Ulterior union motives?
Because a union raised the red flag in this case, it's reasonable to consider the recent history of northern California nurses' unions. During a nurse lockout at nearly Alta Bates Hospital last September, a patient died while under the care of a temporary nurse hired by the facility during the lockout. Charges and counter-charges flew between labor and management.
It's tempting and perhaps cynical to question the motives of unions that raise safety issues during tense labor negotiations. But since a two-year contract was just signed in June between the California Nurses Association and the Contra Costa system, this newest concern doesn't appear to be a negotiation ploy.
DeAnn McEwen, vice president of National Nurses United, of which CNA is a founding member, argues that management is moving toward an over-reliance on technology at the cost of essential caregivers. "We're not Luddites, we're not saying that we don't see the value of some of it, but when it interferes with or overrides our practice, it puts patients at risk of harm."
McEwen, still nursing during two 12-hour shifts per week at a tertiary care medical center in Los Angeles County, talks at length about healthcare labor issues aggravated by technology. At her own hospital, she says flaws in the Epic implementation have required workarounds for five years, with no end in sight.
"Technology should be assistive to the direct care providers and enhance therapeutic communication," McEwen says. "Cash register-styled electronic documentation systems may serve insurers' and billing department purposes, but overall, they have not been shown to improve patient outcomes or enhance professional communication."
McEwen emphasizes that the problem is bigger than Epic, and so it is. A lot of people like to take and give credit for the rapid automation of healthcare in the U.S. today. Vendors are feted in financial publications. We properly credit the vision of government, provider, and payer leaders in pushing hospital technologies forward.
But in the end, the reason the entire proposition isn't completely running off the rails at this point is the result of the efforts of a whole lot of undertrained, overworked line staff and a whole lot of workarounds.
Let's hope that the efforts now underway at the Office of the National Coordinator for Health Information Technology to address usability of EMRs leads to some major reforms soon. Meanwhile, the Joint Commission's words of warning continue to echo.