The Infrastructure Skilled Nursing Was Never Funded to Build

When the HITECH Act paid American health care to digitize in 2009, nursing homes were left out of its central incentive program.

A 2013 report prepared for HHS lists nursing homes among the providers ineligible for Medicare and Medicaid EHR incentives. The exclusion concerned that program; it did not mean every other source of technology funding was closed to them.

Having a record system was also different from having the infrastructure to use it. The National Academies' 2022 report cites a 2021 study of nearly 900 nursing home clinicians: nearly 90 percent reported using an electronic health record, but only 72 percent reported a facility wireless network. It also identifies poor internet connectivity and wireless dead zones as barriers.

In a separate 2021 analysis summarized in the report, 60 percent of resident care systems in rural nursing homes could not interface with outside computerized systems.

These are historical findings, not a survey of nursing homes in 2026. They describe clinical information systems, not equipment tracking. They do show why adopting software and making information usable are separate problems.

That distinction matters for the question raised in the first Equipment Brief: what can a building actually know about the equipment it owns?

An electronic chart can document a resident's needs without telling a purchasing lead whether a suitable bed is available upstairs. A purchase record can establish ownership without establishing location, condition or readiness. Filling in those gaps requires a different kind of information, kept current as equipment moves through the building.

The connection is an operational one. The research does not prove that HITECH exclusion caused a particular facility's missing inventory. It gives us a reason to examine the information available to staff before judging the decisions they make with it.

Consider a specialty bed needed at 4 p.m. If nobody can confirm that the building already has a suitable one ready to use, ordering another can be a reasonable response. Calling around the units may find an answer. It also asks someone to stop their work and assemble information the organization cannot readily provide.

The rental is visible on the invoice. The uncertainty that made it reasonable is harder to see.

The question worth asking is not only what a facility spends. It is what it is able to know when the decision has to be made.

Sources

• HHS / ASPE, EHR Payment Incentives for Providers Ineligible for Payment Incentives and Other Funding Study (2013), Executive Summary and Table 1. Identifies nursing homes as ineligible providers and distinguishes the incentive program from other funding sources.
• National Academies of Sciences, Engineering, and Medicine, The National Imperative to Improve Nursing Home Quality, chapter 9: Health Information Technology (2022), pp. 472–473. Summarizes Enyioha et al. (2021) on wireless networks and Powell et al. (2021) on rural data sharing. The equipment discussion is Norra's analysis.