LAUSR

The U.S. long-term care (LTC) system currently has 15,632 nursing homes (NHs) containing 1.7 million beds. Nursing home occupancy rates average 82%, representing 1.4 million residents. The average length of an NH stay is more than two years (Sifuentes and Lapane, 2020). Additionally, the primary workforce in NHs is nurses, mostly licensed practical nurses and nurse aides (Rantz et al., 2017). Along the resident's journey to or from an LTC setting, there are many transitions from hospitalization to care in their home. Within this journey, electronic, clinical data are collected and shared with residents, families, and providers to support the residents. However, critical limitations exist in the adoption of long-term postacute care (LTPAC), including outdated technologies, poor infrastructure, a reliance on paper transmission, and reduced incentives, which have diminished the success of supporting residents along their care trajectory (Ko et al., 2018). Barriers in health information technology (HIT) adoption may result in longer resident stays, greater resource utilization, and harm. For instance, residents in NHs with greater HIT adoption have been found to have lower odds (10%) of urinary tract infections (Cohen et al., 2022b). The evolution of HIT, which includes electronic health records (EHRs) and other technological innovations used to enhance care delivery, has seen remarkable growth in the last 20 years. In part, HIT growth has been driven by federal policy that has influenced the use of HIT for patient safety, meaningful use, and increased interoperability; furthermore, HIT has improved important clinical processes, such as medication administration, telehealth, and decision support (Alexander et al., 2021; Clemens, 2021; Henry et al., 2018; Vogelsmeier et al., 2021). However, some health-care sectors have not achieved as much success in HIT adoption and use over time; in particular, NHs were excluded from federal policies requiring HIT's widespread use in health care (U.S. Department of Health and Human Services, 2021). The exclusions have led to major differences in resources and disparities in outcomes for millions of NH residents in the United States (AdlerMilstein et al., 2021; Bjarnadottir et al., 2017) The National Academies of Medicine Engineering and Science's (NASEM) report titled The National Imperative to Improve Nursing Home Quality: Honoring our Commitment to Residents, Family, and Staff makes significant recommendations to address these exclusions (National Academies of Science Engineering and Medicine, 2022c) The objectives of this article are threefold: (1) identify failure points in promoting NH HIT adoption; (2) explore past and current federal policies supporting HIT use in Received: 23 January 2023 Accepted: 23 January 2023