing Home Information Technology Maturity Instrument Using a Delphi Method

  • Gregory L. AlexanderEmail author
  • Chelsea Deroche
  • Kimberly Powell
  • Abu Saleh Mohammad Mosa
  • Lori Popejoy
  • Richelle Koopman
Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement


Health information technology capabilities in some healthcare sectors, such as nursing homes, are not well understood because measures for information technology uptake have not been fully developed, tested, validated, or measured consistently. The paper provides a report of the development and testing of a new instrument measuring nursing home information technology maturity and stage of maturity. Methods incorporated a four round Delphi panel composed of 31 nursing home experts from across the nation who reported the highest levels of information technology sophistication in a separate national survey. Experts recommended 183 content items for 27 different content areas specifying the measure of information technology maturity. Additionally, experts ranked each of the 183 content items using an IT maturity instrument containing seven stages (stages 0–6) of information technology maturity. The majority of content items (40% (n = 74)) were associated with information technology maturity stage 4, corresponding to facilities with external connectivity capability. Over 11% of the content items were at the highest maturity stage (Stage 5 and 6). Content areas with content items at the highest stage of maturity are reflected in nursing homes that have technology available for residents or their representatives and used extensively in resident care. An instrument to assess nursing home IT maturity and stage of maturity has important implications for understanding health service delivery systems, regulatory efforts, patient safety and quality of care.


Health information technology Nursing homes Meaningful use 



The authors would like to thank Keely Wise, Project Coordinator, who help keep us all organized, moving forward through this project, and on target to accomplish goals. Further, this study would not be possible without the contributions of many nursing home leaders across the country who were consistent partners in our research.

Funding Information

This project was supported by grant number R01HS022497 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Compliance with Ethical Standards

Conflicts of Interest

Dr. Alexander is Founder and Owner of TechNHOlytics, LLC. A company that provides feedback to nursing homes about information technology.

Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All methods were approved by the universities Institutional Review Board (IRB) under IRB #2009109 HS.


  1. 1.
    Ederhof, M., and Ginsburg, P. B., "meaningful use" of cost-measurement systems - incentives for health care providers. New England Journal of Medicine 381(1):4–6, 2019.CrossRefGoogle Scholar
  2. 2.
    Blumenthal, D., Launching HITECH. New England Journal of Medicine 362(5):382–385, 2010.CrossRefGoogle Scholar
  3. 3.
    Yuan, N., Dudley, R.A., Boscardin, W.J., Lin, G.A., Electronic health records systems and hospital clinical performance: A study of nationwide hospital data. Journal of the American Medical Informatics Association 2019;26(10):999–1009 doi: doi: [published Online First: Epub Date]|.
  4. 4.
    Nolan, R. L., Managing the computer resource: A stage hypothesis. Communications of the ACM 16(7):399–405, 1973.CrossRefGoogle Scholar
  5. 5.
    Alexander, G.L., Madsen, R., Deroche, C.B., Alexander, R.L., Miller, E., Ternary trends in nursing home information technology and quality measures in the United States. Journal of Applied Gerontology 2019 doi: 10.1177%2F0733464819862928[published Online First: Epub Date]|.
  6. 6.
    Alexander, G.L., Madsen, D., A report of information technology and health deficiencies in U.S. nursing homes. Journal for Patient Safety 2017Google Scholar
  7. 7.
    HIMSS. Health Information Management Systems Society Analytics: Electronic Medical Record Adoption Model. 2017. (accessed 09/16/2019).
  8. 8.
    Alexander, G.L., Powell, K., Deroche, C.B., et al. Building consensus toward a National Nursing Home Information Technology Maturity Model. Journal of the Americal Medical Informatics Association 2019 (in press)Google Scholar
  9. 9.
    Alexander, G. L., and Wakefield, D. S., IT sophistication in nursing homes. Journal of the American Medical Directors Association 10(6):398–407, 2009.CrossRefGoogle Scholar
  10. 10.
    Devellis, R. F. (Ed.), Scale development theory and applications. 4th edition. Los Angeles: Sage, 2017.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020
corrected publication 2020

Authors and Affiliations

  1. 1.S415 Sinclair School of NursingUniversity of Missouri ColumbiaColumbiaUSA
  2. 2.Office of Medical ResearchUniversity of Missouri ColumbiaColumbiaUSA
  3. 3.Sinclair School of NursingUniversity of Missouri ColumbiaColumbiaUSA
  4. 4.School of MedicineUniversity of Missouri ColumbiaColumbiaUSA
  5. 5.Family and Community MedicineUniversity of MissouriColumbiaUSA

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