Health Information Technologies (HIT)

Results of the HIT Best Practices Survey
October 22, 2010

HPAE recently conducted a web survey on the impact of Health Information Technology (HIT) on our members' working conditions, including training, staffing, and displinary issues. In general, we found that employers are not implementing "Best Practices" with respect to HIT. Instead,

  • Employers are failing to appropriately engage the union and frontline staff in the introduction and implementation of these new technologies.
  • Staffing and training during roll-out of new HIT appears to be inadequate.
  • The threat of discipline is often associated with HIT.

Giving our members a real "voice" regarding HIT will be a priority in future contract negotiations, as well as through discussions in Labor-Management committees. We need to make sure that HIT helps improve patient care and allows us to do our work more efficiently as professionals.

If your local would like help with strategizing how to have a voice in what happens when new technologies are introduced into your facility, excellent training and consultation is available from Charley Richardson. Charley has worked with HPAE, AFT, and many other unions around the country on this issue, including leading workshops at HPAE PIC, preparing the HIT factsheets on this website and participating in the Working Group that developed the AFT/HPAE Best Practices in HIT. If your local is interested in training or other assistance from Charley, please email Harriet Rubenstein at hrubenstein@hpae.org.

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HIT Best Practices Checklist: How does your facility measure up?

The AFT recently adopted a resolution outlining Best Practices that should govern the development, introduction, and implementation of Health Information Technologies (HIT) in our hospitals, including electronic health records (EHR); computerized physician order entry (CPOE); computerized time and attendance systems; automated pharmacy systems, etc [Click here to view the resolution]. HPAE was part of the Working Group that developed these Best Practices.

We’d like to hear how well your facility or your unit/department measures up to these Best Practices. Please complete and submit this HIT Best Practices Checklist. We’ll share the results of this informal survey with you and policy-makers.

Click here to take the survey and let us know how your facility measures up.

Leapfrog finds high risk of order-entry errors
July 01, 2010

Advocates for the widespread introduction of health information technologies (HIT) in hospitals and other healthcare facilities cite promised reductions in medical errors as a leading justification for implementing these programs. A study by the Leapfrog Group, an employer-backed patient safety organization, provides a cautionary tale and a reminder that HIT is not a magic bullet. The CEO of Leapfrog says “Hospitals and vendors must continue to work together over time to ensure the effectiveness and efficiency of CPOE.” HPAE believes that frontline caregivers must also be at the table when HIT is being developed and implemented in order to assure its effectiveness.

Leapfrog finds high risk of order-entry errors
The Leapfrog Group, a Washington-based healthcare quality organization formed by large employers, has issued a report urging hospitals and information technology vendors to take a closer look at computerized physician order-entry systems to make sure they are detecting potential errors.

In the study that served as the basis for the report, 214 hospitals evaluated their CPOE systems using a Web-based simulation tool from Leapfrog. The simulations, which involved 10 test patients and 50 medication orders, took place between June 2008 and January 2010. More than half of the total medication orders processed in adult hospitals did not trigger the warnings they should have, according to the report. And among 311 potentially fatal medication orders processed in adult hospitals, only 32.8% prompted a warning.

“Although this is a simulation using fictitious patients and medication orders, it should be a red flag for every hospital and information technology company in America,” Leah Binder, Leapfrog's CEO, said in a news release. “The belief that simply buying and installing health information technology will automatically lead to safer and better care is a myth.”

Leapfrog used the findings to press for a “testing and monitoring component for all technology” to be included in meaningful-use requirements. The group also called for a freer exchange of IT best practices among hospitals and further adoption of CPOE.

Feature Story, March/April 2010: Health IT - Our work, our voice

The federal government is determined to provide every American with an electronic health record by 2014. Is the $19 billion project going to help or hurt patient care and the health care professionals who will utilize it? Click here to read the rest of the Healthwire article



Electronic Medical Records and other Health Information Technologies: Challenges and Opportunities for Healthcare Workers and Unions

The following Guest Commentary is by Charley Richardson, Director of the Project on Technology, Work Reorganization and Continuous Bargaining of the Labor Extension Program at UMass Lowell. For over 20 years, Charley has been working with unions in all sectors of the economy, providing training, education and strategic support on issues of changing technology and work restructuring. Charley is consulting with HPAE on health information technology issues and will be leading a workshop on the subject at the October 1st Professional Issues Conference. Charley welcomes your feedback and questions.

A freight train is barreling down the tracks. They’ve just turbo-charged the locomotive and it is accelerating in your direction.

Electronic Medical Records (EMR) and other Health Information Technologies (HIT), pushed for years 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, are receiving a boost in the form of $17 billion worth of incentives in the federal stimulus package for hospitals and other providers to implement HIT. Those who fail to adopt EMR’s by 2015 will suffer penalties in the form of lower Medicare/Medicaid reimbursements.

HIT is coming our way, which is for certain. Electronic Medical Records, more than simply the digitalization of information currently stored on paper, are the digital backbone for a series of transformations that are on the horizon, including telemedicine, robotics, work restructuring and outsourcing – a true Health Information Technology revolution. Electronic Medical Records and other HIT such as automated pharmacy systems, time and attendance systems, location monitoring devices and telemedicine will have a huge impact on health care workers and their unions.

So what should health care workers and their unions do? How can unions and the health care workers they represent have a voice in the technology decisions that are so critical to their futures and the future of health care?

As a start, we need to understand all of the new technologies that are being introduced or are on the horizon and recognize both the positive and negative impacts that HIT can have on health care workers and patients.

Computerized physician ordering systems and medication bar codes can, if properly designed and implemented, help to reduce errors, telemedicine can provide specialist expertise to remote or hard-to-reach patients, and EMRs can facilitate interdisciplinary consultation and communication and provide ready access to critical patient information.

At the same time, we’ve already seen that as HIT is implemented:

  • Jobs can be eliminated.
  • Job duties and work processes change.
  • New skills are required, while “old” skills may be de-valued.
  • Workers’ location, movements, and “productivity” can be monitored electronically.
  • Work may be moved to remote locations.
  • Poor software design can make it harder for caregivers to access the information they need, when and how they need it.
  • Health and safety problems, including stress and repetitive strain injuries arise.
  • Time spent interacting with patients and their families at the bedside is replaced with time in front of the computer screen, and the quality of caregiver-patient interaction and the quality of patient care can suffer.

Because of the profound impact the HIT revolution will have on patient care, working conditions and labor-management relations, there needs to be a knowledgeable, informed, strategic and strong union voice at all the tables where discussions and decision-making about HIT are taking place. But this won’t happen simply because it is right.

The time to take action is now. When it comes to EMR’s and HIT, the reality is that: It is always too late, because we should have been acting on this long ago, and it is never too late, because we can still affect the future and delaying action would be disastrous.

While some employers have held vendor fairs to solicit individual worker input into the selection of HIT hardware or software, our challenge is to insert a collective union voice into all HIT discussions. Specific steps that need to be taken include:

    1) Demanding information about all new technologies that are being introduced or are being planned. This information should be available prior to implementation.
    2) Researching the new technologies and their impacts on the members, patients, and the union.
    3) Demanding to bargain over all aspects of the introduction and implementation of HIT into the workplace.
    4) Providing training and education for the members on the impact of HIT on patient care and working conditions.

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.