Printer FriendlyEMRs and HIT will be aggressively implemented over the next several years. They are being pushed into health care by large stakeholders ranging from IT vendors such as Intel, GE and Microsoft, to insurance companies such as Blue Cross Blue Shield, to large health care purchasers such as AT&T and UPS. HIT implementation is also about to receive a huge boost in the form of approximately $19 billion in federal funding that is part of the stimulus package.
The focus on HIT is not new. George W. Bush consistently touted the presumed benefits of HIT in his State of the Union addresses, even as he did nothing to improve health care for most Americans. Newt Gingrich is the Executive Director of the Center for Health Transformation, an organization that, among other things like opposing the Employee Free Choice Act, aggressively promotes HIT.
President Obama in his first address to Congress spoke about the importance of HIT. But now there is money where the mouth was. The stimulus package includes the HITECH Act which legislates a federal Office of the National Coordinator for Health Information Technology (ONCHIT), provides it with $2 billion to directly promote HIT and HIT policy and promises $17 billion for incentives to hospitals, doctor’s offices and other health care providers to implement EMR.
HIT is on the move. So what should unions do? As a start, unions need to recognize the impacts that HIT will have on health-care workers, from nurses to transcriptionists, from doctors to aides.
- As HIT is implemented, jobs will be eliminated.
Job duties and work processes will change.
New skills will be required, and “old” skills may be devalued.
Workers will be monitored electronically.
Work will be moveable to remote locations.
Health and safety problems will arise, from stress to repetitive strain injuries and more.
And the quality of caregiver-patient interaction could suffer.
There needs to be recognition that Electronic Medical Records, which in particular will be promoted by the provisions of the stimulus package, are not simply the digitalization of information currently stored on paper. EMRs are the backbone for a series of transformations that are on the horizon, including telemedicine, robotics, restructuring and outsourcing – a Health Information Technology revolution.
The HIT revolution will challenge the ability of unions to effectively represent their members and the overall workforce in health care.
It will affect the ability of health-care workers to provide care.
It will create problems in the day-to-day experiences of health care workers.
And it will change power dynamics between health-care unions and employers as skills are shifted, work is made movable and jobs are eliminated, automated or changed.
For all of these reasons, there needs to be a knowledgeable, informed, strategic and strong union voice at the table, at all the tables, where the discussion and decision-making about HIT is taking place. The time to take action is now. In fact, the time to take action was yesterday. When it comes to EMRs and HIT, the reality is that: It is always too late (we should have been acting on this long ago), and it is never too late (we can still affect the future and delaying action would be disastrous).
Why aren’t the voices of health-care workers, with and through their unions, more prominent in the discussions of HIT? Why aren’t unions better prepared for the freight train that is heading toward their members? There are, it seems, several points to recognize:
First, there is a general view that technology is progress - the answer to problems rather than the source of problems. Challenging technology earns one the epithet “Luddite” and tends to remove you from the discussion.
(Some disclosure here: I am a cancer patient who is very glad that my medical record is electronic and follows me from doctor to doctor (sometimes). I celebrate the fact that my scans can be downloaded onto a CD to carry with me to yet another doctor in another state. But that doesn’t mean that I want my health care shipped off to another country or a distant location. It doesn’t mean that I want the health-care workers who are caring for me monitored by an electronic big brother or stressed by unfriendly or ineffective software systems. And it doesn’t mean that I want a robot to replace my caregiver.)
Second, there seems to be a notion that technology decisions are “too big to involve” the workforce (another in the “to big to…” series). These decisions, according to this doctrine, have to be handled by experts and by those with the “big picture.” This is accepted “wisdom,” even though few of us are really fooled into thinking that the big picture folks in the health care institutions, the insurance companies and the technology vendors are really looking out for us as workers, or even as patients.
Finally, in the workplace, the culture of management rights (meaning that management gets to make the big decisions and we get to react when there is demonstrable damage, maybe) predominates and has actually been internalized by too many strong union activists and institutions. This culture is a disaster for working people, particularly in the midst of rapid change in the workplace.
The challenges of inserting a collective workforce voice into the HIT discussion are real, but are not insurmountable. Specific steps that need to be taken include:
1) Unions should demand information about all new technologies that are being introduced or are being planned. This information should be available prior to implementation.
2) Unions need to research the new technologies and their impacts on health care workers and health care unions. No one is looking at this (at least no one who has workforce concerns at heart) in a concerted and organized way.
3) Unions should be demanding a significant role for union representatives within all of the governmental bodies discussing HIT. The two most prominent of these are the recently legislated (as part of the HITECH Act) Policy and Standards committees, but there are similar constructs in many states.
4) Unions need to create internal capacity for staying on top of developments in HIT (both policy and technology) and for providing support to locals experiencing HIT implementation.
5) Training programs should be developed for helping spread the word about HIT and for preparing local unions for bargaining over the introduction of technology, before the fact.
6) Finally, all of the above needs to be directed at achieving bargaining over all aspects of HIT design, development and implementation.
The time is now to demand a real seat at the table (at all of the tables) where HIT discussion and decision-making is taking place. The time is now to develop internal capacity and activity. The time is now to develop a clear union agenda on HIT and a strategy for getting a worker/union voice heard. The time is now to demand that a significant piece of ONCHIT funding be directed toward supporting the development of an independent collective voice for health-care workers around HIT.
But none of this will just happen. It will take concerted and united action by unions representing health-care workers.
The freight train is barreling down the tracks, and those with their hands on the controls aren’t watching out for health-care workers. An immediate and strategic response is needed.
Charley Richardson is the former Director of the Labor Extension Program at UMass Lowell. He works with unions in all sectors of the economy, providing training, education and strategic support on issues of changing technology and work restructuring. He can be reached at charles_richardson@uml.edu .