Printer FriendlyA key problem with the rush to implement HIT is the absence of health-care workers and health-care worker voices in the discussion of what, when and how to implement, despite the fact that EMRs and other HIT will have significant impacts on the health care workforce and on their ability to deliver care. With most public commentators focusing on the presumed positive impacts on both cost and care as well as on the difficulties of implementation, any discussion of downsides for the workforce and for patients is being lost in the shuffle or simply ignored.
Health-care workers are being kept out of the conversation about HIT, but it’s not because they won’t be affected. And it’s not that they don’t have ideas about how to better design EMR/HIT systems and how to improve user interfaces. It’s not that they have no thoughts about the impact of EMR/HIT on patient care. And it’s not that they don’t care.
It’s that no one is listening.
No one is listening when health-care workers complain about poor ergonomic design of the HIT hardware (like the computers on wheels or COWs which are a particular source of concern).
No one is listening when they say that the software is poorly designed – that the information they need is not available or is displayed in a manner that makes it not useful, about the difficulty accessing the information they need, when and how they need it.
No one is listening when they complain that the information technology does not match the way they work, is not user friendly, or simply adds work to their day.
No one is listening when they say (and they say it over and over) that they are spending more time interacting with the computer screen than they do with the patient, and that patient care is suffering as a result.
It makes sense, it would seem, to bring the voices of those who make the health care system work into the conversation about how to create a health information technology system that actually meshes with and improves the delivery of health care. But the nation is moving forward with billions of dollars of public spending, without mechanisms for health care worker voice and input.
Technology affects the workforce, often in significant ways. The number of jobs, the duties involved, the skills required, the workload and pace, stress levels and other health and safety concerns can all be impacted by significant changes in technology.
Technology can make work simpler and easier (which can lead to de-skilling and wage and job loss) or it can make work more complex and stressful. Technology can generate benefits but it can also determine how those benefits are distributed among “stakeholders”. The potential for downside risks from technology implementation in the workplace is increased to the extent that technology is designed and implemented without a voice for the workforce and without significant attention to existing workplace culture and organization.
The government is a significant player in health care and, as a result of the HITECH Act (Health Information Technology for Economic and Clinical Health Act) funding, is going to be a central force in the introduction of health care technology. Given this situation, what should be done, and in particular, what do we need from the government?
- . First and foremost, a recognition at all levels that a voice for workers is needed in any and all technology transitions. We must change the fact that no one is listening to health care workers on these issues and government can set the tone.
· Specifically, the federal government can ensure that there is space within all decision-making or advisory policy, standard and other committees for a significant and organized voice for the workforce. The policy and standard committees created within the Office of the National Coordinator of HIT, in particular, need to have increased worker input.
· Funds for research and training about information technology for the workforce to support and promote active and informed involvement. This is not referring to training on how to use the new technology (which will certainly be needed), but rather to training for the health care workforce on how to actively engage in discussion and decision-making about new technology.
· A clear mandate for collective bargaining in any case where public funds are used to implement EMR/HIT. Although bargaining over the workforce impacts of technological change is already part of federal labor law, there should, at a minimum, be government policy that makes the design and implementation of HIT subject to collective bargaining wherever public funds are used.
Why isn’t this happening? Why wouldn’t the voice of the workforce play a key role when designing and implementing significant new technologies?
It is interesting, at a minimum, that workers who will be using the systems daily, trying to provide health care as they try to provide for their families, are so often called a special interest, while the insurance companies and IT vendors who are looking to HIT to improve their profits are called stakeholders. There are powerful forces pushing the introduction of HIT and these forces are, many of them, driven by pure economics. They are not drive by patient and they have little or no interest in the voice of the workforce.
We have an opportunity with the HITECH Act to promote a different approach. A portion of the $2 billion in the HITECH Act that is directed toward the Office of the National Coordinator for Health Information Technology should be allocated to support training by unions representing health care workers. This training would inform health-care workers about information technology, about HIT’s potential impacts on the workforce and on health care, and about models of collective involvement in technology decision-making, with the goal of preparing health care workers for playing a role in technology design and implementation.
A portion should also be specifically directed toward ongoing research into the impacts of HIT on the health-care workforce as well as on patient care. The $17 billion that is going toward promoting technological change needs to be counter-balanced by investment in the human infrastructure of health care as it relates to information technology.
This does not simply mean training for those who will use the technology, although it certainly means that. It means training for participation, training for those whose voices need to be part of the discussion, training for those who would be excluded.
The HITECH Act includes provisions for a Health Information Technology Extension Program (Sec. 3012 (a)), a Health Information Technology Research Center (Sec. 3012 (b)) and Health Information Technology Regional Extension Centers (Sec. 3012 (c)). Each of these has the potential for serving as a mechanism for supporting the development of capacity within the workforce and for supporting research and evaluation of workforce and related patient care impact.
There is a threat on the horizon, a threat that, with federal funding, new technologies will be pushed into health care that will have negative consequences for health care and health care workers.
There is also an opportunity: an opportunity to promote a different model of technological change that builds on the devotion, knowledge and hard work of the health-care workforce, for the benefit of both patient care and the workers who deliver it. We have an opportunity to listen to those who do the work.
Let’s not blow it.