Health IT not a panacea for what's wrong in healthcare
Deborah Burger, RN
Editor's note: This blog is in response to a post from McKnight's Editorial Director John O'Connor titled, “These nurses are picking a fight they'll be hard-pressed to win.”
If you listen to the lobbyists for medical device manufacturers and many of their best friends forever in the healthcare industry and Washington, health information technology is the answer to our biggest healthcare troubles, from medical errors to the high costs of care.
America's registered nurses, who interact with the machines and have to implement their regimen, all too often have a very different daily experience.
We've launched a national campaign intended to emphasize the point that all that glitters is not gold.
Our campaign describes a number of changes occurring in healthcare delivery at the bedside that registered nurses believe are putting patients at risk. These include the premature discharge of patients to other settings, including the home, where the burden for care falls entirely on family members.
A central theme of our message is about the rapid spread of unproven medical technology and the untested implications for patients. That concern is captured, with a humorous vent, in this video
and this radio ad.
Obviously, with the tens of billions of dollars the hospitals are spending on buying health IT systems, and the $14 billion the Centers & Medicare and Medicaid Services has paid in incentives to hospitals since 2011 to implement them, the machines are not likely going away soon.
National Nurses United has long held that technology should be skill enhancing, not skill displacing, and that doctors and RNs should not be mere adjuncts to machines that supplant their professional expertise, experience, education and judgment.
Bedside computers today are increasingly used to provide a diagnosis of the patient's condition, determine a prognosis of whether to continue or withdraw care, and, if care is permitted, to set out treatment protocols.
Typically, those directives are based on a misapplication of the concept of population-based health, which assesses the patient and determines the protocols and treatment options based on a similar set of conditions or patients.
But you can't treat everyone like an identical Model T Ford. Human beings are not steel girders, they are organisms that adapt and react uniquely.
When you are just following a computer protocol, it can leave out multiple other variables that can affect the source of the patient's illness and what is needed for their treatment and recovery based on that individual, not some other patient or group of patients. Each patient can respond differently, and does.
That's where the skill and judgment comes in, something lacking in HAL 9000 or the FRANK of our video. What is needed for the patient is still best determined by the personal interaction of the doctor and the RN with the individual patient.
And to a growing extent, the directives of the machines are not recommendations but mandates, tied to economic incentives under the threat of discipline for the caregiver who does not follow the computer order and toe the line exactly.
To qualify for the federal incentive payments, hospitals and doctors must show “meaningful use.” This includes using what is sometimes labeled clinical decision support, the computers. They can choose not to follow what the computer suggests and still get the money, but more and more they face organizational pressure to adhere to guidelines.
Not surprisingly, what is mostly behind those decisions is money. Federal incentives and reimbursements are in place because of massive lobbying by the health information technology industry, supported by other healthcare giants, and woe betide those who stand in the way.
The technology generates profits for healthcare corporations that standardize treatment protocols based on a model of care that is derived from earlier experiences on the factory floor. The results were not always great in the industrial sector as the recent GM scandal might illustrate, and in healthcare the life and death consequences are even more pronounced.
Ultimately, the proliferation of health IT and the restrictions it places on caregivers is another reminder of how misguided the priorities of our broken healthcare system have become.
It's the reason NNU and America's nurses will never stop our broader campaign, for a transformation from a health care industry based on profit and greed to one based on a comprehensive, humane, single standard of care system for everyone based on individual patient need.
Deborah Burger is a registered nurse and co-president of National Nurses United.