Thursday, June 20, 2013

EHR backlash: What happens when your staff rebels?


Physicians are familiar with ‘disruptive technology’ ( I coined the term “catalytic innovation) as electronic medical records were introduced into office and clinic practice. The disruption caused decreases in efficiency and required altered work flow.

The introduction of Clinical Information Systems has an identical effect on patient care in hospitals. Training and satisfaction must be assured for the staff well before ‘going live’. There are many instances where staff have felt inadequate to the point where they have argued patient safety is involved.

And here is an example:

Affinity Medical Center registered nurses are asking hospital officials to delay a new electronic health record system set to begin this weekend.

The nurses, who would be the primary users of the Cerner electronic health record (EHR) system, cited inadequate training and short staffing.

Affinity registered nurses, who are represented by the National Nurses Organizing Committee in Ohio, an affiliate of National Nurses United (NNU), documented their concerns in a letter to hospital officials Friday. They said they tried to deliver it by hand along with a second letter demanding to negotiate a contract with the union. The letters were not accepted.

“This is serious,” said Michelle Mahon, a representative based in Cleveland for NNU. “The nurses are concerned about patient safety.”

Mahon said she emailed and faxed the demand to bargain to hospital officials and also emailed the letter of concern to the chief nursing officer and received no response.

Susan Koosh, vice president of marketing and community relations at Affinity, said the use of EHRs will increase quality and safety at Affinity, and significant training opportunities and extra staff and trainers have been added for the transition.

“We are very excited about implementation of our new electronic health record, which will go live this weekend,” Koosh said in an email. “We have thoughtfully prepared for this conversion for months, involving our clinicians in the process, providing significant training opportunities and adding extra staff to the schedule to help ensure a smooth transition.”


The system has the potential of violating the Ohio Nursing Practice Act because it doesn’t permit nurses to communicate individualized, potentially life-saving information about their patients, the union said in a statement.

Other concerns include placement of workstations, which require nurses to turn their backs to patients while they document. Also, during one education session, the system apparently crashed once because 17 users overloaded it, according to the union.

“The National Nurses Organizing Committee’s press release contains inaccurate and offensive statements,” Koosh said.

“To suggest that Affinity has not provided sufficient training or adequate staffing — or that we would ever put patients at risk — is blatantly false and irresponsible. Our computer system is built with safeguards to ensure continuous operations, while the external training site does not have such protections.”

Cerner guidelines call for 16 hours of training for each nurse and nearly 95 percent of nurses have met this requirement, Koosh said. Affinity has established six computer labs with more than 75 stations, and the hospital also is accommodating extra training for clinicians who feel they need additional practice on the system.

Some of these concerns involve union interference with implementation based upon other factors, such as low staffing ratios which may have already existed prior to HER installation, and other non-related conflicts about bargaining powers

The NNOC represents about 225 registered nurses at Affinity, which is part of Tennessee-based Community Health Systems, and continues to refuse to bargain a first contract. The National Labor Relations Board held a five-day hearing in May in Cleveland for a complaint filed by the nurses and NNOC. A decision by an NLRB administrative law judge is pending.

If the planned new system is launched this weekend, the union will file an unfair labor practice charge with the NLRB, Mahon said. Also, registered nurses will begin using Technology Despite Objection forms to document their concerns, as well as verbally notify management each time they fill them out, Mahon said. Nurses also will speak with elected officials and community groups about their concerns, she said.

The disagreement and conflict are patient safety issues which should have been addressed long before the system goes active.  The medical staff should play a major role in the decision making.  The scope of the issue goes way beyond the competency of a National Labor Relations Board and seems to  be an inappropriate use of Labor law.

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